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Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the Art: Acute Encephalitis. Clin Infect Dis 2023; 77:e14-e33. [PMID: 37485952 DOI: 10.1093/cid/ciad306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 07/25/2023] Open
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.
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Affiliation(s)
- Karen C Bloch
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carol Glaser
- California Department of Public Health, Richmond, California, USA
| | - David Gaston
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arun Venkatesan
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
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Wang H, Zhao S, Wang S, Zheng Y, Wang S, Chen H, Pang J, Ma J, Yang X, Chen Y. Global magnitude of encephalitis burden and its evolving pattern over the past 30 years. J Infect 2022; 84:777-787. [PMID: 35452715 DOI: 10.1016/j.jinf.2022.04.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/01/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We aimed to estimate the spatiotemporal patterns of the encephalitis burden along with its attributable risk factors at the national, regional, and global levels, which may be helpful in guiding targeted prevention and treatment programs. METHODS Based on available data sources, the incidence, mortality, and disability-adjusted life years (DALYs) of encephalitis in 204 countries and regions from 1990 to 2019 were reconstructed by the Global Burden of Disease Study 2019 using the Cause of Death Ensemble model, spatiotemporal Gaussian process regression, and DisMod-MR 2.1. We conducted a systematic analysis on the epidemiological characteristics of encephalitis in detail by gender, region, and age over the past three decades. RESULTS Globally, 1,444,720 incident cases, 89,900 deaths, and 4.80 million DALYs related to encephalitis were estimated in 2019. The age-standardized incidence rate and age-standardized mortality rate (ASMR) decreased from 23.17 and 2.18 to 19.33 and 1.19 per 100,000 person-years over the past 30 years, respectively. However, beginning in 2011-2013, the burden of encephalitis has shown an inflection point, with a further decline of the ASRs ceasing. Lower socio-demographic index (SDI) regions in South Asia, Western and Eastern Sub-Saharan Africa had the highest burden of encephalitis in 2019. During the past three decades, most countries of South Asia achieved significant control of the burden. In contrast, developed countries with a higher SDI have shown a notable increase in ASMR and age-standardized DALYs rate. Children and older adults have always been high-risk groups for encephalitis. CONCLUSION Although the global burden of encephalitis has decreased in the past 30 years, a further decline stopped from 2011-2013. The diverse burden in different regions calls for differentiated management, and the persistent high burden in some low-SDI regions and the increased burden in developed countries with higher SDIs deserve more attention. ABBREVIATIONS ASDR: age-standardized DALY rate, ASIR: age-standardized incidence rate, ASMR: age-standardized mortality rate, ASR: age-standardized rate, CI: confidence interval, DALY: disability-adjusted life-year, EAPC: estimated annual percentage change, GBD: Global Burden of Disease Study, HAP: household air pollution from solid fuels, HSE: herpes simplex encephalitis, HSV: herpes simplex virus, ICD: International Classification of Diseases, JE: Japanese encephalitis, PCR: polymerase chain reaction, SDI: socio-demographic index, TBE: tick-borne encephalitis, UI: uncertainty interval.
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Affiliation(s)
- Hao Wang
- Department of Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, China; Department of Pharmacology, School of Basic Medical Sciences, Shandong University, Jinan, China
| | - Shaohua Zhao
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, Jinan, China; Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
| | - Shengjun Wang
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yue Zheng
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China; Qilu Hospital, Cheeloo College of Medicine, Clinical Research Center of Shandong University, Shandong University, Jinan, China
| | - Shaohua Wang
- Department of Internal Medicine, Jinan Hospital, Jinan, China
| | - Hui Chen
- Qilu Hospital, Cheeloo College of Medicine, Clinical Research Center of Shandong University, Shandong University, Jinan, China; Clinical Epidemiology Unit, Qilu Hospital, Shandong University, Jinan, China
| | - Jiaojiao Pang
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China; Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Juan Ma
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, Jinan, China
| | - Xiaorong Yang
- Qilu Hospital, Cheeloo College of Medicine, Clinical Research Center of Shandong University, Shandong University, Jinan, China; Clinical Epidemiology Unit, Qilu Hospital, Shandong University, Jinan, China.
| | - Yuguo Chen
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China; Qilu Hospital, Cheeloo College of Medicine, Clinical Research Center of Shandong University, Shandong University, Jinan, China; Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China.
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