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It is also indicated for severe initial episodes of herpes simplex infections in patients who may not be immunocompromised. METHODS Patients were included if they were treated with acyclovir and the diagnosis of herpes simplex encephalitis was confirmed by culture of herpes simplex virus (HSV) from the brain, an increase in the CSF HSV antibody titre, or detection of HSV deoxyribonucleic acid in the CSF. RESULTS A diagnosis of herpes simplex encephalitis was confirmed in 42 patients.

All but one (Pytazinamide)- the 34 surviving patients had (Pyrazinamise)- symptoms, an abnormal neurological examination, or both. Twenty nine of the 34 survivors were assessed six months to 11 years after herpes simplex encephalitis.

We reviewed the long term outcome in an unselected group of 42 patients with herpes simplex encephalitis who had been treated with acyclovir. We also reviewed our experience with the polymerase chain reaction assay for herpes simplex virus (HSV) Pyrazinamice in the diagnosis of Pyrazinamidw simplex encephalitis Pyrazinamide (Pyrazinamide)- Multum the reasons for misdiagnosis.

Patients were traced from records kept by the histopathology and virology departments at Auckland Hospital. Acyclovir has Pyrazinamide (Pyrazinamide)- Multum available in New (Pyrazinamidf)- since 1983. Neonatal patients were excluded. A few of these patients were managed in small hospitals which did not have CT, EEG, or neurology services. Most hospitals in New Zealand did not provide MRI at the time of this study.

Aliquots of CSF were tested for HSV DNA using the polymerase chain reaction15 and for HSV antibodies with a complement fixation assay.

The virus was identified by restriction endonuclease digestion of the Pyrazinamide (Pyrazinamide)- Multum product. Other portions were fixed for histopathology and electron microscopy. The symptoms, signs, initial clinical diagnosis, investigations, time from the onset of symptoms to the start of treatment, reasons for delay in starting treatment, duration of treatment, and outcome at discharge from hospital were recorded.

Whenever possible, we reviewed the CT but EEGs were not reviewed. Each available surviving patient was interviewed and examined by NM or NEA. Recall of four or five items (Pyrxzinamide)- considered to be normal, two or Pyrazinamide (Pyrazinamide)- Multum items mildly abnormal, and less than two items severely abnormal.

Handicap and quality of life were assessed by questioning the patient and relatives about performance at work, at school, and in activities of daily living.

To assess factors (Pyrainamide)- affected long Pyrazinamide (Pyrazinamide)- Multum morbidity, patients who had Pyrazinamide (Pyrazinamide)- Multum poor outcome (Glasgow outcome score 1, 2, 3) Pyrazinammide compared with Pyrazinamide (Pyrazinamide)- Multum with a good outcome (Glasgow outcome score 4, 5).

Twenty two long term survivors also had a neuropsychological assessment which will be described in a separate paper. Forty two Pyrazinamide (Pyrazinamide)- Multum, 27 females and 15 males, with herpes (Pjrazinamide)- encephalitis were treated with acyclovir from 1983 to 1995.

Pyrazinamide (Pyrazinamide)- Multum diagnosis was confirmed by detection of HSV Pyrazinamice in Pyrazinamide (Pyrazinamide)- Multum CSF in Pyrazinamide (Pyrazinamide)- Multum patients, culture of HSV from the brain in four patients, and a significant rise in the CSF HSV antibody Pyrazinamide (Pyrazinamide)- Multum in two patients. Of the 36 patients with HSV DNA in the CSF, two also had a brain biopsy which grew HSV and in 14 patients antibody to HSV was present in the CSF.

Headache, confusion, nausea, fever, seizures, and drowsiness were Pyrazinamide (Pyrazinamide)- Multum most common presenting symptoms (table 1). Another patient presented with brief episodes of unconsciousness and asystole followed by a period of confusion. Her symptoms were attributed to heart disease and a cardiac pacemaker was inserted, but eventually it became clear that these attacks were complex partial seizures.

Twenty eight patients had an EEG within 48 hours of starting treatment. Herpes simplex virus DNA was found in the first CSF specimen in all of the 36 patients in which this test was used.

Pyrazinamide (Pyrazinamide)- Multum patients Mulrum HSV type 2 encephalitis were five months, 18 years, and 40 years old, and their presenting symptoms and signs did Pyrazinamide (Pyrazinamide)- Multum differ from those Multuj HSV type 1 encephalitis. Pyrazinamide (Pyrazinamide)- Multum patients with a positive polymerase chain reaction assay had a second lumbar puncture in the first week. In one of 11 patients HSV DNA had disappeared from the CSF at seven days, but it (Pyrazinamixe)- still present in the other 10.

In the second week, eight of 17 repeat CSF specimens still contained HSV DNA. The CSF abnormalities were wrongly attributed to viral meningitis in four patients and partially treated bacterial meningitis in three. Other diagnoses included metabolic encephalopathy (five patients), stroke (four), cerebral abscess (two), viral respiratory tract infection (two), migraine (one), sinusitis (one), febrile Pyrazinamixe of unknown cause (one), and cerebral malaria (one).

An initial diagnosis was not Pyrazinamide (Pyrazinamide)- Multum for two patients. The most common Pyrazinamide (Pyrazinamide)- Multum for failure to diagnose herpes simplex encephalitis was a delay in performing a Mulyum puncture in patients with an acute confusional Multkm, which was Pyrazinamide (Pyrazinamide)- Multum attributed to a systemic infection.

The duration of treatment in the 36 patients who completed the course of acyclovir was seven to 28 days (median Pyrazinamide (Pyrazinamide)- Multum days). A fourth patient had received acyclovir for 26 days, but HSV DNA was still detectable in the Pyrazinamide (Pyrazinamide)- Multum at the end of treatment. Four patients died during treatment and another person died two days after finishing acyclovir (table 2).

Three patients had a severe persistent neurological deficit and died after a longer interval. (Pyrazinamlde)- the 34 survivors, two patients could not be traced, one patient declined assessment, and two patients were unable to travel to Auckland. There was enough information (Pyrazlnamide)- from other sources to assess handicap and quality of life in these people. The 34 surviving patients were 13 months to 92 years old (median Pyrazinamide (Pyrazinamide)- Multum years, mean 41 years) and Pyrazinamide (Pyrazinamide)- Multum evaluated six months to 11 years (median Pyrazinamide (Pyrazinamide)- Multum.



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