PO013 Management of suspected herpes simplex virus encephalitis in a district general hospital – putting guidelines into practice?

There are clear national guidelines on the management of suspected herpes simplex virus (HSV) encephalitis, 1 but adherence has been suboptimal. 2 We reviewed case notes of 22 adults who received acyclovir for suspected HSV encephalitis over a one-year period. 18 (82%) patients had a lumbar puncture (LP), which was delayed (u003e6 hours after clinical suspicion) in 12 (67%) of them. Median (range) time from when encephalitis was suspected to performing LP was 22 (1–168) hours. 21 (95%) patients had a CT scan prior to an LP; only 1 had contraindication to an immediate LP. 16 (73%) patients were started on acyclovir within 6 hours from when encephalitis was suspected. In other patients, acyclovir was delayed by between 12 to 72 hours. HSV-PCR (polymerase chain reaction) was sent in all cerebrospinal fluid samples and was positive in one. In this patient, HSV encephalitis was suspected late and her LP was delayed due to brain oedema. One patient had positive PCR for varicella zoster virus but there was no delay in LP or acyclovir. There is need for better awareness and implementation of guidelines. Improved LP training could expedite it being performed in a timely fashion. References 840 Solomon, T. 2012. 841 Backman, Ruth. 2015.