Outcome predictors of alpha herpes virus central nervous system infection
Methods: We reviewed 1180 episodes of CNS infection in our retrospective database from Houston, TX and New Orleans, LA from 1999-2013. The cases with positive HSV PCR or VZV PCR were enrolled into our study. Basic demographic data, presenting symptoms, signs, laboratory results and imaging results were reviewed. Glasgow outcome scale 1-4 was used to identify adverse clinical outcome (ACO) group.
Results: Total of 66 cases (5.6% from total) were identified with positive HSV PCR or VZV PCR in CSF. Of those, 45/66 (68.2%) were HSV meningitis, 13/66 (19.7%) were HSV encephalitis, 7/66 (10.6%) were VZV meningitis, and 1/66 (1.5%) was VZV meningitis. Only 4/66 (6.1%) had recurrent episode with the mean follow up of 1913 days and all were HSV meningitis. The outcome data was available in 57 cases; 22 (38.6%) had ACO. Charlson’s score > 1, the diagnosis of encephalitis and findings associated with encephalitis (seizure, focal neurological deficit, abnormal imaging or EEG) was a strong predictor for ACO (p < 0.001). Type of infection (VZV vs HSV), gender, race, age (< 65 or > 65), HIV status (positive or negative), presenting symptoms (fever, headache, nausea, stiff neck, photo phobia, skin rash) and signs (Brudzinski’s sign, Kernig’s sign), laboratory result (total white blood cells, CSF leukocyte, CSF protein, CSF glucose) and treatment (received antiviral or not received antiviral) were not statistically significant associated with outcome.
Conclusion: The diagnosis of encephalitis and a Charlson’s score > 1 are associated with ACO in the alpha herpes virus CNS infection.
R. Hasbun, None
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