Encephalitis is a sudden onset inflammation of the
brain. Encephalitis with meningitis is known as meningoencephalitis. Symptoms
include headache, fever, confusion, drowsiness, and fatigue. Further symptoms
include seizures or convulsions, tremors, hallucinations, stroke, and memory
problems. The number of new cases a year of acute encephalitis in Western
countries is 7.4 cases per 100,000 population per year. In tropical countries,
the incidence is 6.34 per 100,000 per year. In 2013 encephalitis was estimated
to have resulted in 77,000 deaths, down from 92,000 in 1990. Vaccination is available
against tick-borne and Japanese encephalitis and should be considered for
at-risk individuals. Post-infectious encephalomyelitis complicating smallpox
vaccination is avoidable, for all intents and purposes, as smallpox is nearly
eradicated. Contraindication to Pertussis immunization should be observed in
patients with encephalitis.
In the present book, fifteen typical
literatures about encephalitis published on international
authoritative journals were selected to introduce the worldwide newest progress,
which contains reviews or original researches on medical science, encephalitis,
infectious diseases, inflammations, epidemiology, ect. We hope this book can demonstrate advances in encephalitis as
well as give references to the researchers, students and other related people.
Abstract Background and purpose Acute encephalitis is associated with psychiatric symptoms. Despite this, the extent of mental health problems following encephalitis has not been systematically reported. Methods We recruited adults who had been diagnosed with encephalitis of any aetiology to complete a web‐based questionnaire. Results In total, 445 respondents from 31 countries (55.1% UK, 23.1% USA) responded. Infectious encephalitis constituted 65.4% of cases, autoimmune 29.7%. Mean age was 50.1 years, 65.8% were female, and median time since encephalitis diagnosis was 7 years. The most common self‐reported psychiatric symptoms were anxiety (75.2%), sleep problems (64.4%), mood problems (62.2%), and unexpected crying (35.2%). Self‐reported psychiatric diagnoses were common: anxiety (44.0%), depression (38.6%), panic disorder (15.7%), and posttraumatic stress disorder (PTSD; 21.3%). Severe mental illnesses such as psychosis (3.3%) and bipolar affective disorder (3.1%) were reported. Self‐reported diagnosis rates were broadly consistent with results from the Psychiatric Diagnostic Screening Questionnaire. Many respondents also reported they had symptoms of anxiety (37.5%), depression (28.1%), PTSD (26.8%), or panic disorder (20.9%) that had not been diagnosed. Rates of psychiatric symptoms did not differ between autoimmune and infectious encephalitis. In total, 37.5% respondents had thought about suicide, and 4.4% had attempted suicide, since their encephalitis diagnosis. More than half of respondents (53.5%) reported they had no, or substandard, access to appropriate mental health care. High rates of sensory hypersensitivities (>75%) suggest a previously unreported association. Conclusions This large international survey indicates that psychiatric symptoms following encephalitis are common and that mental health care provision may be inadequate. We highlight a need for proactive psychiatric input.
Encephalitis describes inflammation of the brain parenchyma, typically caused by either an infectious agent or through an autoimmune process which may be postinfectious, paraneoplastic or idiopathic. Patients can present with a combination of fever, alterations in behaviour, personality, cognition and consciousness. They may also exhibit focal neurological deficits, seizures, movement disorders and/or autonomic instability. However, it can sometimes present non-specifically, and this combined with its many causes make it a difficult to manage neurological syndrome. Despite improved treatments in some forms of encephalitides, encephalitis remains a global concern due to its high mortality and morbidity. Prompt diagnosis and administration of specific and supportive management options can lead to better outcomes. Over the last decade, research in encephalitis has led to marked developments in the understanding, diagnosis and management of encephalitis. In parallel, the number of autoimmune encephalitis syndromes has rapidly expanded and clinically characteristic syndromes in association with pathogenic autoantibodies have been defined. By focusing on findings presented at the Encephalitis Society's conference in December 2021, this article reviews the causes, clinical manifestations and management of encephalitis and integrate recent advances and challenges of research into encephalitis.
One year after the onset of the coronavirus disease 2019 (COVID-19) pandemic, we aimed to summarize the frequency of neurologic manifestations reported in patients with COVID-19 and to investigate the association of these manifestations with disease severity and mortality.
Neurological complications occur in 4% of patients following acute COVID-19 infection, causing significant morbidity with lasting health economic consequences. However treatment studies to date in COVID-19 have not addressed neurological complications as outcome measures. We therefore performed a retrospective, non-interventional cohort study using the ISARIC-4C platform, assessing 62,729 hospital inpatients with severe COVID-19 between 31 Jan 2020 and 29 Jun 2021. Treatment with dexamethasone, remdesivir or both was compared to standard of care. The primary outcome was a neurological complication, namely stroke, seizure, meningitis/encephalitis or any other neurological complication, occurring at the point of death, discharge, or resolution of the COVID-19 clinical episode. A propensity scoring methodology was used to balance confounding between treatment groups and between patients with and without neurological complications. Treatment with dexamethasone, remdesivir or both reduced the incidence of neurological complications from severe COVID-19, with odds ratios of 0.76 (0.69-0.83), 0.68 (0.51-0.90) and 0.64 (0.56 -0.72) respec- tively. Neurological complications were associated with increased length of hospital stay, worse ability to self-care on discharge and increased mortality. This study is the first to focus on the prevention of neurological complications and strongly supports the continued use of both dexamethasone and remdesivir in severe COVID-19. Our results suggest that the established benefit of dexamethasone on mortality in COVID-19 is not associated with an increased burden of long-term neurological disability.
