Objective:

To describe clinical characteristics, laboratory findings, treatment courses and outcomes in patients with herpes simplex encephalitis (HSE).

Background:

HSE is a life-threatening infection of the central nervous system, marked by acute neurological deterioration and a high risk of long-term cognitive and functional impairment. Intravenous ACV has significantly improved survival however, the optimal duration of therapy 14 versus 21 days remains uncertain, and neurological sequelae are common.

Design/Methods:

We conducted a retrospective analysis of patients with confirmed HSE  at Columbia University Irving Medical Center who received either 14 or 21 days of intravenous ACV. Demographics, cerebrospinal fluid (CSF) parameters, time to diagnosis and treatment, ICU admission, corticosteroid use, immunosuppression, and discharge disposition were compared between groups. Continuous variables were summarized as mean ± standard deviation and compared using t-tests, while categorical variables were compared using Fisher’s exact test.

Results:

A total of 20 patients were included, 7 in the 14-day group and 13 in the 21-day group. The mean age was 46.3 ± 26.5 years in the 14-day group and 58.1 ± 15.8 years in the 21-day group (p=0.225), with females predominating in the 14-day group (85.7% vs 46.2%, p=0.213). Length of hospital stay was longer in the 14-day group (59.4 ± 97.3 vs 32.9 ± 24.8 days, p=0.355), whereas ICU stay was longer in the 21-day group (16.6 ± 9.3 vs 10.5 ± 9.2 days, p=0.466). CSF parameters, including white blood cell count, glucose, and protein, did not differ significantly. Clinical outcomes, including mortality (28.6% vs 30.8%, p=1.000), ICU admission (42.9% vs 38.5%, p=1.000), and corticosteroid use (42.9% vs 53.8%, p=1.000), were similar.

Conclusions:

Patients with HSE exhibited considerable variability in clinical course and treatment patterns. While outcomes and laboratory findings were generally similar, further research is needed to guide individualized therapy and optimize management strategies.