Encephalitis

Beckham, J. David; Tyler, Kenneth L.

doi:10.1016/b978-1-4557-4801-3.00091-6

Cited by 10 publications

(4 citation statements)

References 227 publications

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“…Glucose is decreased in bacterial (including mycobacterial) and fungal infections and generally normal in viral infections, but it may be decreased in mumps, HSV-2, CMV, and Eastern equine encephalitis infection, as well as in noninfectious causes of meningitis such as leptomeningeal metastases and sarcoidosis. 33 A neutrophilic predominance is generally seen in bacterial infections, whereas a lymphocytic predominance is seen in viral, fungal, and mycobacterial infections. However, a neutrophilic predominance may be seen early in the course of viral infections and throughout the course of West Nile virus encephalitis.…”

Section: Csf Analysismentioning

confidence: 99%

“…CSF in neurologic infections generally shows elevations in white blood cells and protein. Glucose is decreased in bacterial (including mycobacterial) and fungal infections and generally normal in viral infections, but it may be decreased in mumps, HSV-2, CMV, and Eastern equine encephalitis infection, as well as in noninfectious causes of meningitis such as leptomeningeal metastases and sarcoidosis 33 . A neutrophilic predominance is generally seen in bacterial infections, whereas a lymphocytic predominance is seen in viral, fungal, and mycobacterial infections.…”

Section: Diagnostic Testingmentioning

confidence: 99%

“…A neutrophilic predominance is generally seen in bacterial infections, whereas a lymphocytic predominance is seen in viral, fungal, and mycobacterial infections. However, a neutrophilic predominance may be seen early in the course of viral infections and throughout the course of West Nile virus encephalitis 33 . CSF eosinophilia is classically associated with parasitic infections but may also be seen in fungal infections (eg, most commonly coccidioidomycosis), lymphoproliferative diseases, idiopathic hypereosinophilic syndrome, and drug-induced meningitis 34 …”

Section: Diagnostic Testingmentioning

confidence: 99%

“…However, a neutrophilic predominance may be seen early in the course of viral infections and throughout the course of West Nile virus encephalitis. 33 CSF eosinophilia is classically associated with parasitic infections but may also be seen in fungal infections (eg, most commonly coccidioidomycosis), lymphoproliferative diseases, idiopathic hypereosinophilic syndrome, and drug-induced meningitis. 34 The degree of white blood cell and protein increases and glucose decrease is generally more dramatic in bacterial meningitis: a CSF white blood cell count greater than 500 cells/mm 3 is associated with a likelihood ratio of 15 for bacterial meningitis, whereas a CSF white blood cell count less than 500 cells/mm 3 is associated with a likelihood ratio of 0.3; a CSF to blood glucose ratio of less than 0.4 is associated with a likelihood ratio of 18 for bacterial meningitis, whereas a CSF to blood glucose ratio greater than 0.4 has a likelihood ratio of 0.31.…”

Section: Csf Analysismentioning

confidence: 99%

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Approach to Neurologic Infections

Berkowitz¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEWThis article provides an overview of the clinical approach to the diagnosis of neurologic infections, focusing on the symptoms, signs, imaging features, and laboratory findings of the major categories of neuroinfectious diseases.RECENT FINDINGSThe increased use of immunosuppressive and immunomodulatory therapy to treat autoimmune diseases has led to an increase in opportunistic neurologic infections. The description of numerous causes of autoimmune antibody–mediated encephalitis over the past decade has expanded the differential diagnosis of encephalitis beyond infection. The emergence of metagenomic next-generation sequencing has led to diagnoses of rare or unexpected causes of neurologic infections and has the potential to enhance diagnostic precision in neuroinfectious diseases.SUMMARYInfections of the nervous system can affect any level of the neuraxis and present over any time course. Neurologic infections may present atypically with respect to clinical, radiologic, and CSF analysis features in immunocompromised patients or older adults. A thorough evaluation including systemic features, past medical history, travel, exposures, detailed examination, neuroimaging, and CSF analysis is often necessary to make a definitive diagnosis. It is important to be aware of the test characteristics and limitations of microbiological tests on CSF for neurologic infections to avoid being misled by false positives or false negatives.

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Section: Csf Analysismentioning

confidence: 99%

Section: Diagnostic Testingmentioning

confidence: 99%

Section: Diagnostic Testingmentioning

confidence: 99%

Section: Csf Analysismentioning

confidence: 99%

See 2 more Smart Citations

Approach to Neurologic Infections

Berkowitz¹

2021

CONTINUUM: Lifelong Learning in Neurology

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The burden and epidemiology of community-acquired central nervous system infections: a multinational study

Erdem

İnan

Guven

et al. 2017

Eur J Clin Microbiol Infect Dis

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Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.

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