Critical care management of meningitis and encephalitis: an update

Abstract

Purpose of reviewMeningitis and encephalitis represent severe neurological syndromes associated with encephalopathy, seizures, focal deficits, and neurological sequelae in survivors. We update on the critical care management of adult patients with severe meningitis and encephalitis.Recent findingsLarge multicenter studies conducted in the adult population improved current knowledge on the epidemiology and outcomes of patients with severe meningitis and encephalitis. An early multimodal diagnostic workup (including CSF analysis, brain MRI, EEG, and serum studies) is mandatory for diagnosis and prognostication in those patients.New diagnostic methods, including multiplex PCR and next-generation sequencing techniques, allow for a faster differential diagnosis of infectious causes that may require specific antimicrobial therapy. Autoimmune causes of encephalitis, which may require urgent immunotherapy, are also increasingly recognized in the ICU setting. Although observational data suggest that early combined immunotherapy is associated with better neurological outcomes in patients with autoimmune encephalitis, randomized clinical trials have yet to be performed.SummaryOur review highlights the importance of an early multimodal approach for diagnosing severe meningitis and encephalitis. Randomized clinical trials are needed to identify pharmacological interventions that may improve patients’ outcomes.

Basophils absence predicts poor prognosis and indicates immunosuppression of patients in intensive care units

“…Recently, increasing evidence suggested that immunotherapy might be an attractive strategy for the treatment in ICU 4 , 5 . Both innate and adaptive immunity are dysregulated during the progression of critical illness 6 , 7 .…”

Editorial: The neurologist's guide to the ICU galaxy

“…Thus, coma remains one of the most frequent reasons for admission to intensive care. Status epilepticus [1,2] and autoimmune encephalitis [3] are undoubtedly the neuro-critical care pathologies which have attracted the most interest in recent years.…”