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Poussier L, Mailles A, Tattevin P, Stahl JP, Fillâtre P. Characteristics, management and outcome of Herpes Simplex and Varicella-Zoster virus encephalitis: a multicentre prospective cohort study. Clin Microbiol Infect 2024; 30:917-923. [PMID: 38527616 DOI: 10.1016/j.cmi.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/03/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To characterize differences between Herpes Simplex virus encephalitis and Varicella-Zoster virus encephalitis (HSVE and VZVE) and other aetiologies of infectious encephalitis (IE), and to investigate the impact of time-to-aciclovir (ACV) start, ACV dose and duration on outcome. METHODS We compared 132 HSVE, 65 VZVE and 297 other IE enrolled in a prospective cohort (ENCEIF). We estimated associations between time-to-ACV start, dose or duration and outcome through adjusted odds ratio (aOR) using logistic regression analysis. RESULTS Prevalence of immunodepression differed among aetiologies: 15/65 (23%) for VZVE, 13/132 (10%) for HSVE and 30/297 (10%) for other IE (p <0.05), as was presence of seizure at admission: 27/132 (20%) for HSVE, 4/65 (6%) for VZVE and 43/297 (14%) for other IE (p <0.05). Poor outcome at hospital discharge (Glasgow outcome scale ≤3) differed among the three groups: 40/127 (31%) for HSVE, 12/65 (18%) for VZVE and 38/290 (13%) for other IE (p <0.05). Time-to-ACV start was associated with outcome in HSVE (aOR 3.61 [1.25-10.40]), but not in VZVE (aOR 0.84 [0.18-3.85]). Increased ACV dose was not associated with outcome among HSVE (aOR 1.25 [0.44-3.64]) nor VZVE (aOR 1.16 [0.24-5.73]). DISCUSSION HSVE and VZVE are distinct in clinical presentation, outcome and prognostic factors. The impact of early ACV initiation was more apparent for HSVE than for VZVE; however, this could be because of VZVE's smaller sample size and lower outcome rate leading to low statistical power or because of potential distinct IE pathophysiology.
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Affiliation(s)
- Léa Poussier
- Infectious Diseases and Intensive Care Unit, CHU Pontchaillou, Rennes, France; INSERM, CIC 1414, Rennes, France
| | | | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, CHU Pontchaillou, Rennes, France; INSERM, CIC 1414, Rennes, France
| | - Jean-Paul Stahl
- Infectious Diseases Department, University Grenoble Alpes, Grenoble, France
| | - Pierre Fillâtre
- INSERM, CIC 1414, Rennes, France; Intensive Care Unit, Yves Le Foll Hospital, Saint Brieuc, France.
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Contamine M, Ader F, Lepiller Q, Martha B, Cagnon-Chapalain J, Leturnier P, Frober E, Bouiller K, Binquet C, Auvray C, Piroth L, Blot M. Acyclovir treatment of varicella-zoster virus meningeal infections and acute kidney injury: a multicentre case series study. Infect Dis (Lond) 2024:1-9. [PMID: 38822453 DOI: 10.1080/23744235.2024.2355989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/12/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Systematic treatment with intravenous acyclovir is usually given when varicella zoster virus (VZV) DNA is isolated in cerebrospinal fluid (CSF), indicating central nervous system (CNS) involvement. Our study aimed to describe therapeutic management and acute kidney injury (AKI) occurrence during acyclovir treatment of VZV infection with CNS involvement. METHODS Multicentre, retrospective study including all patients from 2010 to 2022 with VZV DNA in CSF. Patient management and outcomes were compared according to clinical presentation and indications for intravenous acyclovir: i) definite (encephalitis, myelitis or stroke, peripheral nervous system (PNS) with ≥ 2 roots, herpes zoster ≥ 3 dermatomes, immunosuppression), ii) questionable (1 or 2 dermatomes) or iii) no indication (other situations). RESULTS 154 patients were included (median age 66 (interquartile range 43-77), 87 (56%) males); 60 (39%) had encephalitis, myelitis or stroke, 35 (23%) had PNS involvement, 37 (24%) had isolated meningitis, 14 (9%) had isolated cutaneous presentation, and 8 (5%) had other presentations. Overall, 128 (83%) received intravenous acyclovir for more than 72 h. AKI occurred in 57 (37%) patients. Finally, 42 (27%) and 25 (16%) patients had respectively no or a questionable indication for intravenous acyclovir, while 29 (69%) and 23 (92%) of them received it for more than 72 h, with AKI in 13 (35%) and 13 (52%) patients, respectively. In-hospital mortality was 12% (n = 18), and no deaths were reported in isolated meningitis. CONCLUSIONS Intravenous acyclovir is widely prescribed when VZV DNA is isolated in CSF, regardless of the clinical presentation, with a high rate of AKI. Further studies are needed to better define the value of intravenous acyclovir in isolated VZV meningitis.
