Acute encephalitis in immunocompetent adults

• Published in: The Lancet (British edition) Vol. 393; no. 10172; pp. 702 - 716
• Main Authors: Venkatesan, Arun, Michael, Benedict D, Probasco, John C, Geocadin, Romergryko G, Solomon, Tom
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 16.02.2019; Elsevier Limited
• Subjects: Acute Disease; Adult; Adults; Antigens; Arthropods; Autoimmune diseases; Brain; Cerebrospinal fluid; Chicken pox; Consciousness; Convulsions & seizures; Diagnosis; Diagnostic systems; Edema; Encephalitis; Encephalitis - diagnosis; Encephalitis - therapy; Encephalopathy; Family medical history; Histopathology; Humans; Illnesses; Immunocompetence; Immunocompromised Host; Immunoglobulins; Immunosuppressive agents; Inflammation; Listeria; Magnetic resonance imaging; Management; Medical diagnosis; Medical imaging; Medical prognosis; Neurological complications; Neurological diseases; Next-generation sequencing; Parenchyma; Proteins; Rabies; Seizures; Tuberculosis; Urine; West Nile virus; Zika virus
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(18)32526-1

Encephalitis is a condition of inflammation of the brain parenchyma, occurs as a result of infectious or autoimmune causes, and can lead to encephalopathy, seizures, focal neurological deficits, neurological disability, and death. Viral causes account for the largest proportion, but in the last decade there has been growing recognition of anti-neuronal antibody syndromes. This Seminar focuses on the diagnosis and management of acute encephalitis in adults. Although viral and autoimmune causes are highlighted because of their prominent roles in encephalitis, other infectious pathogens are also considered. The role of cerebrospinal fluid studies, MRI, and novel diagnostic modalities (eg, next-generation sequencing) are discussed. Management approaches, including treatment of acute neurological complications and the use of immune suppressive and modulatory drugs for cases of suspected or confirmed autoimmune cause, are covered. Additionally, we discuss the remaining challenges in the diagnosis, management, and prognosis of encephalitis.