A Prospective Cohort Study to Identify Clinical, Biological, and Imaging Features That Predict the Etiology of Acute Encephalitis

Abstract

Background New diagnostic tools have been developed to improve the diagnosis of infectious encephalitis. Using a prospective cohort of encephalitis patients, our objective was to identify possible clusters of patients with similar patterns among encephalitis of unknown cause, and to describe to what extent the patient’s initial presentation may be predictive of encephalitis etiology, particularly Herpes simplex virus (HSV) and Varicella-zona virus (VZV). Methods The national cohort of infectious encephalitis in France (ENCEIF) is an ongoing prospective cohort study implemented in France in 2016. Patients presenting with a documented or suspected acute infectious encephalitis were included. Focusing on the variables describing the initial presentation, we performed a factor analysis of mixed data (FAMD) to investigate a pattern of association between the initial presentation of the patient and the etiologic pathogen. Results As of 1st August 2018, data from 349 patients were analysed. The most frequent pathogens were HSV (25%), VZV (11%), Tick-borne encephalitis virus (6%), Listeria (5%), Influenza virus (3%), and encephalitis of unknown cause (EUC) (34%). Using the FAMD, it was not possible to identify a specific pattern related to the group of EUC. Age, temporal or haemorrhagic lesions, and cerebral spinal fluid lymphocytosis were significantly associated with HSV/VZV encephalitis. Conclusion No initial clinical/imaging/biology pattern was identified at admission among EUC, despite the improvement of diagnostic tools. In this context, the recommendation for a universal, early probabilistic initial treatment against HSV and VZV is still relevant, regardless of the initial clinical presentation of the encephalitis.

Neurologic outcome of VZV encephalitis one year after ICU admission: a multicenter cohort study

“…Varicella-zoster virus (VZV) is one of the eight herpes viruses known to cause human infections and is the second cause of acute encephalitis in France after herpes simplex virus (HSV) 1 and 2 [2,3,9]. Its incidence has grown over the last decade [10].…”

Critical care management of meningitis and encephalitis: an update

“…within 4 days) after symptom-onset [1 ▪ ]. The French multicenter ENCEIF cohort on 349 patients with encephalitis found that no initial clinical/imaging/biology pattern at admission was predictive of encephalitis cause [9]. Another analysis of 494 cases of encephalitis from the same cohort revealed that a causative agent was identified in 65.7% of cases, with viruses representing 81.8% of causative agents, especially Herpesviridae (63.6%) [10 ▪ ].…”

Existing Data Sources for Clinical Epidemiology: The Danish Study Group of Infections of the Brain Database (DASGIB)

“…A few studies have investigated hospitalized adults suspected of CNS infections, 7,41 whereas other databases have focused on children or adults with encephalitis. 8,9,42…”

“…The clinical presentation and prognosis of CNS infections has been examined in several high-quality cohort studies and databases, which have provided us with valuable knowledge. [3][4][5][6][7][8][9][10][11][12][13][14][15] However, the majority of studies in CNS infections are still limited by retrospective design and small sample sizes, or they may have relied on administrative registries and microbiological databases without access to detailed clinical data. [14][15][16][17][18] Hence, the Danish Study Group of Infections of the Brain (DASGIB) was established in 2014 and a prospective recording of all adults admitted with CNS infections at departments of infectious diseases in Denmark was initiated as of January 1, 2015.…”