Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
California Department of Public Health, Richmond, California, USA.
Clin Infect Dis. 2023 Sep 11;77(5):e14-e33. doi: 10.1093/cid/ciad306.
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.
脑炎是一种严重的神经疾病，常伴有长期的神经功能缺损。成人患者管理的最佳实践包括对一组核心病因进行普遍检测，包括单纯疱疹病毒（HSV）-1、水痘带状疱疹病毒（VZV）、肠道病毒、西尼罗河病毒和抗 N-甲基-D-天冬氨酸受体（抗 NMDAR）抗体脑炎。在出现症状时应开始经验性使用阿昔洛韦治疗，并在选定的情况下继续使用，直到第二次 HSV-1 聚合酶链反应检测结果为阴性。对于 VZV 脑炎，可以增加阿昔洛韦剂量。对于其他病毒病因，需要进行支持性治疗。对于未确定脑炎病因的患者，治疗具有一定挑战性。治疗包括重复脑部磁共振成像、隐匿性恶性肿瘤成像以及针对自身免疫性疾病的经验性免疫调节治疗。应考虑进行下一代测序（NGS）或脑活检。自身免疫性脑炎的快速发现以及高级分子检测（如 NGS）的发展，提高了诊断和治疗效果。研究重点包括开发新型治疗药物。
