Infectious encephalitis: Management without etiological diagnosis 48hours after onset.
BACKGROUND
The etiological diagnosis of infectious encephalitis is often not established 48hours after onset. We aimed to review existing literature data before providing management guidelines.


METHODS
We performed a literature search on PubMed using filters such as "since 01/01/2000", "human", "adults", "English or French", and "clinical trial/review/guidelines". We also used the Mesh search terms "encephalitis/therapy" and "encephalitis/diagnosis".


RESULTS
With Mesh search terms "encephalitis/therapy" and "encephalitis/diagnosis", we retrieved 223 and 258 articles, respectively. With search terms "encephalitis and corticosteroid", we identified 38 articles, and with "encephalitis and doxycycline" without the above-mentioned filters we identified 85 articles. A total of 210 articles were included in the analysis.


CONCLUSIONS
Etiological investigations must focus on recent travels, animal exposures, age, immunodeficiency, neurological damage characteristics, and potential extra-neurological signs. The interest of a diagnosis of encephalitis for which there is no specific treatment is also to discontinue any empirical treatments initially prescribed. Physicians must consider and search for autoimmune encephalitis.
Service de maladies infectieuses et réanimation médicale, CHU Pontchaillou, 35000 Rennes, France.
P
P
Fillatre
Médecine interne, CHBUA site de Vannes, 56017 Vannes, France.
Y
Y
Crabol
Virologie, CHU Grenoble Alpes, 38043 Grenoble cedex 9, France.
P
P
Morand
Infectiologie, CHU de Dijon, 21000 Dijon, France.
L
L
Piroth
Inserm U1028, CNRS UMR5292, équipe neuro-oncologie et neuro-inflammation (Oncoflam), centre de recherche en neurosciences (CRNL), université Lyon 1, 69500 Bron, France.
J
J
Honnorat
Service d'infectiologie, CHU de Grenoble, 38043 Grenoble cedex 9, France. Electronic address: jpstahl@chu-grenoble.fr.
J P
JP
Stahl
Institut Pasteur, Biology of Infection Unit, CNR CCOMS Listeria, Inserm U1117, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Department of Infectious Diseases and Tropical Medicine, Necker-Enfants-Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
M
M
Lecuit
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D020274:Autoimmune Diseases of the Nervous System / Q000175:diagnosis; D003937:Diagnosis, Differential; D019468:Disease Management; D006801:Humans; D000069544:Infectious Encephalitis / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors
D000890:Anti-Infective Agents
Encéphalite infectieuse; HSV; Infectious encephalitis; Listeria; Tuberculose; Tuberculosis; VZV