Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study
Summary Background Encephalitis has many causes, but for most patients the cause is unknown. We aimed to establish the cause and identify the clinical differences between causes in patients with encephalitis in England. Methods Patients of all ages and with symptoms suggestive of encephalitis were a...
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| Veröffentlicht in: | The Lancet infectious diseases 2010-12, Vol.10 (12), p.835-844 |
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| creator | Granerod, Julia, MSc Ambrose, Helen E, DPhil Davies, Nicholas WS, PhD Clewley, Jonathan P, PhD Walsh, Amanda L, MSc Morgan, Dilys, MD Cunningham, Richard, FRCPath Zuckerman, Mark, FRCPath Mutton, Ken J, MBBS Solomon, Tom, Prof Ward, Katherine N, PhD Lunn, Michael PT, FRCP Irani, Sarosh R, MRCP Vincent, Angela, Prof Brown, David WG, Prof Crowcroft, Natasha S, MD |
| description | Summary Background Encephalitis has many causes, but for most patients the cause is unknown. We aimed to establish the cause and identify the clinical differences between causes in patients with encephalitis in England. Methods Patients of all ages and with symptoms suggestive of encephalitis were actively recruited for 2 years (staged start between October, 2005, and November, 2006) from 24 hospitals by clinical staff. Systematic laboratory testing included PCR and antibody assays for all commonly recognised causes of infectious encephalitis, investigation for less commonly recognised causes in immunocompromised patients, and testing for travel-related causes if indicated. We also tested for non-infectious causes for acute encephalitis including autoimmunity. A multidisciplinary expert team reviewed clinical presentation and hospital tests and directed further investigations. Patients were followed up for 6 months after discharge from hospital. Findings We identified 203 patients with encephalitis. Median age was 30 years (range 0–87). 86 patients (42%, 95% CI 35–49) had infectious causes, including 38 (19%, 14–25) herpes simplex virus, ten (5%, 2–9) varicella zoster virus, and ten (5%, 2–9) Mycobacterium tuberculosis ; 75 (37%, 30–44) had unknown causes. 42 patients (21%, 15–27) had acute immune-mediated encephalitis. 24 patients (12%, 8–17) died, with higher case fatality for infections from M tuberculosis (three patients; 30%, 7–65) and varicella zoster virus (two patients; 20%, 2–56). The 16 patients with antibody-associated encephalitis had the worst outcome of all groups—nine (56%, 30–80) either died or had severe disabilities. Patients who died were more likely to be immunocompromised than were those who survived (OR=3·44). Interpretation Early diagnosis of encephalitis is crucial to ensure that the right treatment is given on time. Extensive testing substantially reduced the proportion with unknown cause, but the proportion of cases with unknown cause was higher than that for any specific identified cause. Funding The Policy Research Programme, Department of Health, UK. |
| doi_str_mv | 10.1016/S1473-3099(10)70222-X |
| format | Article |
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We aimed to establish the cause and identify the clinical differences between causes in patients with encephalitis in England. Methods Patients of all ages and with symptoms suggestive of encephalitis were actively recruited for 2 years (staged start between October, 2005, and November, 2006) from 24 hospitals by clinical staff. Systematic laboratory testing included PCR and antibody assays for all commonly recognised causes of infectious encephalitis, investigation for less commonly recognised causes in immunocompromised patients, and testing for travel-related causes if indicated. We also tested for non-infectious causes for acute encephalitis including autoimmunity. A multidisciplinary expert team reviewed clinical presentation and hospital tests and directed further investigations. Patients were followed up for 6 months after discharge from hospital. Findings We identified 203 patients with encephalitis. Median age was 30 years (range 0–87). 86 patients (42%, 95% CI 35–49) had infectious causes, including 38 (19%, 14–25) herpes simplex virus, ten (5%, 2–9) varicella zoster virus, and ten (5%, 2–9) Mycobacterium tuberculosis ; 75 (37%, 30–44) had unknown causes. 42 patients (21%, 15–27) had acute immune-mediated encephalitis. 24 patients (12%, 8–17) died, with higher case fatality for infections from M tuberculosis (three patients; 30%, 7–65) and varicella zoster virus (two patients; 20%, 2–56). The 16 patients with antibody-associated encephalitis had the worst outcome of all groups—nine (56%, 30–80) either died or had severe disabilities. Patients who died were more likely to be immunocompromised than were those who survived (OR=3·44). Interpretation Early diagnosis of encephalitis is crucial to ensure that the right treatment is given on time. Extensive testing substantially reduced the proportion with unknown cause, but the proportion of cases with unknown cause was higher than that for any specific identified cause. Funding The Policy Research Programme, Department of Health, UK.