Guidelines on the management of infectious encephalitis in adults

Stahl, J.-P.; Azouvi, Philippe; Bruneel, Fabrice; Broucker, T. de; Duval, Xavier; Fantin, Bárbara Souza; Girard, Nancy J.; Herrmann, Jean-Louis; Honnorat, Jérôme; Lecuit, Marc; Mailles, Alexandra; Martinez-Almoyna, L.; Morand, Patrice; Piroth, Lionel; Tattevin, Pierre

doi:10.1016/j.medmal.2017.01.005

Cited by 93 publications

(66 citation statements)

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“…11 The introduction of management guidelines for cases of acute encephalitis syndrome over the last decade has aimed to improve outcomes. 8,[13][14][15][16][17][18][19] Notably, there are many differences between guidelines in the approach to diagnostic evaluation, such as standard and extended diagnostic testing, or whether to administer empirical Aciclovir. 20 These variations may reflect geographically contrasting aetiologies, timing of publication and the rapid acceleration of technologies, as well as available resources.…”

Section: Introduction Deficits In the Current Management Of Encephalitismentioning

confidence: 99%

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Encephalitis diagnosis using metagenomics: application of next generation sequencing for undiagnosed cases

Brown¹,

Bharucha²,

Breuer³

2018

Journal of Infection

213

179

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There is increasing evidence of a role for NGS in the work-up of undiagnosed encephalitis. Lower costs and increasing accessibility of these technologies will facilitate larger studies of these patients. We recommend NGS should be considered as a front-line diagnostic test in chronic and recurring presentations and, given current sample-to-result turn-around times, as second-line in acute cases of encephalitis.

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Section: Introduction Deficits In the Current Management Of Encephalitismentioning

confidence: 99%

“…It is only the newest French guidelines in which NGS is mentioned at all, and the authors reasonably state that the clinical role is still to be evaluated. 19…”

Section: Introduction Deficits In the Current Management Of Encephalitismentioning

confidence: 99%

Encephalitis diagnosis using metagenomics: application of next generation sequencing for undiagnosed cases

Brown¹,

Bharucha²,

Breuer³

2018

Journal of Infection

213

179

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“…6 If the patient is completely well, some would suggest that repeat LP is not necessary. 23 The management of autoimmune encephalitis with immune therapy is non-standardised and based on evidence from retrospective studies. 24 For initial therapy, most neurologists use corticosteroids intravenously or orally.…”

Section: Key Aspects Of Managementmentioning

confidence: 99%

Acute encephalitis – diagnosis and management

2018

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“…Considering the selection and publication bias of the literature reviewed here, the negative predictive value for the aetiologic identification of viral encephalitis, meningoencephalitis, and meningitis is difficult to quantify and further studies are needed. HTS needs to be integrated in clinical management as a second-line technique or in parallel to first-line investigations when a standard work-up according to guidelines [8,58] and additional investigations considering local epidemiology and specific clinical situations fail to identify a causal agent. Brain biopsy should also be considered.…”

Section: Perspectives For Hts Implementation In the Management Of Encmentioning

confidence: 99%

“…High-throughput sequencing (HTS) has brought new perspectives to CNS infection investigations. Although HTS has been recently integrated in encephalitis management guidelines [8], its use is still limited to specific clinical situations or research. The contribution of HTS warrants a better appraisal for further implementation in CNS infection management.…”

Section: Introductionmentioning

confidence: 99%

High-throughput sequencing for the aetiologic identification of viral encephalitis, meningoencephalitis, and meningitis. A narrative review and clinical appraisal

Zanella

Lenggenhager

Schrenzel

et al. 2019

Clinical Microbiology and Infection

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a b s t r a c tBackground: Viral aetiologies are the most common cause of central nervous system (CNS) infections. Approximately one-half of CNS infections remain of undetermined origin. High-throughput sequencing (HTS) brought new perspectives to CNS infection investigations, allowing investigation of viral aetiologies with an unbiased approach. HTS use is still limited to specific clinical situations. Objectives: The aim of this review was to evaluate the contribution and pitfalls of HTS for the aetiologic identification of viral encephalitis, meningoencephalitis, and meningitis in CNS patient samples. Sources: PubMed was searched from 1 January 2008 to 2 August 2018 to retrieve available studies on the topic. Additional publications were included from a review of full-text sources. Content: Among 366 studies retrieved, 29 used HTS as a diagnostic technique. HTS was performed in cerebrospinal fluid and brain biopsy samples of 307 patients, including immunocompromised, immunocompetent paediatric, and adult cases. HTS was performed retrospectively in 18 studies and prospectively in 11. HTS led to the identification of a potential causal virus in 41 patients, with 11 viruses known and ten not expected to cause CNS infections. Various HTS protocols were used. Implications: The additional value of HTS is difficult to quantify because of various biases. Nevertheless, HTS led to the identification of a viral cause in 13% of encephalitis, meningoencephalitis, and meningitis cases in which various assays failed to identify the cause. HTS should be considered early in clinical management as a complement to routine assays. Standardized strategies and systematic studies are needed for the integration of HTS in clinical management. M.-C. Zanella, Clin Microbiol Infect 2019;25:422

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Guidelines on the management of infectious encephalitis in adults

Cited by 93 publications

References 0 publications

Encephalitis diagnosis using metagenomics: application of next generation sequencing for undiagnosed cases

Encephalitis diagnosis using metagenomics: application of next generation sequencing for undiagnosed cases

Acute encephalitis – diagnosis and management

High-throughput sequencing for the aetiologic identification of viral encephalitis, meningoencephalitis, and meningitis. A narrative review and clinical appraisal

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