Presentation of XXXX : implications for a change in therapeutic strategy.

@entity75 @entity1 @entity12949 @entity1576
To identify clinical signs of disease that might lead to more rapid recognition in treatment, we reviewed the time from onset of illness to diagnosis of 42 consecutive cases of @entity12949 seen between 1965 and 1984. The first signs of illness included @entity75 in 14, central nervous system signs in 20, fever in 6 and @entity1576 in 2 @entity1 . The median time from onset of illness to presentation to medical personnel was 1 day. The median time from presentation to medical personnel to obtaining viral cultures was 3 days (range, 1 to 11) and was similar in @entity1 who did and did not have @entity75 . Viral cultures were performed within 24 hours of admission on 8 of 13 noncongenitally infected @entity1 born between 1982 and 1984 compared to 5 of 24 seen between 1965 and 1981 (P less than 0.03). However, a greater than 72-hour delay between presentation to medical personnel and obtaining viral diagnostic studies occurred in 33, 40 and 14% of @entity1 born in the years 1965 to 1977, 1978 to 1981 and 1982 to 1984. Involvement of additional organ systems by HSV was noted in 57% of @entity1 between the time from presentation to medical personnel and diagnosis. @entity12949 was often severe by the time @entity1 presented to medical personnel, and the disease usually progressed rapidly. To achieve a better therapeutic outcome for @entity1 with @entity12949 , consideration should be given to the initiation of antiviral therapy on presumptive clinical and epidemiologic grounds. Future strategies for therapy of @entity12949 should be directed at preventing the acquisition of disease.
