Institut de Veille Sanitaire, Saint-Maurice, Grenoble, France.
Clin Infect Dis. 2009 Dec 15;49(12):1838-47. doi: 10.1086/648419.
Encephalitis is associated with significant mortality and morbidity, but its cause remains largely unknown. We designed a national prospective study in France in 2007 to describe patients with encephalitis, investigate the etiologic diagnosis of encephalitis, and assess risk factors associated with death.
Patients were enrolled by attending physicians according to case definition, and data were collected with a standardized questionnaire. The etiologic diagnosis was investigated after a standardized procedure. Risk factors associated with death during hospitalization were assessed by multivariate logistic regression.
A total of 253 patients with acute infectious encephalitis from 106 medical units throughout France were included in the study. Their ages ranged from 1 month to 89 years (median age, 54 years); 61% were male. Cause of the encephalitis was determined in 131 patients (52%). Herpes simplex virus 1 (42%), varicella-zoster virus (15%), Mycobacterium tuberculosis (15%), and Listeria monocytogenes (10%) were the most frequently identified agents. Twenty-six patients (10%, all adults) died, 6 of them with tuberculosis and 6 with listeriosis. Risk factors independently associated with death during hospitalization identified by the multivariable analysis were age (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0-1.4; for 5-year increase), cancer (OR, 17; 95% CI, 2.3-122.6), immunosuppressive treatment before onset (OR, 24; 95% CI, 1.3-426.0), percentage of hospitalized patients receiving mechanical ventilation (OR, 2.0; 95% CI, 1.4-3.0; for 10% increase), the etiologic agent, coma on day 5 after admission (OR, 16; 95% CI, 2.8-92.3), and sepsis on day 5 after admission (OR, 94; 95% CI, 4.9-1792.2).
Our prospective study provides an overview of the clinical and etiologic patterns of acute infectious encephalitis in adults in France. Herpes simplex virus 1 remains the main cause of encephalitis, but bacteria accounts for the highest case-fatality rates.
脑炎与显著的死亡率和发病率相关，但病因仍大多未知。我们于 2007 年在法国设计了一项全国性前瞻性研究，旨在描述脑炎患者，调查脑炎的病因诊断，并评估与死亡相关的危险因素。
根据病例定义，由主治医生纳入患者，并用标准化问卷收集数据。通过标准化程序调查病因诊断。使用多变量逻辑回归评估住院期间死亡的相关危险因素。
共纳入法国 106 个医疗单位的 253 例急性感染性脑炎患者。年龄 1 个月至 89 岁（中位数 54 岁），61%为男性。确定了 131 例（52%）脑炎的病因。最常鉴定出的病原体为单纯疱疹病毒 1 型（42%）、水痘-带状疱疹病毒（15%）、结核分枝杆菌（15%）和李斯特菌（10%）。26 例（10%，均为成年人）死亡，其中 6 例死于结核病，6 例死于李斯特菌病。多变量分析确定的与住院期间死亡相关的独立危险因素为年龄（比值比[OR]，1.2；95%置信区间[CI]，1.0-1.4；每增加 5 岁）、癌症（OR，17；95% CI，2.3-122.6）、发病前免疫抑制治疗（OR，24；95% CI，1.3-426.0）、住院患者接受机械通气的比例（OR，2.0；95% CI，1.4-3.0；每增加 10%）、病因、入院后第 5 天昏迷（OR，16；95% CI，2.8-92.3）和入院后第 5 天脓毒症（OR，94；95% CI，4.9-1792.2）。
我们的前瞻性研究提供了法国成人急性感染性脑炎的临床和病因模式概述。单纯疱疹病毒 1 仍然是脑炎的主要病因，但细菌是导致死亡率最高的病因。
