Abstract / Summary
Background: Encephalitis is difficult to diagnose and manage, posing a challenge to clinicians. Since the last European guidelines were published in 2010, novel causes have emerged, diagnostic processes have evolved and treatments assessed which need to be reflected in updated guidelines.
Objective: We aimed to produce recommendations for the diagnosis and management of infectious encephalitis in adults based on current evidence to equip clinicians to improve patient outcomes.
Methods: These guidelines were developed jointly with the support of two European specialist medical organisations. Clinical questions were prioritised and formulated in PICO format. A systematic literature search was conducted for each question, and the quality of evidence was assessed using standardised tools. Recommendations were developed according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Where only indirect evidence was available, a good practice statement was made.
Results: Sixteen questions were considered, with two recommendations reached: for initiation of intravenous aciclovir as soon as possible upon suspicion of encephalitis and against replacing pathogen-specific polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) with multiplex CSF PCR panels for diagnosis of adult patients with suspected infectious encephalitis. For adults with proven HSV encephalitis, we were unable to recommend for or against the use of corticosteroids. A further 13 good practice statements regarding when to clinically suspect infectious encephalitis, microbiological investigations, additional investigations, treatment and ongoing care and rehabilitation were agreed.
Conclusions: Given the clinical severity and public health importance of this condition, the paucity of high-quality evidence is striking. Transnational, large-scale research in infective encephalitis is encouraged.