Herpes simplex virus type 2 encephalitis in critically ill adults: A retrospective analysis of EURECA and Herpetics cohort studies
Year: 2026
Type: article
Abstract: BACKGROUND: Herpes simplex virus type 1 (HSV-1) is the leading cause of sporadic infectious encephalitis. Although typically associated with benign meningitis, HSV-2 can also cause encephalitis in adults, a condition that remains poorly characterized in intensive care unit (ICU). We aimed to compare the characteristics, management, and outcomes of critically ill adult with HSV-2 and HSV-1 encephalitis. METHODS: We performed a retrospective analysis of adults with herpes simplex encephalitis (HSE) admitted to the ICU in two large multicenter cohorts. Patients were classified according to cerebrospinal fluid (CSF) HSV genotype. The primary endpoint was unfavourable outcome at 3 months, defined as a modified Rankin Scale score 3–6. RESULTS: Among 285 HSE patients, 17 (6%) had HSV-2 encephalitis (age 60 [53–67] years, female sex 58.8%). Although the proportion of immunocompromised status did not differ significantly between groups (29.4% vs 15.4%, p = 0.13), HSV-2 cases had a significantly higher prevalence of HIV infection (17.6 vs 1.5%, p < 0.01), less frequent brain MRI abnormalities (85.7% vs 97.7%, p = 0.01) and similar CSF findings compared to HSV-1 cases. The duration of intravenous acyclovir treatment was shorter for HSV-2 cases (18 [4–21] days) versus 21[20–21] days, p = 0.04). Unfavourable outcome occurred in 9/16 (56.3%) patients with HSV-2 encephalitis and in 175/236 (74.2%) patients with HSV-1 encephalitis (p = 0.25). CONCLUSION: Encephalitis caused by HSV-2 represent a consistent proportion of severe HSE. Clinical presentation and outcomes and broadly comparable to those of HSV-1 cases, underscoring the importance of early recognition and standardized management of encephalitis caused by HSV, regardless of genotype.
Source: Critical Care
Authors: Thomas Volpé, Nolan Hassold, Etienne de Montmollin, Claire Dupuis, Benjamine Sarton, Bertrand Guidet, Fabrice Bruneel, Charline Sazio, Russell Chabanne, Noelle Brulé, Ahmed El Kalioubie, Mikael Alves, Jean-Marc Tadié, Giuseppe Citerio, Raimund Helbok, Janneke Horn, Sophie Demeret, Pierre Bailly, Aurélien Frérou, Omar Ben Hadj Salem, Nicolas Engrand, Daniel da Silva, Jean-François Timsit, Romain Sonneville, Pierre Jaquet, the ENCEPHALITICA, C. Sazio, M. Conrad, V. Susset, L. Argaud, F. Barbier, D. Daubin, N. Lerolle, S. Silva, P. Bailly, M. Wolff, L. Bouadma, J. Marechal, B. Mourvillier, F. Dailler, A. Lautrette, E. Novy, B. Guidet, F. Mateos, C. Brault, Q. Maestraggi, J.P. Quenot, A. Joret, A. Levrat, A. Massri, A. Robert, D. Contou, J.P. Mira, S. Gaudry, G. Voiriot, A. Berger, V. Das, N. Engrand, M. Murgier, S. Siami, S. Hraiech, E. Mariotte, C. Ragot, A. Stoclin, P. Trouiller, M. Schmidt, EURECA study groups, D. Contou, R. Ferrer, Mo Gurjar, K. Klouche, E. Escudier, L. Le Guennec, R. Chabanne, L. Argaud, M. Thyrault, G. Louis, G. De Pascale, G. Geri, F. Bruneel, I. Martin-Loeches, M. Santafe, R. Smonig, D. Roux, G. Voiriot, B. Souweine, K. Razazi, T. Duburcq, M. Kofler, P. Boronat, N. Aissaoui, D. Reuter, A. Cariou, P. Mateu, B. Balandin Moreno, P. Vera, E. Val Jordan, F. Barbier, M. Landais, J. Bourenne, A. Marchalot, B. Sztrympf, C. Schwebel, S. Bedanta Mishra, P. Chillet, M. Martin, H. Georges, J.C Lacherade, R. Larcher, G. Papin, D. Schnell, S. Saxena, F. Chemouni, J. Audibert, E. Mariotte, S. Siami, I. Calamai, C. Bruel, T. Ritzenthaler, S. Hraiech, A. Radjou, M. K. Renuka
Institutions: Assistance Publique – Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Centre Hospitalier Saint-Denis, Université Paris Diderot, Infection, Anti-microbiens, Modélisation, Evolution, Hôpital Purpan, Hôpital Saint-Antoine, Centre Hospitalier de Versailles, Centre Hospitalier Universitaire de Bordeaux, Centre Hospitalier Universitaire de Clermont-Ferrand, Centre Hospitalier Universitaire de Nantes, Hôpital Roger Salengro, Centre Hospitalier Intercommunal de Poissy, Hôpital Pontchaillou, University of Milano-Bicocca, Johannes Kepler University of Linz, Kepler Universitätsklinikum, Amsterdam University Medical Centers, Pitié-Salpêtrière Hospital, Hôpital Rothschild, Fondation de Rothschild, Inserm, Sorbonne Paris Cité, Laboratoire de Recherche Vasculaire Translationnelle
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,190
OpenAlex ID: W7135200440