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Affiliation(s)
- Myriam Contamine
- Department of Infectious Diseases, Dijon-Bourgogne University Hospital, Dijon, France
| | - Florence Ader
- Department of Infectious Diseases, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Quentin Lepiller
- Laboratory of virology, Besançon University Hospital, Besançon, France
| | - Benoit Martha
- Department of Infectious Diseases, William Morey Hospital, Chalon sur Saône, France
| | | | - Paul Leturnier
- Infectious and Tropical Diseases Unit, Cayenne General Hospital, Cayenne, French Guiana
- Cayenne General Hospital, INSERM, Cayenne, French Guiana
| | - Emilie Frober
- Laboratory of virology, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Kevin Bouiller
- Department of infectious and tropical diseases, Université de Franche-Comté, CHU Besançon, UMR-CNRS 6249 Chrono-environnement, Besançon, France
| | - Christine Binquet
- CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
- LabEx LipSTIC, University of Burgundy, Dijon, France
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
| | - Christelle Auvray
- Laboratory of virology, Dijon-Bourgogne University Hospital, Dijon, France
| | - Lionel Piroth
- Department of Infectious Diseases, Dijon-Bourgogne University Hospital, Dijon, France
- CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
- LabEx LipSTIC, University of Burgundy, Dijon, France
| | - Mathieu Blot
- Department of Infectious Diseases, Dijon-Bourgogne University Hospital, Dijon, France
- CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
- LabEx LipSTIC, University of Burgundy, Dijon, France
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
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Landré S, Ader F, Epaulard O, Tattevin P, Stahl JP, Mailles A. Encephalitis in HIV-negative immunodeficient patients: a prospective multicentre study, France, 2016 to 2019. Euro Surveill 2024; 29:2300046. [PMID: 38333938 PMCID: PMC10853978 DOI: 10.2807/1560-7917.es.2024.29.6.2300046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/01/2023] [Indexed: 02/10/2024] Open
Abstract
BackgroundData on infectious encephalitis in immunodeficient (ID) individuals are scarce. This population may present with atypical clinical symptoms, be infected by uncommon pathogens and develop poor outcomes.AimWe aimed to describe the epidemiology of infectious encephalitis among HIV-negative ID patients.MethodsPatients from the ENCEIF (Etude Nationale de Cohorte des Encéphalites Infectieuses en France) prospective cohort meeting criteria for infectious encephalitis between January 2016 and December 2019 were included. We compared clinical presentation, magnetic resonance imaging (MRI) results, biological results, infection causes and outcome of ID patients with immunocompetent (IC) patients using Pearson's chi-squared test and Student's t-test. We carried out logistic regression to assess the role of immunodeficiency as risk factor for poor outcome.ResultsID patients (n = 58) were older (mean 72 vs 59 years), had higher prevalence of diabetes (26% vs 12%), pre-existing neurological disorders (12% vs 5%) and higher case-fatality rate (23.6% vs 5.6%) compared to IC patients (n = 436). Varicella zoster virus was the primary cause of encephalitis in ID patients (this aetiology was more frequent in ID (25.9%) than in IC patients (11.5%)), with herpes simplex virus second (22.4% in ID patients vs 27.3% in IC patients). Immunodeficiency was an independent risk factor for death or major sequelae (odds ratio: 3.41, 95%CI: 1.70-6.85).ConclusionsVaricella zoster virus is the most frequent cause of infectious encephalitis in ID patients. Immunodeficiency is a major risk factor for poor outcome. ID encephalitis patients should benefit from stringent investigation of cause and early empiric treatment.
