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Semin Neurol 2016; 36(04): 367-372
DOI: 10.1055/s-0036-1585099
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Infectious Meningitis and Encephalitis

Amanda L. Piquet
1   Division of Neuroimmunology, Department of Neurology, University of Utah Hospital, Salt Lake City, Utah
,
Jennifer L. Lyons
2   Division of Neurological Infections and Inflammatory Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
3   Harvard Medical School, Boston, Massachusetts
› Author Affiliations
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Publication History

Publication Date:
19 September 2016 (online)

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Abstract

The clinician who is evaluating a patient with a suspected central nervous system infection often faces a large differential diagnosis. There are several signs, symptoms, geographical clues, and diagnostic testing, such as cerebrospinal fluid abnormalities and magnetic resonance imaging abnormalities, which can be helpful in identifying the etiological agent. By taking a systematic approach, one can often identify life-threatening, common, and/or treatable etiologies. Here the authors describe some of the pearls and pitfalls in diagnosing and treating acute infectious meningitis and encephalitis.

Keywords

encephalitis - meningitis - herpes simplex virus - arbovirus
 

  • References

  • 1 Venkatesan A, Tunkel AR, Bloch KC , et al; International Encephalitis Consortium. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis 2013; 57 (8) 1114-1128
    CrossrefPubMedGoogle Scholar
  • 2 Steiner I. Herpes simplex virus encephalitis: new infection or reactivation?. Curr Opin Neurol 2011; 24 (3) 268-274
    CrossrefPubMedGoogle Scholar
  • 3 Whitley RJ, Soong SJ, Linneman Jr C, Liu C, Pazin G, Alford CA ; Clinical Assessment. Herpes simplex encephalitis. JAMA 1982; 247 (3) 317-320
    CrossrefPubMedGoogle Scholar
  • 4 Bhattacharyya S, Lyons L. Neurology. Encephalitis. In: Singh AK, , editor. Scientific American Medicine [online] Hamilton (ON): Decker Intellectual Properties; May 2015. DOI: 10.2310/7900.1203. http://www.sciammedicine.com . Accessed June 27, 2016.
    Google Scholar
  • 5 Leypoldt F, Titulaer MJ, Aguilar E , et al. Herpes simplex virus-1 encephalitis can trigger anti-NMDA receptor encephalitis: case report. Neurology 2013; 81 (18) 1637-1639
    CrossrefPubMedGoogle Scholar
  • 6 Armangue T, Leypoldt F, Málaga I , et al. Herpes simplex virus encephalitis is a trigger of brain autoimmunity. Ann Neurol 2014; 75 (2) 317-323
    CrossrefPubMedGoogle Scholar
  • 7 Tyler KL. Current developments in understanding of West Nile virus central nervous system disease. Curr Opin Neurol 2014; 27 (3) 342-348
    CrossrefPubMedGoogle Scholar
  • 8 Lakeman FD, Whitley RJ ; National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. J Infect Dis 1995; 171 (4) 857-863
    CrossrefPubMedGoogle Scholar
  • 9 Sköldenberg B. Herpes simplex encephalitis. Scand J Infect Dis Suppl 1996; 100: 8-13
    PubMedGoogle Scholar
  • 10 Debiasi RL, Tyler KL. Molecular methods for diagnosis of viral encephalitis. Clin Microbiol Rev 2004; 17 (4) 903-925
    CrossrefPubMedGoogle Scholar
  • 11 Lanciotti RS, Kerst AJ, Nasci RS , et al. Rapid detection of West Nile virus from human clinical specimens, field-collected mosquitoes, and avian samples by a TaqMan reverse transcriptase-PCR assay. J Clin Microbiol 2000; 38 (11) 4066-4071
    PubMedGoogle Scholar
  • 12 Tardei G, Ruta S, Chitu V, Rossi C, Tsai TF, Cernescu C. Evaluation of immunoglobulin M (IgM) and IgG enzyme immunoassays in serologic diagnosis of West Nile virus infection. J Clin Microbiol 2000; 38 (6) 2232-2239
    PubMedGoogle Scholar
  • 13 Schubert RD, Wilson MR. A tale of two approaches: how metagenomics and proteomics are shaping the future of encephalitis diagnostics. Curr Opin Neurol 2015; 28 (3) 283-287
    CrossrefPubMedGoogle Scholar
  • 14 Wilson MR, Naccache SN, Samayoa E , et al. Actionable diagnosis of neuroleptospirosis by next-generation sequencing. N Engl J Med 2014; 370 (25) 2408-2417
    CrossrefPubMedGoogle Scholar
  • 15 Cho TA, Mckendall RR. Clinical approach to the syndromes of viral encephalitis, myelitis, and meningitis. Handb Clin Neurol 2014; 123: 89-121
    PubMedGoogle Scholar
  • 16 Ramos-Estebanez C, Lizarraga KJ, Merenda A. A systematic review on the role of adjunctive corticosteroids in herpes simplex virus encephalitis: is timing critical for safety and efficacy?. Antivir Ther 2014; 19 (2) 133-139
    PubMedGoogle Scholar
  • 17 Martinez-Torres F, Menon S, Pritsch M , et al; GACHE Investigators. Protocol for German trial of acyclovir and corticosteroids in herpes-simplex-virus-encephalitis (GACHE): a multicenter, multinational, randomized, double-blind, placebo-controlled German, Austrian and Dutch trial [ISRCTN45122933]. BMC Neurol 2008; 8: 40
    CrossrefPubMedGoogle Scholar
  • 18 van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351 (18) 1849-1859
    CrossrefPubMedGoogle Scholar
  • 19 Tsai J, Nagel MA, Gilden D. Skin rash in meningitis and meningoencephalitis. Neurology 2013; 80 (19) 1808-1811
    CrossrefPubMedGoogle Scholar
  • 20 Ramers C, Billman G, Hartin M, Ho S, Sawyer MH. Impact of a diagnostic cerebrospinal fluid enterovirus polymerase chain reaction test on patient management. JAMA 2000; 283 (20) 2680-2685
    CrossrefPubMedGoogle Scholar
  • 21 Roos KL. Pearls: infectious diseases. Semin Neurol 2010; 30 (1) 71-73
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Hsu HE, Shutt KA, Moore MR , et al. Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. N Engl J Med 2009; 360 (3) 244-256
    CrossrefPubMedGoogle Scholar
  • 23 Tunkel AR, Hartman BJ, Kaplan SL , et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39 (9) 1267-1284
    CrossrefPubMedGoogle Scholar
  • 24 Aurelius E, Franzen-Röhl E, Glimåker M , et al; HSV-2 Meningitis Study Group. Long-term valacyclovir suppressive treatment after herpes simplex virus type 2 meningitis: a double-blind, randomized controlled trial. Clin Infect Dis 2012; 54 (9) 1304-1313
    CrossrefPubMedGoogle Scholar
  • 25 Tunkel AR, Glaser CA, Bloch KC , et al; Infectious Diseases Society of America. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2008; 47 (3) 303-327
    CrossrefPubMedGoogle Scholar
  • 26 Centers for Disease Control and Prevention. USA cumulative human disease cases reported to CDC ArboNET 2003-2015. http://diseasemaps.usgs.gov/index.html . Accessed June 22, 2016
    PubMedGoogle Scholar