Management of infectious encephalitis in adults: Highlights from the French guidelines (short version) - 11/09/19

Doi : 10.1016/j.neurol.2019.07.009

L. Martinez-Almoyna ^a,^⁎ , T. De Broucker ^b, A. Mailles ^c, J.-P. Stahl ^c,^d
on behalf of the
Scientific Committee of the French Guidelines on the Management of Infectious Encephalitis in Adults
^a Neurologie, hôpital Nord, Assistance publique des Hôpitaux de Marseille, 13015 Marseille, France
^b Neurologie, centre hospitalier de Saint-Denis, 93200 Saint-Denis, France
^c Direction des maladies infectieuses, santé publique, 94415 Saint-Maurice, France
^d Infectiologie, université et CHU Grenoble Alpes, 38700 La Tronche, France

^⁎Corresponding author.

Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Abstract

The article highlights the French clinical guidelines for the management of adult patients with acute infectious encephalitis.

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Keywords : Encephalitis, Guidelines, HSV, VZV- Infection

Plan

Introduction

Question 1: when and how acute infectious encephalitis should be considered?

Clinical and biological recommendations

CSF recommendations

Lumbar puncture contraindication, EEG, and imaging recommendations

Question 2: what is the initial conduct to adopt (first 48h)?

Where to hospitalize the patient?

Anti-infective treatments

Symptomatic treatments, adjuvant treatments, and surgery

Clinical monitoring of patients presenting with a confirmed or suspected encephalitis

QUESTION 3: Management when the diagnosis is confirmed within 48h

Management of HSV Encephalitis in immunocompetent adult (Box 4)

VZV encephalitis in immunocompetent adults

Listeria monocytogenes encephalitis in immunocompetent adults

Tuberculous encephalitis in immunocompetent adults

Question 4: which conduct should be adopted when the diagnosis is not confirmed within 48h?

Should acyclovir be continued when the HSV PCR is negative?

Should acyclovir be continued when the VZV PCR is negative?

Should amoxicillin be continued?

Should a trial of antituberculosis treatment be initiated or continued after 48h?

Should a corticoid therapy be initiated when the diagnosis still needs to be confirmed at 48h?

Should a trial of doxycycline treatment be initiated?

Continuing the diagnostic investigation

Disclosure of interest

☆

These recommendations are the short version of former publications: Stahl JP, et al. Guidelines on the management of infectious encephalitis in adults. Med Mal Infect 2017;47:170–94 and Stahl JP, et al. Recommandations de prise en charge des encéphalites infectieuses de l’adulte. Prat Neurol 2018;9:195–203. (French translation). With permission.