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Herpetic encephalitis: which treatment for which body weight?

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Abstract

Background

Prognosis of herpetic encephalitis remains severe, with a high proportion of deaths and sequelae. Its treatment is based on acyclovir, but the precise and most effective modalities of this treatment are not established. The objective of this study was to determine them.

Methods

For this, we carried out a descriptive, retrospective, monocentric study, using the current coding database at Marseille University Hospitals. Cohort was intended to be exhaustive for the disease, from January 2000 to June 2019, including patients hospitalized in intensive care and conventional hospitalization sector. Patients (n = 76) included were at least 16 years of age and had a clinical presentation, cerebral Magnetic Resonance Imaging, and/or electroencephalogram abnormalities consistent with herpetic encephalitis confirmed by a positive HSV-PCR in the CSF. Clinical data and treatment, including the doses actually administered to the patient, were compared according to patient’s outcome.

Results

The mortality rate was 12%, whereas 49% had complete recovery and 39% sequelae impeding independence. Poor outcome was statistically associated with persistence of confusion, aphasia, and impaired consciousness lasting more than 5 days, superinfection, status epilepticus, and length of stay in intensive care unit. A statistical decision tree, constructed using the Classification And Regression Tree model, to prioritize treatment management, showed two main factors that influence the outcome: the patient’s weight, and the average daily acyclovir dose actually administered.

Conclusion

These results suggest to modify acyclovir management in herpetic encephalitis, for low-weight patients (< 79 kg) with a minimum dosage of 2550 mg/day (850 mg/ 8 h), when possible.

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Funding

The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grants, or other support was received.

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Authors and Affiliations

  1. Service de Médecine Interne, CHU Conception, Assistance Publique Hôpitaux de Marseille, 147 Boulevard Baille, 13385, Marseille Cedex 5, France

    Marine Mulatero, Gilles Kaplanski & Elsa Kaphan

  2. Aix-Marseille Univ, Faculté de Médecine, Secteur Timone, EA 3279: CEReSS, Centre d’Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, 27 Boulevard Jean Moulin, 13005, Marseille, France

    Mohamed Boucekine

  3. Service de Neuropsychologie, CHU Timone, Assistance Publique Hôpitaux de Marseille, Pôle de Neurosciences Cliniques, Marseille, France

    Olivier Felician

  4. Aix-Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France

    Olivier Felician

  5. Service d’Anesthésie-Réanimation, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France

    Salah Boussen

  6. Service de Médecine Interne, CHU Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France

    Pascal Rossi

  7. Institut Hospitalo-Universitaire Méditerranée Infection, CHU Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France

    Philippe Parola, Andréas Stein, Philippe Brouqui & Jean Christophe Lagier

  8. Département de Réanimation, CHU Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France

    Marc Leone

Authors
  1. Marine Mulatero
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  2. Mohamed Boucekine
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  3. Olivier Felician
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  4. Salah Boussen
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  5. Gilles Kaplanski
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  6. Pascal Rossi
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  7. Philippe Parola
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  8. Andréas Stein
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  9. Philippe Brouqui
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  10. Jean Christophe Lagier
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  11. Marc Leone
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  12. Elsa Kaphan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MM and EK. The first draft of the manuscript was written by MM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Elsa Kaphan.

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Conflicts of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was registered on the Portal of Access to Health Data of the Assistance Publique-Hôpitaux de Marseille (N°2019-201), as it is required in France for retrospective studies, with the agreement of the Human Investigation Committee (IRB) of Aix-Marseille University.

Consent to participate

In this retrospective study, from data obtained for clinical purposes, with anonymized informations, informed consent to participate was not required, according to the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to publication

In this retrospective study, from data obtained for clinical purposes, with anonymized informations, and without any individual material that could be used to identify any participant, informed consent for publication was not required.

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Mulatero, M., Boucekine, M., Felician, O. et al. Herpetic encephalitis: which treatment for which body weight?. J Neurol 269, 3625–3635 (2022). https://doi.org/10.1007/s00415-022-10981-8

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  • DOI: https://doi.org/10.1007/s00415-022-10981-8

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