Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- febre
- erupção cutânea
- estado mental alterado
- deficit neurológico focal
- meningismo
- parotidite
- linfadenopatia
- neurite óptica
- paralisia flácida aguda
- distúrbios de movimento
Other diagnostic factors
- tosse
- infecção gastrointestinal
- convulsões
- enfermidade bifásica
- distúrbios autonômicos e hipotalâmicos
- miocardite/pericardite
- icterícia
- artrite
- retinite
- parkinsonismo
Risk factors
- idade <1 ou >65 anos
- imunodeficiência
- exposição a vetores e/ou picadas de animais
- localização
- vacinação
- pós-infecção
- exposição a fluidos corporais/sangue
- transplante de órgãos
- estação do ano
- profissão
- caça/passeio em florestas
- nadar ou mergulhar em água doce morna ou irrigação do seio/nariz
- espeleologia (exploração de cavernas)
- morte em animais
- câncer
Diagnostic investigations
1st investigations to order
- Hemograma completo
- esfregaço de sangue periférico
- eletrólitos séricos
- testes da função hepática
- hemoculturas
- swab da garganta
- aspirado nasofaríngeo
- radiografia torácica
- TC cranioencefálica
- ressonância nuclear magnética (RNM) cranioencefálica
- eletroencefalograma (EEG)
- Análise do líquido cefalorraquidiano (LCR)
- cultura do LCR
- sorologia do LCR
- Reação em cadeia da polimerase do LCR
Investigations to consider
- coprocultura para enterovírus
- cultura de escarro
- anticorpos IgM e IgG (sangue e LCR)
- reação em cadeia da polimerase (sangue)
- sorologia do vírus da imunodeficiência humana (HIV)/teste do ácido ribonucleico (RNA)
- ensaio de biomarcadores do líquido cefalorraquidiano (LCR)/proteína príon
- anticorpos paraneoplásicos (sangue e LCR)
- ultrassonografia abdominal/pélvica
- TC do corpo inteiro
- tomografia por emissão de pósitrons (PET) do corpo inteiro
- espectroscopia por ressonância magnética
- sequenciamento de próxima geração de LCR
- biópsia do cérebro
Treatment algorithm
hospedeiro imunocompetente: suspeita de etiologia viral
hospedeiro imunocomprometido: suspeita de etiologia viral
confirmação de encefalite por vírus do herpes simples (HSV)
confirmação de encefalite por vírus da varicela-zóster (VZV)
confirmação de encefalite por citomegalovírus (CMV)
confirmação de encefalite por vírus Epstein-Barr (EBV)
encefalite por herpes B confirmada
encefalite por herpes 6 humano confirmada
etiologia não herpes-vírus confirmada
etiologia não viral
fase convalescente: todas as etiologias
Contributors
Authors
Sung G Ji, MD, PhD
Behavioral Neurology Fellow
Department of Neurology
University of Washington
Seattle
WA
Disclosures
SGJ declares that he has no competing interests.
Payal B. Patel, MD
Assistant Professor of Neurology
Department of Neurology
University of Washington
Seattle
WA
Disclosures
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.
Acknowledgements
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.
Disclosures
LHW, LTW, CCI, MM, DJ, RS, and KDR declare that they have no competing interests.
Peer reviewers
Alejandro Rabinstein, MD
Professor of Neurology
Mayo Clinic
Rochester
MN
Disclosures
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
Disclosures
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
Disclosures
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.
References
Key articles
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Meningite viral
- Encefalopatia (tóxica/metabólica)
- Estado de mal epiléptico
More DifferentialsGuidelines
- 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
More GuidelinesPatient information
Punção lombar
Meningite e septicemia
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer