The Optimal Management of Acute Febrile Encephalopathy in the Aged Patient: A Systematic Review

Abstract

The elderly comprise less than 13 percent of world population. Nonetheless, they represent nearly half of all hospitalized adults. Acute change in mental status from baseline is commonly seen among the elderly even when the main process does not involve the central nervous system. The term “geriatric syndrome” is used to capture those clinical conditions in older people that do not fit into discrete disease categories, including delirium, falls, frailty, dizziness, syncope, and urinary incontinence. Despite the growing number of elderly population, especially those who require hospitalization and the high burden of common infections accompanied by encephalopathy among them, there are several unresolved questions regarding the optimal management they deserve. The questions posed in this systematic review concern the need to rule out CNS infection in all elderly patients presented with fever and altered mental status in the routine management of febrile encephalopathy. In doing so, we sought to identify all potentially relevant articles using searches of web-based databases with no language restriction. Finally, we reviewed 93 research articles that were relevant to each part of our study. No prospective study was found to address how should AFE in the aged be optimally managed.

The Etiological Spectrum of Febrile Encephalopathy in Adult Patients: A Cross-Sectional Study from a Developing Country

“…The etiological spectrum of febrile encephalopathy varied across different geographic regions, as well as on the basis of the age range of the participants and the study population [ 3 ]. Several studies have investigated the etiological spectrum of febrile encephalopathy and the appropriate threshold for urgent diagnostic evaluation to either verify or rule out CNS infection in the pediatric age group [ 18 , 19 ].…”

“…The list of differential diagnosis of the clinical syndrome of febrile encephalopathy is long and timely differentiation between these disorders is very important because correct diagnosis and treatment have a significant impact on morbidity and mortality. This diagnostic challenge is especially important in dealing with patients with multiple chronic medical conditions [ 3 ]. The first challenge facing the emergency clinician is to define what is meant by an altered mental status or confusion and to ascertain why it led to a visit to the emergency department (ED) [ 2 ].…”

“…The latter refers to a noninflammatory diffuse cerebral dysfunction, mostly triggered by a number of metabolic or toxic conditions [ 4 ]. It is important to note that when cerebral dysfunction is accompanied by fever or sepsis syndrome, the possibility of an infectious process, especially pertaining to a central nervous system (CNS) infection, as an etiologic cause for an alteration in the mental status should be considered [ 3 ]. Since these potentially treatable infectious processes might be associated with significant morbidity and mortality, timely diagnosis and treatment are of great importance for saving a patient's life [ 5 , 6 ].…”

“…The profile of febrile encephalopathy varies on the basis of different demographic and geographical characteristics of the study population [ 3 ]. It is important to determine the etiologic spectrum of febrile encephalopathy syndrome, with an emphasis on the CNS infection by focusing on epidemiology and age groups.…”

Infectious encephalitis in elderly patients: a prospective multicentre observational study in France 2016–2019

“…Our findings outline the difficulties to diagnose encephalitis in elderly patients, as i) cardinal signs, such as fever, are usually absent; ii) confusion or delirium in the elderlies may be triggered by many other mechanisms, including metabolic, neoplastic, vascular, septic, or toxic pathways. Central nervous system infections, including encephalitis, may be mistaken for many other diseases, and this is especially true in the elderlies, for whom the diagnosis of encephalitis is particularly challenging [33] [34]. Nevertheless, in our study, time from symptoms onset to aciclovir treatment start was similar across all age groups.…”