Management of suspected viral encephalitis in children – Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group National Guidelines - 18/04/12

Doi : 10.1016/j.jinf.2011.11.013

R. Kneen ^a,^b,^{^{r
R. Kneen and B.D. Michael are joint first authors.},}^⁎ , B.D. Michael ^b,^c,^i,^{^{j
Tel.: +44 151 529 5460; fax: +44 151 529 5465.},}^{^{r
R. Kneen and B.D. Michael are joint first authors.}} , E. Menson ^d,^{^{k
Tel.: +44 20 7188 7188.}} , B. Mehta ^a,^{^{l
Tel.: +44 151 228 4811; fax: +44 151 228 032.}} , A. Easton ^e,^{^{m
Tel.: +44 1653 692 583; fax: +44 1653 604 369.}} , C. Hemingway ^f,^{^{n
Tel.: +44 207 405 9200x8308; fax: +44 20 7813 8279.}} , P.E. Klapper ^g,^{^{o
Tel.: +44 161 276 8853; fax: +44 161 276 5744.}} , A. Vincent ^h,^{^{p
Tel.: +44 1865 280528; fax: +44 1865 280535.}} , M. Lim ^d,^{^{k
Tel.: +44 20 7188 7188.}} , E. Carrol ^a,^{^{q
Tel.: +44 151 252 5160.}} , T. Solomon ^b,^c,^i,^{^{j
Tel.: +44 151 529 5460; fax: +44 151 529 5465.}}
On behalf of the National Encephalitis Guidelines Development and Stakeholder Groups
^a Alder Hey Children’s NHS Foundation Trust, Eaton Road, West Derby, Liverpool L12 2AP, UK
^b Institute of Infection and Global Health, University of Liverpool, 8th Floor Duncan Building, Daulby Street, Liverpool L69 3GA, UK
^c The Walton Centre Neurology NHS Foundation Trust, Lower Lane, Fazakerly, Liverpool L9 7JL, UK
^d Evelina Children’s Hospital London, Guys and St Thomas’, Westminster Bridge Road, London SE1 7EH, UK
^e Encephalitis Society, 32 Castlegate, Malton, North Yorkshire, Y017 7DT, UK
^f Great Ormond Street Hospital, 40 Bernard Street, London WC1N 1LE, UK
^g University of Manchester, 2nd Floor, Clinical Sciences Building 2, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
^h Oxford Ion Channel and Disease Initiative, Department of Clinical and Experimental Neuroimmunology, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, UK
ⁱ Department of Neurological Science, University of Liverpool, 8th Floor Duncan Building, Daulby Street, Liverpool L69 3GA, UK

Corresponding author. Tel.: +44 151 228 4811; fax: +44 151 228 032.

Summary

In the 1980s the outcome of patients with herpes simplex encephalitis was shown to be dramatically improved with aciclovir treatment. Delays in starting treatment, particularly beyond 48 h after hospital admission, are associated with a worse prognosis. Several comprehensive reviews of the investigation and management of encephalitis have been published. However, their impact on day-to-day clinical practice appears to be limited. The emergency management of meningitis in children and adults was revolutionised by the introduction of a simple algorithm as part of management guidelines.

In February 2008 a group of clinicians met in Liverpool to begin the development process for clinical care guidelines based around a similar simple algorithm, supported by an evidence base, whose implementation is hoped would improve the management of patients with suspected encephalitis.

Le texte complet de cet article est disponible en PDF.

Keywords : Encephalitis, Viral encephalitis, Herpes simplex virus, Immunocompromised, Varicella zoster virus, Enterovirus, Antibody-associated encephalitis

Plan

Introduction

Classification of encephalitis

Epidemiology

Aims and scope of the guideline

Methods

Definition of childhood for this document

Diagnosing encephalitis

Which clinical features should lead to a suspicion of encephalitis in children, how do they differ from other encephalopathies, and can they be used to diagnose the underlying cause?

Distinguishing HSV encephalitis from other encephalopathies

Which patients with suspected encephalitis should have a lumbar puncture (LP), and in which should this be preceded by a computed tomography (CT) scan?

What information should be gathered from the LP?

What virological investigations should be performed ?

What antibody testing should be done on serum & CSF?

What PCR/culture should be done on other samples (e.g. throat swab, stool, vesicle etc)?

Which children with encephalitis should have an HIV test?

What is the role of brain biopsy in children with suspected viral encephalitis?

What is the role of magnetic resonance imaging (MRI) and other advanced imaging techniques in children with suspected viral encephalitis?

Which children with suspected viral encephalitis should have an electroencephalogram (EEG)?

Treatment of viral encephalitis

For which patients should aciclovir treatment be started empirically?

How long should aciclovir be continued in proven HSV encephalitis, and is there a role for oral treatment?

When can presumptive treatment with aciclovir be safely stopped, in patients that are HSV PCR negative?

What is the role of corticosteroids in HSV encephalitis?

What should be the specific management of VZV encephalitis?

What should be the specific management of enterovirus meningoencephalitis?

What acute facilities should be available and which patients should be transferred to a specialist unit?

What rehabilitation and support services should be available for children affected by encephalitis and their families?

Special circumstances

What is the management of suspected encephalitis in children returning from travelling overseas?

What differences are there in the management of suspected encephalitis in the immunocompromised?

What differences are there in the presentation and management of encephalitis associated with antibodies?

Encephalitis associated with antibodies to the voltage-gated potassium channel (VGKC)-complex proteins

What are the differences in patients with encephalitis associated with antibodies to N-methyl-D-Aspartic acid (NMDA) receptor?

Guideline implementation and audit

Export

Vol 64 - N° 5

P. 449-477 - mai 2012 Retour au numéro

Article suivant

Community-onset healthcare-related urinary tract infections: Comparison with community and hospital-acquired urinary tract infections
Silvia Aguilar-Duran, Juan P. Horcajada, Luisa Sorlí, Milagro Montero, Margarita Salvadó, Santiago Grau, Julià Gómez, Hernando Knobel

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

connectez-vous ou créez un compte

Management of suspected viral encephalitis in children – Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group National Guidelines - 18/04/12

Summary

Plan

Export citations

Fichier

Contenu

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL