Kings College Hospital, London, UK.
Neurosciences, East Kent Hospitals University NHS Foundation Trust, Kent & Canterbury Hospital, Ethelbert Road, CanterburyCT1 3NG, UK.
Epidemiol Infect. 2020 Feb 5;148:e23. doi: 10.1017/S0950268820000047.
Encephalitis causes high morbidity and mortality. An incidence of 4.3 cases of encephalitis/100 000 population has been reported in the UK. We performed a retrospective evaluation of the diagnosis and management of adults admitted to hospital with a clinical diagnosis of encephalitis/meningoencephalitis. Clinical, laboratory and radiological data were collated from electronic records. Thirty-six patients, median age 55 years and 24 (67%) male were included. The aetiology was confirmed over nine months in 25 (69%) of whom 16 were infections (six viral, seven bacterial, two parasitic and one viral and parasitic co-infection); 7 autoimmune; 1 metabolic and 1 neoplastic. Of 24 patients with fever, 15 (63%) had an infection. The median time to computed topography, magnetic resonance imaging and electroencephalography (EEG) was 1, 8 and 3 days respectively. Neuroimaging was abnormal in 25 (69%) and 17 (89%) had abnormal EEGs. Only 19 (53%) received aciclovir treatment. Six (17%) made good recoveries, 16 (44%) had moderate disability, 8 (22%) severe disability and 6 (17%) died. Outcomes were worse for those with an infectious cause. In summary, a diagnosis was made in 69.4% of patients admitted with encephalitis/meningoencephalitis. Autoimmune causes are important to consider at an early stage due to a successful response to treatment. Only 53% of patients received aciclovir on admission. Neuroimaging and EEG studies were delayed. The results of this work resulted in further developing the clinical algorithm for managing these patients.
脑炎可导致高发病率和高死亡率。在英国，脑炎的发病率为每 10 万人中有 4.3 例。我们对因脑炎/脑膜脑炎而住院的成年人的诊断和治疗进行了回顾性评估。从电子病历中整理了临床、实验室和影像学数据。共纳入 36 例患者，中位年龄为 55 岁，24 例（67%）为男性。25 例（69%）病因在 9 个月内得到确认，其中 16 例为感染（6 例病毒、7 例细菌、2 例寄生虫和 1 例病毒和寄生虫混合感染）；7 例为自身免疫性疾病；1 例代谢性疾病；1 例肿瘤性疾病。24 例发热患者中，15 例（63%）有感染。计算机断层扫描、磁共振成像和脑电图（EEG）的中位时间分别为 1、8 和 3 天。25 例（69%）神经影像学异常，17 例（89%）EEG 异常。仅 19 例（53%）接受阿昔洛韦治疗。6 例（17%）恢复良好，16 例（44%）中度残疾，8 例（22%）重度残疾，6 例（17%）死亡。感染性病因患者的预后较差。总之，脑炎/脑膜脑炎住院患者中 69.4%的诊断得到明确。由于治疗效果良好，早期应考虑自身免疫性病因。仅 53%的患者在入院时接受阿昔洛韦治疗。神经影像学和脑电图检查延迟。这项工作的结果进一步制定了管理这些患者的临床算法。