</description><identifier>ISSN: 1473-3099</identifier><identifier>EISSN: 1474-4457</identifier><identifier>DOI: 10.1016/S1473-3099(10)70222-X</identifier><identifier>PMID: 20952256</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Age ; Aged ; Aged, 80 and over ; Bacterial diseases ; Biological and medical sciences ; Child ; Child, Preschool ; Communicable Diseases - epidemiology ; Communicable Diseases - etiology ; Communicable Diseases - immunology ; Communicable Diseases - microbiology ; Encephalitis - epidemiology ; Encephalitis - etiology ; Encephalitis - immunology ; Encephalitis - microbiology ; England - epidemiology ; Female ; Herpes simplex virus ; Human bacterial diseases ; Human viral diseases ; Humans ; Infant ; Infant, Newborn ; Infectious Disease ; Infectious diseases ; Laboratory tests ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Policy research ; Prospective Studies ; Regression Analysis ; Tuberculosis ; Tuberculosis and atypical mycobacterial infections ; Viral diseases ; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye ; Young Adult</subject><ispartof>The Lancet infectious diseases, 2010-12, Vol.10 (12), p.835-844</ispartof><rights>Elsevier Ltd</rights><rights>2010 Elsevier Ltd</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Limited Dec 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c607t-64e4956e19885c6633e651e6b93e1e4d360a860b6b2947ca345b9f1b35c7094b3</citedby><cites>FETCH-LOGICAL-c607t-64e4956e19885c6633e651e6b93e1e4d360a860b6b2947ca345b9f1b35c7094b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S147330991070222X$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23433389$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20952256$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Granerod, Julia, MSc</creatorcontrib><creatorcontrib>Ambrose, Helen E, DPhil</creatorcontrib><creatorcontrib>Davies, Nicholas WS, PhD</creatorcontrib><creatorcontrib>Clewley, Jonathan P, PhD</creatorcontrib><creatorcontrib>Walsh, Amanda L, MSc</creatorcontrib><creatorcontrib>Morgan, Dilys, MD</creatorcontrib><creatorcontrib>Cunningham, Richard, FRCPath</creatorcontrib><creatorcontrib>Zuckerman, Mark, FRCPath</creatorcontrib><creatorcontrib>Mutton, Ken J, MBBS</creatorcontrib><creatorcontrib>Solomon, Tom, Prof</creatorcontrib><creatorcontrib>Ward, Katherine N, PhD</creatorcontrib><creatorcontrib>Lunn, Michael PT, FRCP</creatorcontrib><creatorcontrib>Irani, Sarosh R, MRCP</creatorcontrib><creatorcontrib>Vincent, Angela, Prof</creatorcontrib><creatorcontrib>Brown, David WG, Prof</creatorcontrib><creatorcontrib>Crowcroft, Natasha S, MD</creatorcontrib><creatorcontrib>on behalf of the UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group</creatorcontrib><creatorcontrib>UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group</creatorcontrib><title>Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study</title><title>The Lancet infectious diseases</title><addtitle>Lancet Infect Dis</addtitle><description>Summary Background Encephalitis has many causes, but for most patients the cause is unknown. We aimed to establish the cause and identify the clinical differences between causes in patients with encephalitis in England. Methods Patients of all ages and with symptoms suggestive of encephalitis were actively recruited for 2 years (staged start between October, 2005, and November, 2006) from 24 hospitals by clinical staff. Systematic laboratory testing included PCR and antibody assays for all commonly recognised causes of infectious encephalitis, investigation for less commonly recognised causes in immunocompromised patients, and testing for travel-related causes if indicated. We also tested for non-infectious causes for acute encephalitis including autoimmunity. A multidisciplinary expert team reviewed clinical presentation and hospital tests and directed further investigations. Patients were followed up for 6 months after discharge from hospital. Findings We identified 203 patients with encephalitis. Median age was 30 years (range 0–87). 86 patients (42%, 95% CI 35–49) had infectious causes, including 38 (19%, 14–25) herpes simplex virus, ten (5%, 2–9) varicella zoster virus, and ten (5%, 2–9) Mycobacterium tuberculosis ; 75 (37%, 30–44) had unknown causes. 42 patients (21%, 15–27) had acute immune-mediated encephalitis. 