Diagnostic tools to tackle infectious causes of encephalitis and meningoencephalitis in immunocompetent adults in Europe.
Clin Microbiol Infect 2019;
25:408-414. [PMID:
30654044 DOI:
10.1016/j.cmi.2018.12.035]
[Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/19/2018] [Accepted: 12/23/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND
Encephalitis and meningoencephalitis imply inflammation of the brain parenchyma, and comprise many diagnostic entities, such as various infections and causes of dysimmunity. The cause remains unknown in around 50% of cases.
OBJECTIVES
To summarize the main infectious causes of encephalitis and meningoencephalitis acquired in Europe, and the diagnostic means to identify them.
SOURCES
PubMed, ECDC and WHO websites, personal experience.
CONTENT
The principal infectious causes of encephalitis and meningoencephalitis acquired in Europe in adults are discussed in this review, with special emphasis on the microbiological and imaging diagnostic approaches. The role of electroencephalography in diagnosing encephalitis is also mentioned. Among infections, viruses are more frequent than other pathogen types, and their epidemiology varies according to geographic area. A few bacteria, such as Listeria monocytogenes and Mycobacterium tuberculosis, are also to be considered. In contrast, parasites and fungi are rare encephalitis causes in Europe.
IMPLICATIONS
Identifying the causative pathogen of infectious encephalitis and meningoencephalitis is complex because of the variety of pathogens, the epidemiology of which is determined by geography and environmental factors. Furthermore, despite extensive microbiological testing, many cases of encephalitis remain of unknown origin. Brain magnetic resonance imaging and electroencephalography are useful complementary diagnostic tools, and newer unbiased sequencing technologies might help to fill in the diagnostic gap.
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