Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicenter study

Clin Infect Dis. 2002 Aug 1;35(3):254-60. doi: 10.1086/341405. Epub 2002 Jul 10.


Management of herpes simplex encephalitis (HSE) has been considerably improved by the availability of acyclovir therapy and rapid polymerase chain reaction (PCR)-based diagnostic assays. Prognostic factors for this rare affliction are, however, misestimated. We conducted a large retrospective multicenter study that included 93 adult patients in whom HSE was diagnosed by PCR from 1991 through 1998 and who were treated with intravenous acyclovir. Among the 85 patients assessed at 6 months, 30 (35%) had a poor outcome, which led to death in 13 patients (15%) and severe disability in 17 (20%). The outcome was favorable for 55 patients (65%). A multivariate analysis identified 2 factors that were found to be independently associated with poor outcome: a Simplified Acute Physiology Score II >/=27 at admission and a delay of >2 days between admission to the hospital and initiation of acyclovir therapy. Early administration of antiviral therapy is the only parameter that can be modified to improve the prognosis of patients with HSE.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acyclovir / therapeutic use*
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antiviral Agents / therapeutic use*
  • Brain / diagnostic imaging
  • Brain / virology
  • Encephalitis, Herpes Simplex / diagnosis
  • Encephalitis, Herpes Simplex / diagnostic imaging
  • Encephalitis, Herpes Simplex / drug therapy*
  • Encephalitis, Herpes Simplex / physiopathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Multivariate Analysis
  • Prognosis
  • Radiography
  • Retrospective Studies
  • Treatment Outcome


  • Antiviral Agents
  • Acyclovir