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. 2023 Sep 11;77(5):e14-e33.
doi: 10.1093/cid/ciad306.

State of the Art: Acute Encephalitis

Karen C Bloch  1 , Carol Glaser  2 , David Gaston  3 , Arun Venkatesan  4
Affiliations

State of the Art: Acute Encephalitis

Karen C Bloch et al. Clin Infect Dis. .

Abstract

Encephalitis is a devastating neurologic disease often complicated by prolonged neurologic deficits. Best practices for the management of adult patients include universal testing for a core group of etiologies, including herpes simplex virus (HSV)-1, varicella zoster virus (VZV), enteroviruses, West Nile virus, and anti-N-methyl-D-aspartate receptor (anti-NMDAR) antibody encephalitis. Empiric acyclovir therapy should be started at presentation and in selected cases continued until a second HSV-1 polymerase chain reaction test is negative. Acyclovir dose can be increased for VZV encephalitis. Supportive care is necessary for other viral etiologies. Patients in whom no cause for encephalitis is identified represent a particular challenge. Management includes repeat brain magnetic resonance imaging, imaging for occult malignancy, and empiric immunomodulatory treatment for autoimmune conditions. Next-generation sequencing (NGS) or brain biopsy should be considered. The rapid pace of discovery regarding autoimmune encephalitis and the development of advanced molecular tests such as NGS have improved diagnosis and outcomes. Research priorities include development of novel therapeutics.

Keywords: HSV-1 encephalitis; West Nile virus encephalitis; anti-NMDAR antibody encephalitis; encephalitis review; next-generation sequencing.

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Conflict of interest statement

Potential conflicts of interest. K. C. B., A. V., and C. G. had a role as a Medical Advisor of Encephalitis 411 (unpaid). K. C. B. and A. V. report unpaid participation on a Data Safety and Monitoring Board for the French Dex Enceph Study. A. V. received payment for expert testimony as an expert witness for the Vaccine Injury Compensation Program and an expert witness for medicolegal cases; travel support partly paid directly to the author for the UK Encephalitis Society Annual Meeting; and an unpaid role as a scientific advisory panel member, UK Encephalitis Society. D. G. received research reagents from Illumina, Inc, and IDbyDNA, Inc; serves on the Scientific Advisory Board for bioMerieux; reports grants or contracts from the Fisher Center Discovery Program, Johns Hopkins; and payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing, or educational events from the American Association of Clinical Chemistry and Pan American Society of Clinical Virology. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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