Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- fever
- rash
- altered mental state
- focal neurologic deficit
- meningismus
- parotitis
- lymphadenopathy
- optic neuritis
- acute flaccid paralysis
- movement disorder
Outros fatores diagnósticos
- cough
- gastrointestinal infection
- seizures
- biphasic illness
- autonomic and hypothalamic disturbances
- myocarditis/pericarditis
- jaundice
- arthritis
- retinitis
- parkinsonism
Fatores de risco
- age <1 or >65 years
- immunodeficiency
- vector exposure and/or animal bites
- location
- vaccination
- postinfection
- blood/body fluid exposure
- organ transplantation
- season
- occupation
- hunting/trekking in woods
- swimming or diving in warm freshwater or nasal/sinus irrigation
- spelunking (cave-exploring)
- death in animals
- cancer
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- CBC
- peripheral blood smear
- serum electrolytes
- liver function tests
- blood cultures
- throat swab
- nasopharyngeal aspirate
- chest radiography
- CT brain
- MRI brain
- electroencephalogram (EEG)
- cerebrospinal fluid (CSF) analysis
- CSF culture
- CSF serology
- CSF polymerase chain reaction (PCR)
Investigações a serem consideradas
- stool enteroviral culture
- sputum culture
- IgG and IgM antibodies (blood or CSF)
- PCR (blood)
- HIV serology/RNA test
- CSF biomarkers/prion protein assay
- paraneoplastic antibodies (blood and CSF)
- abdominal/pelvic ultrasound
- whole-body CT
- whole-body PET scans
- magnetic resonance spectroscopy
- next-generation sequencing of CSF
- brain biopsy
Algoritmo de tratamento
immunocompetent host: suspected viral etiology
immunocompromised host: suspected viral etiology
confirmed herpes simplex virus (HSV) encephalitis
confirmed varicella zoster virus (VZV) encephalitis
confirmed cytomegalovirus (CMV) encephalitis
confirmed Epstein-Barr virus (EBV) encephalitis
confirmed herpes B encephalitis
confirmed human herpes 6 encephalitis
confirmed nonherpes virus etiology
nonviral etiology
convalescent phase: all etiologies
Colaboradores
Autores
Sung G Ji, MD, PhD
Behavioral Neurology Fellow
Department of Neurology
University of Washington
Seattle
WA
Declarações
SGJ declares that he has no competing interests.
Payal B. Patel, MD
Assistant Professor of Neurology
Department of Neurology
University of Washington
Seattle
WA
Declarações
PBP has received research funding support from the National Institute of Health and Bayer Pharmaceuticals. PBP has received an honorarium as an author from Medlink Neurology and Continuum Neurology.
Agradecimentos
Dr Payal B. Patel would like to gratefully acknowledge Dr Leo H. Wang, Dr Louise T. Wang, Dr Catalina C. Ionita, Dr Manjunath Markandaya, Dr David Janicke, Dr Robert Schmidt, and Dr Kimiko Domoto-Reilly, previous contributors to this topic.
Declarações
LHW, LTW, CCI, MM, DJ, RS, and KDR declare that they have no competing interests.
Revisores
Alejandro Rabinstein, MD
Professor of Neurology
Mayo Clinic
Rochester
MN
Declarações
AR has participated in advisory board meetings for Astra Zeneca, Chiesi, and Shionogi.
Rodrigo Hasbun, MD, MPH, FIDSA
Professor of Medicine
UT Health McGovern Medical School
Houston
TX
Declarações
RH has received research support and personal fees from Biomeriaux (Biofare Diagnostics).
Russel Dale, MBChB, MRCPCH, MSc, PhD
Professor of Paediatric Neurology
The University of Sydney
Consultant Neurologist
The Children's Hospital at Westmead
Sydney
Australia
Declarações
RD declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Venkatesan A, Tunkel AR, Bloch KC, et al. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the International Encephalitis Consortium. Clin Infect Dis. 2013 Oct;57(8):1114-28.Texto completo Resumo
Solomon T, Michael BD, Smith PE, et al. Management of suspected viral encephalitis in adults--Association of British Neurologists and British Infection Association National Guidelines. J Infect. 2012 Apr;64(4):347-73.Texto completo Resumo
Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104.Texto completo Resumo
Kneen R, Michael BD, Menson E, et al. Management of suspected viral encephalitis in children - Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group national guidelines. J Infect. 2012 May;64(5):449-77.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Viral meningitis
- Encephalopathy (toxic/metabolic)
- Status epilepticus
Mais Diagnósticos diferenciaisDiretrizes
- Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases
- Canadian consensus guidelines for the diagnosis and treatment of autoimmune encephalitis in adults
Mais DiretrizesFolhetos informativos para os pacientes
Meningitis and septicemia
Lumbar puncture
Mais Folhetos informativos para os pacientes
Conectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal