title: Infectious encephalitis: utility of a rational approach to aetiological diagnosis in daily clinical practice.
abstract: In this study we attempt to assess the utility of a simplified step-wise diagnostic algorithm to determinate the aetiology of encephalitis in daily clinical practice and to describe the main causes in our setting. This was a prospective cohort study of all consecutive cases of encephalitis in adult patients diagnosed between January 2010 and March 2015 at the University Hospital Vall d'Hebron in Barcelona, Spain. The aetiological study was carried out following the proposed step-wise algorithm. The proportion of aetiological diagnoses achieved in each step was analysed. Data from 97 patients with encephalitis were assessed. Following a simplified step-wise algorithm, a definite diagnosis was made in the first step in 53 patients (55 %) and in 12 additional cases (12 %) in the second step. Overall, a definite or probable aetiological diagnosis was achieved in 78 % of the cases. Herpes virus, L. monocytogenes and M. tuberculosis were the leading causative agents demonstrated, whereas less frequent aetiologies were observed, mainly in immunosuppressed patients. The overall related mortality was 13.4 %. According to our experience, the leading and treatable causes of encephalitis can be identified in a first diagnostic step with limited microbiological studies. L. monocytogenes treatment should be considered on arrival in some patients. Additional diagnostic effort should be made in immunosuppressed patients.
authors.affiliation: Infectious Diseases Department, University Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Paseo de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: López-Sánchez
authors.affiliation: Microbiology Department, University Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Sulleiro
authors.affiliation: Infectious Diseases Department, University Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Paseo de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.|Tropical Medicine Unit Drassanes-Vall d'Hebron, PROSICS, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Bocanegra
authors.affiliation: Emergency Department, University Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Romero
authors.affiliation: Microbiology Department, University Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Codina
authors.affiliation: Emergency Department, University Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Sanz
authors.affiliation: Microbiology Department, University Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Esperalba
authors.affiliation: Intensive Care Department, University Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Serra
authors.affiliation: Infectious Diseases Department, University Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Paseo de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Pigrau
authors.affiliation: Infectious Diseases Department, University Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Paseo de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Burgos
authors.affiliation: Infectious Diseases Department, University Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Paseo de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Almirante
authors.affiliation: Infectious Diseases Department, University Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Paseo de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain. vfalco@vhebron.net.
authors.forename: V
authors.initials: V
authors.lastname: Falcó
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D019411:Clinical Laboratory Techniques / Q000379:methods*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D000069544:Infectious Encephalitis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013030:Spain; D055815:Young Adult