BACKGROUND: Prompt recognition and rapid initiation of adequate treatment are important for the outcome of encephalitis. Despite extensive diagnostic testing, the causative agent often remains unknown. The aim of this study was to investigate in how many patients the causative agent was found. METHODS: Adults (≥ 18 y) diagnosed with ICD codes indicating encephalitis between 2000 and 2009 at Oslo University Hospital, Ullevål were retrospectively studied. Causative agents, clinical presentation, and demographic characteristics were registered. Those with an identified causative agent were compared to those for whom no agent could be found. RESULTS: Of 136 registered patients, 70 were included in the study. Sixty-six did not fulfil our inclusion criteria or were diagnosed with other, more probable conditions. The causative agent was found in 30/70 (43%) patients; herpes simplex type 1 (10/70, 14%) and varicella zoster virus (6/70, 9%) were the most frequently identified agents. A bacterial cause was found in 6/70 (9%). Patients with an identified agent were more often men and had been ill longer than those for whom no agent could be found. Computed tomography and magnetic resonance imaging were more likely to be abnormal in those patients where a causative agent was found. Five of the 70 (7%) patients died of the infection. The identification rate did not increase during the study period. CONCLUSIONS: The diagnosis of encephalitis remains a challenge, and in many patients no causative agent is found. Clinically, immune-mediated encephalitis cannot be differentiated from infectious encephalitis and represents an important differential diagnosis. More knowledge is needed to improve our diagnostic skills.
BACKGROUND: Prompt recognition and rapid initiation of adequate treatment are important for the outcome of encephalitis. Despite extensive diagnostic testing, the causative agent often remains unknown. The aim of this study was to investigate in how many patients the causative agent was found. METHODS: Adults (≥ 18 y) diagnosed with ICD codes indicating encephalitis between 2000 and 2009 at Oslo University Hospital, Ullevål were retrospectively studied. Causative agents, clinical presentation, and demographic characteristics were registered. Those with an identified causative agent were compared to those for whom no agent could be found. RESULTS: Of 136 registered patients, 70 were included in the study. Sixty-six did not fulfil our inclusion criteria or were diagnosed with other, more probable conditions. The causative agent was found in 30/70 (43%) patients; herpes simplex type 1 (10/70, 14%) and varicella zoster virus (6/70, 9%) were the most frequently identified agents. A bacterial cause was found in 6/70 (9%). Patients with an identified agent were more often men and had been ill longer than those for whom no agent could be found. Computed tomography and magnetic resonance imaging were more likely to be abnormal in those patients where a causative agent was found. Five of the 70 (7%) patients died of the infection. The identification rate did not increase during the study period. CONCLUSIONS: The diagnosis of encephalitis remains a challenge, and in many patients no causative agent is found. Clinically, immune-mediated encephalitis cannot be differentiated from infectious encephalitis and represents an important differential diagnosis. More knowledge is needed to improve our diagnostic skills.
Authors: Samantha J Dando; Alan Mackay-Sim; Robert Norton; Bart J Currie; James A St John; Jenny A K Ekberg; Michael Batzloff; Glen C Ulett; Ifor R Beacham Journal: Clin Microbiol Rev Date: 2014-10 Impact factor: 26.132
Authors: Jason M Mehal; Robert C Holman; Neil M Vora; Jesse Blanton; Paul H Gordon; James E Cheek Journal: Am J Trop Med Hyg Date: 2014-02-10 Impact factor: 2.345
Authors: Arthur H P Mawuntu; Janno B B Bernadus; Rama Dhenni; Ageng Wiyatno; Riane Anggreani; Frilasita A Yudhaputri; Ungke Anton Jaya; Chairin Nisa Ma'roef; Aghnianditya K Dewantari; Araniy Fadhilah; Jeremy P Ledermann; Ann M Powers; Dodi Safari; Khin Saw Aye Myint Journal: PLoS One Date: 2018-11-16 Impact factor: 3.240
Authors: Sara Ghaderi; Ketil Størdal; Nina Gunnes; Inger J Bakken; Per Magnus; Siri E Håberg Journal: Int J Epidemiol Date: 2017-10-01 Impact factor: 7.196