Abstract
In this study we attempt to assess the utility of a simplified step-wise diagnostic algorithm to determinate the aetiology of encephalitis in daily clinical practice and to describe the main causes in our setting. This was a prospective cohort study of all consecutive cases of encephalitis in adult patients diagnosed between January 2010 and March 2015 at the University Hospital Vall d’Hebron in Barcelona, Spain. The aetiological study was carried out following the proposed step-wise algorithm. The proportion of aetiological diagnoses achieved in each step was analysed. Data from 97 patients with encephalitis were assessed. Following a simplified step-wise algorithm, a definite diagnosis was made in the first step in 53 patients (55 %) and in 12 additional cases (12 %) in the second step. Overall, a definite or probable aetiological diagnosis was achieved in 78 % of the cases. Herpes virus, L. monocytogenes and M. tuberculosis were the leading causative agents demonstrated, whereas less frequent aetiologies were observed, mainly in immunosuppressed patients. The overall related mortality was 13.4 %. According to our experience, the leading and treatable causes of encephalitis can be identified in a first diagnostic step with limited microbiological studies. L. monocytogenes treatment should be considered on arrival in some patients. Additional diagnostic effort should be made in immunosuppressed patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Glaser CA, Honarmand S, Anderson LJ et al (2006) Beyond viruses: clinical profiles and etiologies associated with encephalitis. Clin Infect Dis 43:1565–1577
Solomon T, Michael BD, Smith PE et al (2012) Management of suspected viral encephalitis in adults—Association of British Neurologists and British Infection Association National Guidelines. J Infect 64:347–373
Steiner I, Budka H, Chaudhuri A et al (2010) Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 17:999–1009
Tunkel AR, Glaser CA, Bloch KC et al (2008) The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 47:303–327
Poissy J, Wolff M, Dewilde A et al (2009) Factors associated with delay to acyclovir administration in 184 patients with herpes simplex virus encephalitis. Clin Microbiol Infect 15:560–564
Riera-Mestre A, Gubieras L, Martínez-Yelamos S, Cabellos C, Fernández-Viladrich P (2009) Adult herpes simplex encephalitis: fifteen years’ experience. Enferm Infecc Microbiol Clin 27:143–147
Davies NWS, Brown LJ, Gonde J et al (2005) Factors influencing PCR detection of viruses in cerebrospinal fluid of patients with suspected CNS infections. J Neurol Neurosurg Psychiatry 76:82–87
Venkatesan A, Tunkel AR, Bloch KC et al (2013) Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis 57:1114–1128
Granerod J, Ambrose HE, Davies NWS et al (2010) Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis 10:835–844
Mailles A, Stahl J-P (2009) Infectious encephalitis in France in 2007: a national prospective study. Clin Infect Dis 49:1838–1847
Ambrose HE, Granerod J, Clewley JP et al (2011) Diagnostic strategy used to establish etiologies of encephalitis in a prospective cohort of patients in England. J Clin Microbiol 49:3576–3583
Schmidt A, Bühler R, Mühlemann K, Hess CW, Täuber MG (2011) Long-term outcome of acute encephalitis of unknown aetiology in adults. Clin Microbiol Infect 17:621–626
Singh TD, Fugate JE, Rabinstein AA (2015) The spectrum of acute encephalitis: causes, management, and predictors of outcome. Neurology 84:359–366
Fredericks P, Britz M, Eastman R, Carr JA, Bateman KJ (2015) Listerial brainstem encephalitis—treatable, but easily missed. S Afr Med J 105:17–20
Jubelt B, Mihai C, Li TM, Veerapaneni P (2011) Rhombencephalitis/brainstem encephalitis. Curr Neurol Neurosci Rep 11:543–552
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
This study received no funding. It was approved by the Ethics Committee of Vall d’Hebron Research Institute. All patients included, or their relatives, gave written informed consent to use the information available in the database and medical records.
Conflicts of interest
The authors have no conflicts of interest to declare.
Rights and permissions
About this article
Cite this article
López-Sánchez, C., Sulleiro, E., Bocanegra, C. et al. Infectious encephalitis: utility of a rational approach to aetiological diagnosis in daily clinical practice. Eur J Clin Microbiol Infect Dis 36, 641–648 (2017). https://doi.org/10.1007/s10096-016-2840-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-016-2840-4