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Affiliation(s)
- Sophie Landré
- University Claude Bernard Lyon 1, Hospices Civils de Lyon, Infectious disease department, Lyon, France
| | - Florence Ader
- University Claude Bernard Lyon 1, Hospices Civils de Lyon, Infectious disease department, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, France
| | - Olivier Epaulard
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland
- University Grenoble Alpes, Infectious diseases department, Grenoble, France
| | - Pierre Tattevin
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland
- Infectious diseases department, CHU Pontchaillou, Rennes, France
| | - Jean Paul Stahl
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland
- University Grenoble Alpes, Infectious diseases department, Grenoble, France
| | - Alexandra Mailles
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland
- Santé Publique France, Saint-Maurice, France
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Petersen PT, Bodilsen J, Jepsen MPG, Larsen L, Storgaard M, Helweg-Larsen J, Wiese L, Hansen BR, Lüttichau HR, Andersen CØ, Nielsen H, Brandt CT. Ramsay Hunt syndrome and concurrent varicella-zoster virus meningitis in Denmark: A nationwide cohort study. J Med Virol 2023; 95:e29291. [PMID: 38058258 DOI: 10.1002/jmv.29291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/06/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
Ramsay Hunt syndrome (RHS) is a manifestation of reactivated varicella-zoster virus (VZV) from the geniculate ganglion. Data on clinical features and outcomes of patients with RHS and concurrent VZV meningitis (henceforth RHS meningitis) are limited. Thus, we conducted a nationwide population-based cohort study of all adults hospitalized for RHS meningitis at the departments of infectious diseases in Denmark from 2015 to 2020. Patients with VZV meningitis without cranial nerve palsies were included for comparison. In total, 37 patients with RHS meningitis (mean annual incidence: 1.6/1 000 000 adults) and 162 with VZV meningitis without cranial nerve palsies were included. In RHS meningitis, the median age was 52 years (interquartile range: 35-64), and in addition to peripheral facial nerve palsy (100%), dizziness (46%), and hearing loss (35%) were common symptoms. The triad of headache, neck stiffness, and photophobia/hyperacusis was less common in RHS meningitis than in VZV meningitis without cranial nerve palsies (0/27 [0%] vs. 24/143 [17%]; p = 0.02). At 30 days after discharge, 18/36 (50%) patients with RHS meningitis had persistent peripheral facial nerve palsy, with no statistically significant difference between those treated with and without adjuvant glucocorticoids (6/16 [38%] vs. 12/20 [60%]; p = 0.18). Additional sequelae of RHS meningitis included dizziness (29%), neuralgia (14%), tinnitus/hyperacusis (11%), hearing loss (9%), headache (9%), fatigue (6%), and concentration difficulties (3%). In conclusion, clinical features and outcomes of RHS meningitis were primarily related to cranial neuropathies.
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Affiliation(s)
- Pelle T Petersen
- Department of Pulmonary and Infectious Diseases, Nordsjaellands Hospital, Hillerød, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Micha P G Jepsen
- Department of Pulmonary and Infectious Diseases, Nordsjaellands Hospital, Hillerød, Denmark
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lothar Wiese
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Birgitte R Hansen
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
| | - Hans R Lüttichau
- Department of Infectious Diseases, Herlev Hospital, Herlev, Denmark
| | | | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Abbuehl LS, Hofmann E, Hakim A, Dietmann A. Can we forecast poor outcome in herpes simplex and varicella zoster encephalitis? A narrative review. Front Neurol 2023; 14:1130090. [PMID: 37435162 PMCID: PMC10331601 DOI: 10.3389/fneur.2023.1130090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/31/2023] [Indexed: 07/13/2023] Open
Abstract
Herpes simplex virus (HSV) and varicella zoster virus (VZV) are among the most commonly diagnosed infectious causes of sporadic encephalitis worldwide. Despite treatment, mortality and morbidity rates remain high, especially for HSV encephalitis. This review is intended to provide an overview of the existing scientific literature on this topic from the perspective of a clinician who is confronted with serious decisions about continuation or withdrawal of therapeutic interventions. We performed a literature review searching two databases and included 55 studies in the review. These studies documented or investigated specifically outcome and predictive parameters of outcome of HSV and/or VZV encephalitis. Two reviewers independently screened and reviewed full-text articles meeting the inclusion criteria. Key data were extracted and presented as a narrative summary. Both, HSV and VZV encephalitis have mortality rates between 5 and 20% and complete recovery rates range from 14 to 43% for HSV and 33 to 49% for VZV encephalitis. Prognostic factors for both VZV and HSV encephalitis are older age and comorbidity, as well as severity of disease and extent of magnetic resonance imaging (MRI) lesions on admission, and delay in treatment initiation for HSV encephalitis. Although numerous studies are available, the main limiting factors are the inconsistent patient selection and case definitions as well as the non-standardised outcome measures, which hampers the comparability of the studies. Therefore, larger and standardised observational studies applying validated case definitions and outcome measures including quality of life assessment are required to provide solid evidence to answer the research question.
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Affiliation(s)
- Lena S. Abbuehl
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eveline Hofmann
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arsany Hakim
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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