These results confirm that BIA is useful to identify poor prognostic factors at the time of diagnosis and during follow-up and thus could be used to monitor patients during follow-up. Early identification of poor prognostic factors enables nutritional management and might improve patient survival.

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.

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Purpose. Data on encephalitis in the elderly remain scarce. We aimed to describe the characteristics, aetiologies, management, and outcome of encephalitis in patients older than 65 years. Methods.We performed an ancillary study of ENCEIF, a prospective cohort that enrolled all cases of encephalitis managed in 46 clinical sites in France during years 2016-2019. Cases were categorized in 3 age groups: i) 18-64; ii) 65-79; iii) ≥80 years.Results. Of the 494 adults with encephalitis enrolled, 258 (52%) were ≥65 years, including 74 (15%) ≥80 years. Patients ≥65 years were more likely to present with coma, impaired consciousness, confusion, aphasia, and rash, but less likely to present with fever, and headache (P<0.05 for each). Median cerebrospinal fluid (CSF) white cells count was 61/mm 3 [13-220] in 65-79 years, 62 [17-180] in ≥80 years, vs. 114 [34-302] in <65 years (P=0.01). The proportion of cases due to Listeria monocytogenes and VZV increased after 65 years (P<0.001), while the proportion of tick-borne encephalitis and Mycobacterium tuberculosis decreased with age (P<0.05 for each).In-hospital mortality was 6/234 (3%) in <65 years, 18/183 (10%) in 65-79 years, and 13/73 (18%) in ≥80 years (P<0.001). Age ≥80 years, coma on admission, CSF protein ≥0.8 g/L and viral encephalitis were independently predictive of 6-month mortality. Conclusion.The elderlies represent >50% of adult patients with encephalitis in France, with higher proportion of L. monocytogenes and VZV encephalitis, increased risk of death, and sequels. The empirical treatment currently recommended, aciclovir and amoxicillin, is appropriate for this age group.