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The management of infants and children treated with aciclovir for suspected viral encephalitis
  1. Rachel Kneen1,
  2. Srinivasa Jakka1,
  3. Renuka Mithyantha1,
  4. Andrew Riordan2,
  5. Tom Solomon3
  1. 1Department of Neurology, Littlewood’s Neuroscience Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
  2. 2Department of Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
  3. 3Divisions of Neurological Science and Medical Microbiology, and School of Tropical Medicine, University of Liverpool, UK
  1. Correspondence to Dr Rachel Kneen, Department of Neurology, Littlewood’s Neuroscience Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK; rachel.kneen{at}alderhey.nhs.uk

Abstract

Objective To investigate how infants and children with suspected viral encephalitis are currently managed in a UK tertiary children’s hospital.

Methods Case notes of all infants and children who received intravenous aciclovir for suspected encephalitis over a 6-month period were reviewed. Suspected viral encephalitis was defined as a child with fever or history of febrile illness and a reduced level of consciousness, irritability or a change in personality or behaviour or focal neurological signs.

Results Fifty one children were identified. Two had proven herpes simplex encephalitis (HSV) and two had clinically diagnosed viral encephalitis with no cause identified. Forty children had cerebrospinal fluid (CSF) analysis, but basic results were incomplete in 13 cases. CSF was sent for the detection of HSV DNA by PCR in 27 cases. The initial dose of aciclovir was incorrect in 38 cases. The median (range) length of intravenous aciclovir treatment was 4 (1–21) days. Six children were given a full course of aciclovir (10 or more days). For 14 children, there appeared to be no real indication for starting aciclovir. Case note documentation was generally inadequate.

Conclusions The management of children with suspected viral encephalitis appears haphazard in many cases. Guidelines for the management of children with suspected viral encephalitis are needed.

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Footnotes

  • Competing interests None.

  • Funding TS is an Medical Research Council senior fellow.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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