Abstract Objective Thanks to the introduction of recent national guidelines for treating herpes simplex virus (HSV) encephalitis health outcomes have improved. This paper evaluates the costs and the health-related quality of life implications of these guidelines. Design and setting A sub-analysis of data from a prospective, multi-centre, observational cohort ENCEPH-UK study conducted across 29 hospitals in the UK from 2012 to 2015. Study participants Data for patients aged ≥16 years with a confirmed HSV encephalitis diagnosis admitted for treatment with aciclovir were collected at discharge, 3 and 12 months. Primary and secondary outcome measures Patient health outcomes were measured by the Glasgow outcome score (GOS), modified ranking score (mRS), and the EuroQoL; health care costs were estimated per patient at discharge from hospital and at 12 months follow-up. In addition, Quality Adjusted Life years (QALYs) were calculated from the EQ-5D utility scores. Cost-utility analysis was performed using the NHS and Social Scare perspective. Results A total of 49 patients were included, 35 treated within 48 hours “early” (median [IQR] 8.25 [3.7-20.5]) and 14 treated after 48 hours (median [IQR] 93.9 [66.7 - 100.1]). At discharge, 30 (86%) in the early treatment group had a good mRS outcome score (0–3) compared to 4 (29%) in the delayed group. EQ-5D-3L utility value at discharge was significantly higher for early treatment (0.609 vs 0.221, p<0.000). After adjusting for age and symptom duration at admission, early treatment incurred a lower average cost at discharge, £23,086 (95% CI: £15,186 to £30,987) vs £42,405 (95% CI: £25,457 to £59,354) [p<0.04]. A -£20,218 (95% CI: -£52,173 to £11,783) cost difference was observed at 12-month follow-up post discharge. Conclusions This study suggests that early treatment may be associated with better health outcomes and reduced patient healthcare costs, with a potential for savings to the NHS with faster treatment. Article Summary Strengths and limitations of this study - Admissions to acute hospitals with suspected encephalitis, using predetermined inclusion criteria were recruited across 29 hospitals in the UK within a 3-year period, giving the largest cohort of prospectively recruited HSV encephalitis cases in the UK to date. - Precise definitions to characterise those individuals with proven HSV encephalitis were applied thus ensuring accurate diagnoses. - Individuals were followed up systematically for 12 months after discharge for clinical, and quality of life data providing the first study to assess the effect of treatment delays on health care resources, costs and health related quality of life. - The analysis is limited by its relatively small sample size due to it being a rare disease, and the case record forms although thorough may not capture all health care costs incurred. This is particularly so for primary care and community care contact outside of the study hospitals.
As bacterial meningitis decreases in incidence, viral meningitis becomes relatively more important. The incidence and costs of viral meningitis in adults are unknown.
Methods
An epidemiological study of adults with suspected meningitis in England, was carried out between 2011 and 2014. We estimated incidence and healthcare costs using patient level data from the Northwest of England, and extrapolated to estimate resource use throughout the UK.
Results
Among 1117 patients enrolled, 638 (57%) had meningitis. 231/638 (36%) had viral meningitis, 99/638 (16%) bacterial and 267/638 (42%) unknown aetiology. Estimated annual incidences of viral and bacterial meningitis were 2.73 and 1.24 per 1 00 000 respectively. The yearly healthcare cost of viral and bacterial meningitis were similar: £3,220,343 (95% CI £1,206,963 – £4,418,424) and £4,860,218 (95% CI £3,728,598 – £6,358,419) respectively, p=0.57. The median length of stay for patients with viral meningitis was 4 days, increasing to 8 days in those treated with antivirals, which are of no proven benefit. Hospitalisation accounted for 79% of the cost.
Conclusions
Viral meningitis is the predominant cause of meningitis in adults in the UK. The total annual healthcare costs could be reduced by earlier discharge. This might be achieved through speedier diagnostics and avoiding unnecessary treatments.
Summary Encephalitis is an inflammation and swelling of the brain, which is often caused by a viral infection; it is an important cause of acute symptomatic seizures as well as subsequent epilepsy. Herein we describe the definition, epidemiology, and etiology of encephalitis as a cause of seizures. We then focus on encephalitis due to herpes simplex virus (the most common sporadic viral cause of encephalitis) and Japanese encephalitis virus (the most common epidemic viral cause). We also discuss the evidence for seizures occurring in the context of antibody‐associated encephalitis, an increasingly important condition. Finally, we describe the acute and longer‐term management of encephalitis‐related seizures and their potential pathophysiologic mechanisms, concluding with the emerging etiologic role of human herpesvirus 6.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)