Infectious Encephalitis in France in 2007: A National Prospective Study

Mailles, Alexandra; Stahl, J.-P.

doi:10.1086/648419

Cited by 360 publications

(358 citation statements)

References 27 publications

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“…Even with broad testing for HSV (84% of patients), HSV encephalitis was diagnosed in only 5%, confirming recent reports that HSV encephalitis is less common in children than adults with encephalitis. 4,29,30 Despite early acyclovir therapy (not described), the outcomes after HSV encephalitis were poor, as described in recent pediatric cohorts. 30,31 Interestingly, 1 patient with HSV encephalitis relapsed with chorea and had NMDAR and D2R antibodies.…”

Section: Discussionmentioning

confidence: 96%

Infectious and Autoantibody-Associated Encephalitis: Clinical Features and Long-term Outcome

et al. 2015

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BACKGROUND AND OBJECTIVES: Pediatric encephalitis has a wide range of etiologies, clinical presentations, and outcomes. This study seeks to classify and characterize infectious, immunemediated/autoantibody-associated and unknown forms of encephalitis, including relative frequencies, clinical and radiologic phenotypes, and long-term outcome.METHODS: By using consensus definitions and a retrospective single-center cohort of 164 Australian children, we performed clinical and radiologic phenotyping blinded to etiology and outcomes, and we tested archived acute sera for autoantibodies to N-methyl-D-aspartate receptor, voltage-gated potassium channel complex, and other neuronal antigens. Through telephone interviews, we defined outcomes by using the Liverpool Outcome Score (for encephalitis).RESULTS: An infectious encephalitis occurred in 30%, infection-associated encephalopathy in 8%, immune-mediated/autoantibody-associated encephalitis in 34%, and unknown encephalitis in 28%. In descending order of frequency, the larger subgroups were acute disseminated encephalomyelitis (21%), enterovirus (12%), Mycoplasma pneumoniae (7%), N-methyl-D-aspartate receptor antibody (6%), herpes simplex virus (5%), and voltage-gated potassium channel complex antibody (4%). Movement disorders, psychiatric symptoms, agitation, speech dysfunction, cerebrospinal fluid oligoclonal bands, MRI limbic encephalitis, and clinical relapse were more common in patients with autoantibodies. An abnormal outcome occurred in 49% of patients after a median follow-up of 5.8 years. Herpes simplex virus and unknown forms had the worst outcomes. According to our multivariate analysis, an abnormal outcome was more common in patients with status epilepticus, magnetic resonance diffusion restriction, and ICU admission. CONCLUSIONS:We have defined clinical and radiologic phenotypes of infectious and immunemediated/autoantibody-associated encephalitis. In this resource-rich cohort, immune-mediated/ autoantibody-associated etiologies are common, and the recognition and treatment of these entities should be a clinical priority. WHAT'S KNOWN ON THIS SUBJECT:Encephalitis is a serious and disabling condition. There are infectious and immune-mediated causes of encephalitis, but many cases remain undiagnosed. WHAT THIS STUDY ADDS:This large single-center study on childhood encephalitis provides insight into the relative frequency and clinicoradiologic phenotypes of infectious, autoantibody-associated, and unknown encephalitis. Risk factors for an abnormal outcome are also defined. 4 and a prospective study of adults (n = 134) and children (n = 69) with encephalitis found that infectious encephalitis and immunemediated forms were identified in 42% and 21% of the cohort, respectively. 5 However, most of the previous larger studies of encephalitis in children were undertaken before the advent of neuronal autoantibody testing. [6][7][8] We studied clinical and radiologic features, serum autoantibodies in acute archived samples, and longterm outcomes in a large ret...

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Section: Discussionmentioning

confidence: 96%

Infectious and Autoantibody-Associated Encephalitis: Clinical Features and Long-term Outcome

et al. 2015

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“…While HSV-2 is also capable of causing encephalitis (particularly in the immunocompromised host), HSV-1 is responsible for~90 % of HSV encephalitis in adults and children, and is the focus of this review [41]. Despite only rarely manifesting as encephalitis in infected individuals, HSV-1 is consistently the single most common cause of sporadic encephalitis worldwide [42][43][44][45][46][47][48][49][50][51][52]. The incidence of HSVE worldwide is estimated to be between 2 and 4 cases/1,000,000 [44], and the incidence in the USA is similar [53].…”

Section: Epidemiologymentioning

confidence: 99%

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

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Herpetic infections have plagued humanity for thousands of years, but only recently have advances in antiviral medications and supportive treatments equipped physicians to combat the most severe manifestations of disease. Prompt recognition and treatment can be lifesaving in the care of patients with herpes simplex-1 virus encephalitis, the most commonly identified cause of sporadic encephalitis worldwide. Clinicians should be able to recognize the clinical signs and symptoms of the infection and familiarize themselves with a rational diagnostic approach and therapeutic modalities, as early recognition and treatment are key to improving outcomes. Clinicians should also be vigilant for the development of acute complications, including cerebral edema and status epilepticus, as well as chronic complications, including the development of autoimmune encephalitis associated with antibodies to the N-methyl-D-aspartate receptor and other neuronal cell surface and synaptic epitopes. Herein, we review the pathophysiology, differential diagnosis, and clinical and radiological features of herpes simplex virus-1 encephalitis in adults, including a discussion of the most common complications and their treatment. While great progress has been made in the treatment of this life-threatening infection, a majority of patients will not return to their previous neurologic baseline, indicating the need for further research efforts aimed at improving the long-term sequelae.

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“…Further definition of HPeV CNS syndromes are needed because although many infants have benign outcome after CNS infection, 4,8,13,16 there have been isolated reports of adverse neurodevelopmental outcomes with HPeV3 in the context of abnormal neuroimaging. 3,26,27 Encephalitis is the most severe manifestation of HPeV CNS infection and rigorous case definitions for encephalitis have been published in the past 10 years in studies from California, 28 the United Kingdom, 29 and France, 30 as well as consensus definitions from the Brighton Collaboration 31 and the International Encephalitis Consortium. 32 The Australian Childhood Encephalitis (ACE) study is an ongoing prospective study of childhood encephalitis that uses these case definitions.…”

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confidence: 99%

Parechovirus Encephalitis and Neurodevelopmental Outcomes

et al. 2016

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Infectious Encephalitis in France in 2007: A National Prospective Study

Abstract: Our prospective study provides an overview of the clinical and etiologic patterns of acute infectious encephalitis in adults in France. Herpes simplex virus 1 remains the main cause of encephalitis, but bacteria accounts for the highest case-fatality rates.

Cited by 360 publications

References 27 publications

Infectious and Autoantibody-Associated Encephalitis: Clinical Features and Long-term Outcome

Infectious and Autoantibody-Associated Encephalitis: Clinical Features and Long-term Outcome

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Parechovirus Encephalitis and Neurodevelopmental Outcomes

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