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Intern Med J. 2015 May;45(5):563-76. doi: 10.1111/imj.12749.

Consensus guidelines for the investigation and management of encephalitis in adults and children in Australia and New Zealand.

Author information

1
Discipline of Paediatrics and Child Health and Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Sydney Medical School, University of Sydney, Sydney, Australia.
2
Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia.
3
Health Protection, Hunter New England Population Health, Newcastle, New South Wales, Australia.
4
Biopreparedness, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
5
Department of Neurology, The Children's Hospital at Westmead, Sydney, Australia.
6
Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.
7
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
8
Departments of, General Medicine, Auckland City Hospital, Auckland, New Zealand, USA.
9
Liaison Psychiatry, Auckland City Hospital, Auckland, New Zealand, USA.
10
Department of Medicine and Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA.
11
St Vincent's Centre for applied medical research, University of New South Wales, Sydney, Australia.
12
Department of Neurology, St Vincent's Hospital, Sydney, Australia.
13
Department of Neurology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
14
Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia.
15
Emergency Department, Fremantle Hospital, Fremantle, Western Australia, Australia.
16
Emergency Department, Royal Perth Hospital, Perth, Australia.
17
Department of Infectious Diseases, North Shore Hospital, Auckland, New Zealand, USA.
18
National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia.

Abstract

Encephalitis is a complex neurological syndrome caused by inflammation of the brain parenchyma. The management of encephalitis is challenging because: the differential diagnosis of encephalopathy is broad; there is often rapid disease progression; it often requires intensive supportive management; and there are many aetiologic agents for which there is no definitive treatment. Patients with possible meningoencephalitis are often encountered in the emergency care environment where clinicians must consider differential diagnoses, perform appropriate investigations and initiate empiric antimicrobials. For patients who require admission to hospital and in whom encephalitis is likely, a staged approach to investigation and management is preferred with the potential involvement of multiple medical specialties. Key considerations in the investigation and management of patients with encephalitis addressed in this guideline include: Which first-line investigations should be performed?; Which aetiologies should be considered possible based on clinical features, risk factors and radiological features?; What tests should be arranged in order to diagnose the common causes of encephalitis?; When to consider empiric antimicrobials and immune modulatory therapies?; and What is the role of brain biopsy?

KEYWORDS:

Australia; New Zealand; encephalitis; guideline

PMID:
25955462
DOI:
10.1111/imj.12749
[Indexed for MEDLINE]

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