Department of Intensive Care Medicine.
Department of Infectious and Tropical Diseases, AP-HP, Bichat Hospital.
Curr Opin Crit Care. 2023 Oct 1;29(5):415-422. doi: 10.1097/MCC.0000000000001087. Epub 2023 Aug 9.
This article aims to provide an updated review on the epidemiology and outcomes of severe meningoencephalitis.
Meningoencephalitis is a critical medical condition characterized by inflammation in both the meninges and brain parenchyma. Bacterial, viral, or fungal infections are common causes, although noninfectious factors, such as autoimmune causes, can also contribute. In patients requiring intensive care, meningoencephalitis is associated with a severe prognosis, including mortality rates ranging from 11 to 25% and functional disability in 15-25% of survivors. Recent multicenter studies have identified several parameters linked to poor outcomes, including older age, immunocompromised status, focal neurologic signs, abnormal brain imaging, and delayed administration of antimicrobials. The use of new multiplex PCR techniques for diagnosis has generated debate based on recent data. Investigation is still needed to determine the effectiveness of adjunctive therapies, including seizure prophylaxis, and adjunctive steroids for nonbacterial causes.
Recent multicenter studies have enhanced our understanding of the current epidemiology and outcomes of severe meningoencephalitis in adult patients.
本文旨在对严重脑膜脑炎的流行病学和转归进行最新的综述。
脑膜脑炎是一种严重的医学病症,其特征是脑膜和脑实质同时发生炎症。细菌、病毒或真菌感染是常见的病因,但非传染性因素,如自身免疫性病因,也可能导致这种疾病。在需要重症监护的患者中,脑膜脑炎与严重的预后相关,包括死亡率在 11%至 25%之间,幸存者中有 15%至 25%存在功能障碍。最近的多中心研究确定了几个与不良预后相关的参数,包括年龄较大、免疫功能低下、局灶性神经体征、异常脑成像和抗菌药物延迟使用。基于最近的数据,新的多重 PCR 技术在诊断中的应用引发了争议。仍需要进一步研究以确定辅助治疗的有效性,包括预防癫痫发作和针对非细菌性病因的辅助性类固醇治疗。
最近的多中心研究增强了我们对成人严重脑膜脑炎的当前流行病学和转归的理解。