Managing acute central nervous system infections in the UK adult intensive care unit in the wake of UK encephalitis guidelines

Abstract

The acute central nervous system infections meningitis and encephalitis commonly require management on intensive care units. The clinical features often overlap and in the acute phase-altered consciousness and seizures may also need to be managed. In April 2012, the first UK national guideline for the management of suspected viral encephalitis was published by the British Infection Association and Association of British Neurologists, and other key stakeholders, and included a simple management algorithm. The new guideline results from evidence demonstrating a number of common oversights in the standard management of suspected viral encephalitis in many settings. In combination with British Infection Association meningitis guidelines, evidence-based approaches now exist to facilitate the non-expert managing patients with suspected central nervous system infections. Here we bring together these guidelines and the supporting evidence applicable for intensivists into a single resource.

Update in Viral Infections in the Intensive Care Unit

“…Similarly, treatment of choice for severe VZV CNS infection is intravenous aciclovir for 14–21 days, but in higher doses than those administered in HSV encephalitis [i.e., up to 15 mg/kg three times a day; ( 238 )]. Of note, aciclovir can cause crystal nephropathy and acute renal failure in 12–49% of patients, with those in ICU being at greater risk ( 239 ). Treatment of CMV encephalitis consists of dual therapy with foscarnet and ganciclovir, as no survival benefit has been observed with either agent alone; duration of treatment is 3 weeks for immunocompetent patients and 6 weeks for those with immunodeficiency ( 240 ).…”

Characteristics and biomarkers of patients with central nervous system infection admitted to a referral hospital in Northern Vietnam

“…CNS infections have some classical features, including headache, altered mental status, loss of consciousness, and neck stiffness in the background of fever or recent febrile illness [ 22 ]. In our study, we found that 84.7% patients with CNS infection had headache, 37.9% had a history of loss of consciousness, 38.4% had neck stiffness, and 38.8% had fever (>38C).…”

Case Report: A Candida Meningitis in an Immunocompetent Patient Detected Through the Next-Generation Sequencing

“…According to the results of the current research (7), a high index of suspicion is needed in any patient with risk factors such as abdominal surgery, bowel perforation, recent broadspectrum antibiotic therapy, intravenous drug use, advanced in years, indwelling catheters, low immune function, severe burns, antineoplastic therapy, and long-term glucocorticoid usage (12, 13). The development of fungal infections largely depend on the interplay between the health status of the patients and the virulence of pathogenic fungal species.…”

“…Even if the etiological culture is positive, it will take 3-5 days at the fastest. With respect to the timing of initiation of empirical treatment, some studies are still controversial, with some showing that mortality was lower in the patients who received the antifungal early (7,17), while other studies showed that there was no significant difference in in-hospital mortality (18,19).…”

“…According to the Infectious Diseases Society of America (IDSA) guidelines (recommendations 28, 32, 33, and 94) (3), the change of the clinical symptoms is the most important basis for the clinicians without basis. Furthermore, the empirical treatment of adults with encephalitis is with drugs within 6 h of suspicion (7), and delay in the diagnosis and inappropriate therapy would result in permanent damage, even also death. It was an unacceptable outcome.…”