24 patients (12%, 8–17) died, with higher case fatality for infections from M tuberculosis (three patients; 30%, 7–65) and varicella zoster virus (two patients; 20%, 2–56). The 16 patients with antibody-associated encephalitis had the worst outcome of all groups—nine (56%, 30–80) either died or had severe disabilities. Patients who died were more likely to be immunocompromised than were those who survived (OR=3·44). Interpretation Early diagnosis of encephalitis is crucial to ensure that the right treatment is given on time. Extensive testing substantially reduced the proportion with unknown cause, but the proportion of cases with unknown cause was higher than that for any specific identified cause. Funding The Policy Research Programme, Department of Health, UK.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bacterial diseases</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Communicable Diseases - epidemiology</subject><subject>Communicable Diseases - etiology</subject><subject>Communicable Diseases - immunology</subject><subject>Communicable Diseases - microbiology</subject><subject>Encephalitis - epidemiology</subject><subject>Encephalitis - etiology</subject><subject>Encephalitis - immunology</subject><subject>Encephalitis - microbiology</subject><subject>England - epidemiology</subject><subject>Female</subject><subject>Herpes simplex virus</subject><subject>Human bacterial diseases</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infectious Disease</subject><subject>Infectious diseases</subject><subject>Laboratory tests</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Policy research</subject><subject>Prospective Studies</subject><subject>Regression Analysis</subject><subject>Tuberculosis</subject><subject>Tuberculosis and atypical mycobacterial infections</subject><subject>Viral diseases</subject><subject>Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye</subject><subject>Young 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England: a multicentre, population-based prospective study</title><author>Granerod, Julia, MSc ; Ambrose, Helen E, DPhil ; Davies, Nicholas WS, PhD ; Clewley, Jonathan P, PhD ; Walsh, Amanda L, MSc ; Morgan, Dilys, MD ; Cunningham, Richard, FRCPath ; Zuckerman, Mark, FRCPath ; Mutton, Ken J, MBBS ; Solomon, Tom, Prof ; Ward, Katherine N, PhD ; Lunn, Michael PT, FRCP ; Irani, Sarosh R, MRCP ; Vincent, Angela, Prof ; Brown, David WG, Prof ; Crowcroft, Natasha S, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c607t-64e4956e19885c6633e651e6b93e1e4d360a860b6b2947ca345b9f1b35c7094b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bacterial diseases</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Communicable Diseases - epidemiology</topic><topic>Communicable Diseases - etiology</topic><topic>Communicable Diseases - immunology</topic><topic>Communicable Diseases - microbiology</topic><topic>Encephalitis - epidemiology</topic><topic>Encephalitis - etiology</topic><topic>Encephalitis - immunology</topic><topic>Encephalitis - microbiology</topic><topic>England - epidemiology</topic><topic>Female</topic><topic>Herpes simplex virus</topic><topic>Human bacterial diseases</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infectious Disease</topic><topic>Infectious diseases</topic><topic>Laboratory tests</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Policy research</topic><topic>Prospective Studies</topic><topic>Regression Analysis</topic><topic>Tuberculosis</topic><topic>Tuberculosis and atypical mycobacterial infections</topic><topic>Viral diseases</topic><topic>Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Granerod, Julia, MSc</creatorcontrib><creatorcontrib>Ambrose, Helen E, DPhil</creatorcontrib><creatorcontrib>Davies, Nicholas WS, PhD</creatorcontrib><creatorcontrib>Clewley, Jonathan P, PhD</creatorcontrib><creatorcontrib>Walsh, Amanda L, MSc</creatorcontrib><creatorcontrib>Morgan, Dilys, MD</creatorcontrib><creatorcontrib>Cunningham, Richard, FRCPath</creatorcontrib><creatorcontrib>Zuckerman, Mark, FRCPath</creatorcontrib><creatorcontrib>Mutton, Ken J, MBBS</creatorcontrib><creatorcontrib>Solomon, Tom, Prof</creatorcontrib><creatorcontrib>Ward, Katherine N, PhD</creatorcontrib><creatorcontrib>Lunn, Michael PT, FRCP</creatorcontrib><creatorcontrib>Irani, Sarosh R, MRCP</creatorcontrib><creatorcontrib>Vincent, Angela, Prof</creatorcontrib><creatorcontrib>Brown, David WG, Prof</creatorcontrib><creatorcontrib>Crowcroft, Natasha S, MD</creatorcontrib><creatorcontrib>on behalf of the UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group</creatorcontrib><creatorcontrib>UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Pharma and Biotech Premium PRO</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and 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(Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><jtitle>The Lancet infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Granerod, Julia, MSc</au><au>Ambrose, Helen E, DPhil</au><au>Davies, Nicholas WS, PhD</au><au>Clewley, Jonathan