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Review
. 2017 May;47(3):236-251.
doi: 10.1016/j.medmal.2017.02.004. Epub 2017 Mar 15.

Infectious Encephalitis: Management Without Etiological Diagnosis 48hours After Onset

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Free PMC article
Review

Infectious Encephalitis: Management Without Etiological Diagnosis 48hours After Onset

P Fillatre et al. Med Mal Infect. .
Free PMC article

Abstract

Introduction: The etiological diagnosis of infectious encephalitis is often not established 48hours after onset. We aimed to review existing literature data before providing management guidelines.

Method: We performed a literature search on PubMed using filters such as "since 01/01/2000", "human", "adults", "English or French", and "clinical trial/review/guidelines". We also used the Mesh search terms "encephalitis/therapy" and "encephalitis/diagnosis".

Results: With Mesh search terms "encephalitis/therapy" and "encephalitis/diagnosis", we retrieved 223 and 258 articles, respectively. With search terms "encephalitis and corticosteroid", we identified 38 articles, and with "encephalitis and doxycycline" without the above-mentioned filters we identified 85 articles. A total of 210 articles were included in the analysis.

Discussion: Etiological investigations must focus on recent travels, animal exposures, age, immunodeficiency, neurological damage characteristics, and potential extra-neurological signs. The interest of a diagnosis of encephalitis for which there is no specific treatment is also to discontinue any empirical treatments initially prescribed. Physicians must consider and search for autoimmune encephalitis.

Introduction: L’absence de diagnostic étiologique après 48 heures de prise en charge d’une encéphalite infectieuse est fréquente. Nous avons voulu faire le point de la littérature existante avant de donner des recommandations de prise en charge.

Méthode: Dans PubMed, nous avons utilisé les filtres « since 01/01/2000 », « human », « adults », « English or French » et « clinical trial/review/guidelines », ainsi que les mots clés Mesh « encephalitis/therapy » et « encephalitis/diagnosis ».

Résultats: Les mots clés Mesh « encephalitis/therapy » et « encephalitis/diagnosis » aboutissent respectivement à 223 et 258 articles. Les mots clés « encephalitis and corticosteroid » aboutissent à 38 articles et « encephalitis and doxycycline » sans les filtres sus-cités à 85 articles. Au total, 210 articles ont été retenus.

Discussion: Les recherches étiologiques doivent être guidées par les notions de voyages, d’expositions animales, l’âge ou l’immunodépression, ainsi que par les caractéristiques de l’atteinte neurologique et les éventuels signes extra-neurologiques. L’intérêt du diagnostic des encéphalites qui ne disposent pas de traitement spécifique est également d’arrêter les traitements probabilistes initialement mis en route. Les encéphalites auto-immunes doivent être recherchées.

Keywords: Encéphalite infectieuse; HSV; Infectious encephalitis; Listeria; Tuberculose; Tuberculosis; VZV.

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