The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America

Tunkel, Allan R.; Glaser, Carol; Bloch, Karen C.; Sejvar, James J.; Marra, Christina M.; Roos, Karen L.; Hartman, Barry J.; Kaplan, Sheldon L.; Scheld, W. Michael; Whitley, Richard J.

doi:10.1086/589747

Cited by 937 publications

(787 citation statements)

References 113 publications

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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%

“…PCR for HSV-1 and HSV-2, which has supplanted viral cultures and other studies as the test of choice, should be obtained from the CSF and has high sensitivity (96 %) and specificity (99 %) [67,68]. False-negative PCR can occur early in the illness [98][99][100], and if the clinical suspicion is high, aciclovir should be continued empirically and repeat CSF HSV PCR obtained within 3-7 days [43].…”

Section: Laboratory Studiesmentioning

confidence: 99%

“…HSV-1 PCR may yield a false-negative, particularly early in the course of the HSVE and among children [98][99][100]. When suspicion is high, patients should be treated empirically, despite a negative PCR, and HSV PCR from the CSF should be repeated within 3-7 days [43].…”

Section: Diagnostic Pitfallsmentioning

confidence: 99%

“…While clinical, laboratory, radiographic, and neurophysiologic findings on presentation may suggest HSVE, no combination of features is sufficiently sensitive and empirical treatment should be initiated in all patients with encephalitis [43]. As noted below, early initiation of aciclovir is the most readily modifiable factor for improving outcomes.…”

Section: Empirical Treatment Of Encephalitismentioning

confidence: 99%

“…As noted below, early initiation of aciclovir is the most readily modifiable factor for improving outcomes. Intravenous aciclovir 10 mg/kg q8h for 14-21 days should, therefore, be initiated promptly and the diagnostic evaluation should never delay antimicrobial therapy in patients with encephalitis [43]. As bacterial meningoencephalitis often cannot be excluded on clinical grounds, and septic encephalopathy is a common mimic of HSVE [102], we recommend the addition of broad-spectrum antibiotics until bacterial infection can be excluded.…”

Section: Empirical Treatment Of Encephalitismentioning

confidence: 99%

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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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Section: Epidemiologymentioning

confidence: 99%

Section: Laboratory Studiesmentioning

confidence: 99%

Section: Diagnostic Pitfallsmentioning

confidence: 99%

Section: Empirical Treatment Of Encephalitismentioning

confidence: 99%

Section: Empirical Treatment Of Encephalitismentioning

confidence: 99%

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

2016

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Emerging Viral Infections of the Central Nervous System

Tyler¹

2009

Arch Neurol

107

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n this 2-part review, I will focus on emerging virus infections of the central nervous system (CNS). Part 1 will introduce the basic features of emerging infections, including their definition, epidemiology, and the frequency of CNS involvement. Important mechanisms of emergence will be reviewed, including viruses spreading into new host ranges as exemplified by West Nile virus (WNV), Japanese encephalitis (JE) virus, Toscana virus, and enterovirus 71 (EV71). Emerging infections also result from opportunistic spread of viruses into known niches, often resulting from attenuated host resistance to infection. This process is exemplified by transplantassociated cases of viral CNS infection caused by WNV, rabies virus, lymphocytic choriomeningitis, and lymphocytic choriomeningitis-like viruses and by the syndrome of human herpesvirus 6 (HHV6)-associated posttransplantation acute limbic encephalitis. The second part of this review begins with a discussion of JC virus and the occurrence of progressive multifocal leukoencephalopathy in association with novel immunomodulatory therapies and then continues with an overview of the risk of infection introduced by imported animals (eg, monkeypox virus) and examples of emerging diseases caused by enhanced competence of viruses for vectors and the spread of vectors (eg, chikungunya virus) and then concludes with examples of novel viruses causing CNS infection as exemplified by Nipah and Hendra viruses and bat lyssaviruses.

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Raccoon Rabies Virus Variant Transmission Through Solid Organ Transplantation

Vora

Basavaraju

Feldman

et al. 2013

JAMA

103

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Unlike the 2 previous clusters of rabies virus transmission through solid organ transplantation, there was a long incubation period in the recipient who developed rabies, and survival of 3 other recipients without pretransplant rabies vaccination. Rabies should be considered in patients with acute progressive encephalitis of unexplained etiology, especially for potential organ donors. A standard evaluation of potential donors who meet screening criteria for infectious encephalitis should be considered, and risks and benefits for recipients of organs from these donors should be evaluated.

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The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America

Cited by 937 publications

References 113 publications

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

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

Emerging Viral Infections of the Central Nervous System

Raccoon Rabies Virus Variant Transmission Through Solid Organ Transplantation

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