P, PhD</au><au>Walsh, Amanda L, MSc</au><au>Morgan, Dilys, MD</au><au>Cunningham, Richard, FRCPath</au><au>Zuckerman, Mark, FRCPath</au><au>Mutton, Ken J, MBBS</au><au>Solomon, Tom, Prof</au><au>Ward, Katherine N, PhD</au><au>Lunn, Michael PT, FRCP</au><au>Irani, Sarosh R, MRCP</au><au>Vincent, Angela, Prof</au><au>Brown, David WG, Prof</au><au>Crowcroft, Natasha S, MD</au><aucorp>on behalf of the UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group</aucorp><aucorp>UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study</atitle><jtitle>The Lancet infectious diseases</jtitle><addtitle>Lancet Infect Dis</addtitle><date>2010-12-01</date><risdate>2010</risdate><volume>10</volume><issue>12</issue><spage>835</spage><epage>844</epage><pages>835-844</pages><issn>1473-3099</issn><eissn>1474-4457</eissn><coden>LANCAO</coden><abstract>Summary Background Encephalitis has many causes, but for most patients the cause is unknown. We aimed to establish the cause and identify the clinical differences between causes in patients with encephalitis in England. Methods Patients of all ages and with symptoms suggestive of encephalitis were actively recruited for 2 years (staged start between October, 2005, and November, 2006) from 24 hospitals by clinical staff. Systematic laboratory testing included PCR and antibody assays for all commonly recognised causes of infectious encephalitis, investigation for less commonly recognised causes in immunocompromised patients, and testing for travel-related causes if indicated. We also tested for non-infectious causes for acute encephalitis including autoimmunity. A multidisciplinary expert team reviewed clinical presentation and hospital tests and directed further investigations. Patients were followed up for 6 months after discharge from hospital. Findings We identified 203 patients with encephalitis. Median age was 30 years (range 0–87). 86 patients (42%, 95% CI 35–49) had infectious causes, including 38 (19%, 14–25) herpes simplex virus, ten (5%, 2–9) varicella zoster virus, and ten (5%, 2–9) Mycobacterium tuberculosis ; 75 (37%, 30–44) had unknown causes. 42 patients (21%, 15–27) had acute immune-mediated encephalitis. 24 patients (12%, 8–17) died, with higher case fatality for infections from M tuberculosis (three patients; 30%, 7–65) and varicella zoster virus (two patients; 20%, 2–56). The 16 patients with antibody-associated encephalitis had the worst outcome of all groups—nine (56%, 30–80) either died or had severe disabilities. Patients who died were more likely to be immunocompromised than were those who survived (OR=3·44). Interpretation Early diagnosis of encephalitis is crucial to ensure that the right treatment is given on time. Extensive testing substantially reduced the proportion with unknown cause, but the proportion of cases with unknown cause was higher than that for any specific identified cause. Funding The Policy Research Programme, Department of Health, UK.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>20952256</pmid><doi>10.1016/S1473-3099(10)70222-X</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_proquest_miscellaneous_954590445 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adolescent Adult Age Aged Aged, 80 and over Bacterial diseases Biological and medical sciences Child Child, Preschool Communicable Diseases - epidemiology Communicable Diseases - etiology Communicable Diseases - immunology Communicable Diseases - microbiology Encephalitis - epidemiology Encephalitis - etiology Encephalitis - immunology Encephalitis - microbiology England - epidemiology Female Herpes simplex virus Human bacterial diseases Human viral diseases Humans Infant Infant, Newborn Infectious Disease Infectious diseases Laboratory tests Male Medical sciences Middle Aged Multivariate Analysis Policy research Prospective Studies Regression Analysis Tuberculosis Tuberculosis and atypical mycobacterial infections Viral diseases Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye Young Adult |
| title | Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-03T03%3A33%3A08IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Causes%20of%20encephalitis%20and%20differences%20in%20their%20clinical%20presentations%20in%20England:%20a%20multicentre,%20population-based%20prospective%20study&rft.jtitle=The%20Lancet%20infectious%20diseases&rft.au=Granerod,%20Julia,%20MSc&rft.aucorp=on%20behalf%20of%20the%20UK%20Health%20Protection%20Agency%20(HPA)%20Aetiology%20of%20Encephalitis%20Study%20Group&rft.date=2010-12-01&rft.volume=10&rft.issue=12&rft.spage=835&rft.epage=844&rft.pages=835-844&rft.issn=1473-3099&rft.eissn=1474-4457&rft.coden=LANCAO&rft_id=info:doi/10.1016/S1473-3099(10)70222-X&rft_dat=%3Cproquest_cross%3E817650313%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=814379591&rft_id=info:pmid/20952256&rft_els_id=S147330991070222X&rfr_iscdi=true |