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Multicenter Study
. 2020 Jun:127:104369.
doi: 10.1016/j.jcv.2020.104369. Epub 2020 Apr 14.

Compliance with international guidelines in adults with encephalitis

Mohammed Samannodi  1 , Michael Hansen  2 , Ambreen Allana  3 , Rodrigo Hasbun  3
Affiliations
Multicenter Study

Compliance with international guidelines in adults with encephalitis

Mohammed Samannodi et al. J Clin Virol. 2020 Jun.

Abstract

Background: Encephalitis is associated with significant neurological disability and mortality. Many guidelines are published for encephalitis management but compliance with them is unknown.

Objectives: To evaluate the appropriate management and compliance to the current guidelines in adults with encephalitis.

Study design: A retrospective multicenter study at 17 hospitals in the Greater Houston area from August 1, 2008 through September 30, 2017. All cases met the definition for possible or probable encephalitis as per the international encephalitis consortium guidelines.

Results: A total of 241 adults (age >17 years) with encephalitis were enrolled. The most common etiologies were unknown (41.9 %), viral (27.8 %) and autoimmune (21.2 %). An adverse clinical outcome was seen in 49 % with 12.4 % in hospital mortality. A high compliance with guidelines (>90 %) was only seen in obtaining a brain computerized tomography (CT) scan, blood cultures and cerebrospinal fluid (CSF) gram stain and culture. A CSF herpes virus simplex (HSV) polymerase chain reaction (PCR) was done in 84 % and only repeated in 14.2 % of patients with an initial negative result. Furthermore, only two-thirds of patients were started empirically on intravenous acyclovir and antibiotics. Evaluation for other etiologies were not uniformly performed: arboviral serologies (57.3 %), CSF anti-N-Methyl-d-Aspartate Receptor (NMDA) receptor antibody (35.7 %), and CSF varicella zoster virus (VZV) PCR (32 %). The highest yield for the tests were arboviral serologies (42 %), anti-NMDA antibodies (41.2 %) and VZV PCR (16.4 %).

Conclusion: The management of encephalitis as per current guidelines is suboptimal leading to underutilization of currently available diagnostic tests and empirical therapy.

Keywords: Compliance; Encephalitis; Exposure and outcome.

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Conflict of interest statement

Declaration of Competing Interest Dr. Hasbun is a speaker and has research support from Biofire®. All other authors do not have any conflicts of interest.

References

    1. Venkatesan A., Michael B.D., Probasco J.C., Geocadin R.G., Solomon T. Acute encephalitis in immunocompetent adults. Lancet. 2019;393:702–716. - PubMed
    1. Boucher A., Herrmann J.L., Morand P. Epidemiology of infectious encephalitis causes in 2016. Med. Mal. Infect. 2017;47:221–235. - PubMed
    1. Ooi M.H., Lewthwaite P., Lai B.F. The epidemiology, clinical features, and long-term prognosis of Japanese encephalitis in Central Sarawak, Malaysia, 1997–2005. Clin. Infect. Dis. 2008;47(4):458–468. - PubMed
    1. Erdem H., Cag Y., Engin D.O. Results of a multinational study suggest the need for rapid diagnosis and early antiviral treatment at the onset of herpetic meningoencephalitis. Antimicrob. Agents Chemother. 2015;59(6):3084–3089. - PMC - PubMed
    1. Murray K.O., Nolan M.S., Ronca S.E. The neurocognitive and MRI outcomes of West Nile virus infection: preliminary analysis using an external control group. Front. Neurol. 2018;9(March):111. - PMC - PubMed

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