337. The use of adjunctive steroids in 438 adults with Herpes simplex virus encephalitis.
Session: Poster Abstract Session: CNS Infections
Thursday, October 4, 2018
Room: S Poster Hall
  • Steroids in HSV Encephalitis.pdf (96.9 kB)
  • Background:

    Herpes simplex virus (HSV) encephalitis is associated with adverse clinical outcomes in 50% of patients. The use and impact of adjunctive steroids in improving the prognosis of this devastating disease is unknown.


    A multicenter international retrospective study of adults (age> 15 years) with confirmed HSV encephalitis. An adverse clinical outcome was defined as death or survived with sequelae.


    A total of 438 adults with HSV encephalitis were enrolled. The mean age was 50.58 years (15.94, SD), 226 (51.6%) were female and 59 (13.5%) were immunosuppressed. New onset seizures were seen in 91 (20.8%) patients and the median Glasgow coma scale was 14 (13-15, IQR). A total of 73 (16.6%) patients received adjunctive steroids during their hospitalization. Adjunctive steroids were given more frequently to patients with fever (84.5% vs. 66.7%, P=0.003), seizures (38.3% vs. 17.3%, P <0.001), abnormalities on MRI (77.7% vs. 61.8%, P=0.017), lower mean Glasgow coma scales (10.42 vs. 11.3, P=0.013) and it was also associated with a longer length of stay (median duration of 23 days vs. 20 days, P=0.012). Adjunctive steroids were not associated with an impact on adverse clinical outcomes (46.6% vs. 46.9%, P=0.95).


    Adjunctive steroids in HSV encephalitis are used more commonly in the sicker patients and are not associated with a benefit in clinical outcomes.

    Hakan Erdem, MD, Prof, Gulhane Medical, Ankara, Turkey, Yasemin Cag, MD, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey, Derya Ozturk-Engin, Associate Professor, Haydarpasa Numume Education and Reseach Hospital, Istanbul, Turkey, Sylviane Defres, MD, Institute of Infection & Global Health, University of Liverpool, Liverpool, United Kingdom, Selcuk Kaya, Associate Professor, Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University, Medical Faculty, Trabzon, Turkey, Lykke Larsen, MD, Odense University Hospital, Department of Infectious Diseases Q, Odense, Denmark, odense, Denmark, Mario Poljak, MD, Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana,, Ljubljana, Slovenia, Bruno Barsic, MD, Dr. Fran Mihaljevic University Hospital for Infectious Diseases, Department of Infectious Diseases, University of Zagreb School of Medicine, , Croatiai, Zagreb, Croatia, Xavier Argemi, MD, Nouvel Hôpital Civil, Department of Infectious Diseases,, Strasbourg, France, Signe Maj Sørensen, MD, Aalborg University Hospital, Department of Infectious Diseases,, Aalborg, Denmark, Anne Lisbeth Bohr, MD, Copenhagen University Hospital, Institute of Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet,, Copenhagen, Denmark, Pierre Tattevin, MD, PHD, Infectious Diseases and Intensive Care Unit, Pontchaillou Univ. Hosp.; ESGIB, Rennes, France, Jesper Damsgaard Gunst, MD, Aarhus University Hospital, Department of Infectious Diseases,, Aarhus, Denmark, Lenka Baštáková, MD, Faculty Hospital Brno, Department of Infectious Diseases and Masaryk University Faculty of Medicine,, Brno,, Czech Republic, Matjaž Jereb, MS, University Medical Centre, Department of Infectious Diseases,, Ljubljana, Slovenia, Rodrigo Hasbun, MD, MPH, Division of Infectious Diseases, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX and Infectious Diseases International Research Initiative Group


    H. Erdem, None

    Y. Cag, None

    D. Ozturk-Engin, None

    S. Defres, None

    S. Kaya, None

    L. Larsen, None

    M. Poljak, None

    B. Barsic, None

    X. Argemi, None

    S. M. Sørensen, None

    A. L. Bohr, None

    P. Tattevin, None

    J. Damsgaard Gunst, None

    L. Baštáková, None

    M. Jereb, None

    R. Hasbun, None

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