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Herpes Simplex Encephalitis — Vidarabine Therapy and Diagnostic Problems

List of authors.
  • Richard J. Whitley, M.D.,
  • Seng-Jaw Soong, Ph.D.,
  • Martin S. Hirsch, M.D.,
  • Adolf W. Karchmer, M.D.,
  • Raphael Dolin, M.D.,
  • George Galasso, Ph.D.,
  • June K. Dunnick, Ph.D.,
  • Charles A. Alford, M.D.,
  • and NIAID Collaborative Antiviral Study Group

Abstract

To learn more about the treatment of herpes simplex encephalitis with vidarabine, we conducted an uncontrolled study of 132 patients referred to 22 hospitals because of suspected disease. All had a brain biopsy and were started on vidarabine, but only 75 were diagnosed by isolation of virus from a brain-biopsy specimen. Cumulative mortality in the latter group was 39 per cent at one year.

Other than therapy, levels of consciousness and age were the major variables that influenced outcome. Of 23 patients under 30 years of age who were lethargic at the initiation of therapy, two died and 16 returned to normal. Of 26 patients over 30 years of age who were lethargic at the outset, nine died and 10 returned to normal. Semicoma and coma were associated with worse outcomes, especially in older patients. Our data suggest that outcome is improved with treatment; they provide more support for the use of brain biopsy to diagnose the infection and indicate a need for better therapy. (N Engl J Med. 1981; 304:313–8.)

Funding and Disclosures

Initiated and supported under a contract (N01 AI 22532) with the Development and Applications Branch of the National Institute of Allergy and Infectious Diseases (NIAID), by grants from the National Cancer Institute (CA13148) and the General Clinical Research Centers Programs (RR-032) of the National Institutes of Health, and by the Robert Meyer Foundation.

Members of the Collaborative Antiviral Study Group include G. Galasso and J. Dunnick (project officers) and S. Straus, NIAID, NIH; R. Whitley, C. Alford, N. Barton, C. G. Cobbs, and R. Morawetz, Central Unit, University of Alabama in Birmingham; S. Soong and C. L. Fleming, Department of Biostatistics, University of Alabama in Birmingham; J. Overall and S. Spurance, University of Utah College of Medicine; F. Hayden and J. Gwaltney, University of Virginia; M. Hilty, Ohio State University College of Medicine; I. Baird, Riverside Hospital, Columbus, Ohio; C. Linnemann, University of Cincinnati; C. Liu, D. Hinthorn, and L. Baker, University of Kansas Medical Center; J. Luby, University of Texas, Southwestern; S. Schwartzman, A. Visintine, and A. Nahmias, Emory University; J. Connor, D. Richman, and M. Oxman, University of California at San Diego; Y. Bryson, University of California at Los Angeles; M. Ho, G. Pazin, and J. Dowling, University of Pittsburgh; M. Hirsch and A. Karchmer, Massachusetts General Hospital, Boston; J. Tilles, University of California at Irvine; R. Betts and R. G. Douglas, University of Rochester; K. Mclntosch and N. Halsey, University of Colorado; R. Haynes, Wright State University, Dayton; R. Couch, S. Greenberg, and L. Taber, Baylor University, Houston; R. Dolin and R. C. Reichman, University of Vermont; and R. Buchanan, Parke-Davis Company, Ann Arbor, Mich.

We are indebted to Parke-Davis Research Division of Warner-Lambert Company, Ann Arbor, Mich., for kindly supplying the drug.

Author Affiliations

From the Division of Virology and the departments of Pediatrics, Microbiology, and Biostatistics, University of Alabama in Birmingham; the Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston; the Division of Infectious Diseases, Department of Medicine, University of Vermont College of Medicine, Burlington, Vt.; and the Microbiology and Infectious Diseases Program, National Institutes of Health (NIH), Bethesda, Md. Address reprint requests to Dr. Whitley at the Department of Pediatrics, Room 609 CDLD Building, University of Alabama in Birmingham, University Station, Birmingham, AL 35294.

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