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Abstract：
BACKGROUND: Herpes simplex encephalitis (HSE) is an important central nervous infection with severe neurological sequelae. The aim of this study was to describe clinical characteristic and outcomes of patients with HSE in Vietnam.
METHODS: This was a retrospective study of 66 patients with herpes simplex encephalitis who admitted to the National Hospital for Tropical Diseases, Hanoi, Vietnam from 2018 to 2021. The detection of herpes simplex virus (HSV) in cerebrospinal fluid was made by the real-time PCR assay. We reported the clinical manifestation on admission and evaluated clinical outcomes at the hospital discharge by modified Rankin Scale (mRS). Multivariate logistic regression analysis was used to analyze the independent risk factors of severe outcomes.
RESULTS: Of the 66 patients with laboratory confirmed HSE, the median age was 53 years (IQR 38-60) and 44 patients (69.7%) were male. The most common manifestations included fever (100%), followed by the consciousness disorder (95.5%). Other neurological manifestation were seizures (36.4%), memory disorders (31.8%), language disorders (19.7%) and behavioral disorders (13.6%). Conventional magnetic resonance imaging (MRI) showed 93.8% patients with temporal lobe lesions, followed by abnormalities in insula (50%), frontal lobe (34.4%) and 48.4% of patients had bilateral lesions. At discharge, 19 patients (28.8%) completely recovered, 15 patients (22.7%) had mild sequelae, 28 patients (42.4%) had moderate to severe sequelae. Severe neurological sequelae were memory disorders (55.8%), movement disorders (53.5%), language disorders (30.2%). Multivariate logistic regression analysis showed that Glasgow score decrement at admission, seizures, and time duration from onset of symptoms to the start of Acyclovir treatment > 4 days were independent factors associated with severe outcomes in HSE patients.
CONCLUSIONS: Glasgow score decrement, seizures and delay treatment with Acyclovir were associated with the poor outcome of patients with HSE.
METHODS: This was a retrospective study of 66 patients with herpes simplex encephalitis who admitted to the National Hospital for Tropical Diseases, Hanoi, Vietnam from 2018 to 2021. The detection of herpes simplex virus (HSV) in cerebrospinal fluid was made by the real-time PCR assay. We reported the clinical manifestation on admission and evaluated clinical outcomes at the hospital discharge by modified Rankin Scale (mRS). Multivariate logistic regression analysis was used to analyze the independent risk factors of severe outcomes.
RESULTS: Of the 66 patients with laboratory confirmed HSE, the median age was 53 years (IQR 38-60) and 44 patients (69.7%) were male. The most common manifestations included fever (100%), followed by the consciousness disorder (95.5%). Other neurological manifestation were seizures (36.4%), memory disorders (31.8%), language disorders (19.7%) and behavioral disorders (13.6%). Conventional magnetic resonance imaging (MRI) showed 93.8% patients with temporal lobe lesions, followed by abnormalities in insula (50%), frontal lobe (34.4%) and 48.4% of patients had bilateral lesions. At discharge, 19 patients (28.8%) completely recovered, 15 patients (22.7%) had mild sequelae, 28 patients (42.4%) had moderate to severe sequelae. Severe neurological sequelae were memory disorders (55.8%), movement disorders (53.5%), language disorders (30.2%). Multivariate logistic regression analysis showed that Glasgow score decrement at admission, seizures, and time duration from onset of symptoms to the start of Acyclovir treatment > 4 days were independent factors associated with severe outcomes in HSE patients.
CONCLUSIONS: Glasgow score decrement, seizures and delay treatment with Acyclovir were associated with the poor outcome of patients with HSE.
摘要：
背景：单纯疱疹性脑炎（HSE）是一种重要的中枢神经感染，伴有严重的神经系统后遗症。这项研究的目的是描述越南HSE患者的临床特征和结果。
方法：这是一项对国家热带病医院收治的66例单纯疱疹性脑炎患者的回顾性研究，河内,越南从2018年到2021年。实时荧光定量PCR检测脑脊液中单纯疱疹病毒(HSV)。我们报告了入院时的临床表现，并通过改良的Rankin量表（mRS）评估了出院时的临床结果。采用多因素logistic回归分析严重结局的独立危险因素。
结果：在66例实验室确诊的HSE患者中，中位年龄为53岁(IQR38~60),44例(69.7%)患者为男性.最常见的表现包括发热（100%），其次是意识障碍(95.5%)。其他神经系统表现为癫痫发作（36.4%），记忆障碍(31.8%)，语言障碍（19.7%）和行为障碍（13.6%）。常规磁共振成像(MRI)显示颞叶病变占93.8%,其次是脑岛异常（50％），额叶（34.4％）和48.4％的患者有双侧病变。出院时,19例患者（28.8%）完全恢复，15例(22.7%)有轻度后遗症,28例（42.4％）有中度至重度后遗症。严重的神经系统后遗症是记忆障碍（55.8%），运动障碍（53.5%），语言障碍（30.2%）。多因素logistic回归分析显示，入院时格拉斯哥评分下降，癫痫发作,从症状出现到阿昔洛韦治疗开始的持续时间>4天是与HSE患者严重结局相关的独立因素。
结论：格拉斯哥评分下降，癫痫发作和阿昔洛韦延迟治疗与HSE患者的不良预后相关.
方法：这是一项对国家热带病医院收治的66例单纯疱疹性脑炎患者的回顾性研究，河内,越南从2018年到2021年。实时荧光定量PCR检测脑脊液中单纯疱疹病毒(HSV)。我们报告了入院时的临床表现，并通过改良的Rankin量表（mRS）评估了出院时的临床结果。采用多因素logistic回归分析严重结局的独立危险因素。
结果：在66例实验室确诊的HSE患者中，中位年龄为53岁(IQR38~60),44例(69.7%)患者为男性.最常见的表现包括发热（100%），其次是意识障碍(95.5%)。其他神经系统表现为癫痫发作（36.4%），记忆障碍(31.8%)，语言障碍（19.7%）和行为障碍（13.6%）。常规磁共振成像(MRI)显示颞叶病变占93.8%,其次是脑岛异常（50％），额叶（34.4％）和48.4％的患者有双侧病变。出院时,19例患者（28.8%）完全恢复，15例(22.7%)有轻度后遗症,28例（42.4％）有中度至重度后遗症。严重的神经系统后遗症是记忆障碍（55.8%），运动障碍（53.5%），语言障碍（30.2%）。多因素logistic回归分析显示，入院时格拉斯哥评分下降，癫痫发作,从症状出现到阿昔洛韦治疗开始的持续时间>4天是与HSE患者严重结局相关的独立因素。
结论：格拉斯哥评分下降，癫痫发作和阿昔洛韦延迟治疗与HSE患者的不良预后相关.
