Diagnosis and treatment of acute encephalitis
Diagnosis and treatment of acute encephalitis
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DOI：
10.1097/00127893-200006030-00001
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发表时间：
2000-05-01
期刊：
影响因子：
1.2
通讯作者：
Davis, LE
中科院分区：
文献类型：
--
作者：
Davis, LE
背景-脑炎是中枢神经系统第二常见的感染类型，并且仍然是死亡和发病的重要原因。综述摘要-对于怀疑患有脑炎的患者，必须区分脑炎和脑病以及感染性脑炎和急性播散性脑脊髓炎。一旦诊断出传染性脑炎，就应该确定患者是否患有单纯疱疹脑炎，因为使用阿昔洛韦等抗病毒药物治疗可以大大改善预后。大多数传染性脑炎病例是由病毒引起的，但细菌、真菌和寄生虫也可能是原因，特别是在免疫抑制的个体中。快速确定传染性脑炎的病因仍然很困难，但检测脑脊液或血清中感染原的 IgM 抗体的新检测方法以及检测脑脊液中感染原核酸片段的聚合酶链反应检测可以实现更快、更准确的诊断。现在，抗菌药物可用于治疗许多传染原和一些 DNA 病毒，但对患者症状的良好治疗仍然非常重要。结论 - 本综述通过询问和回答几个关键问题，提供了一种诊断可能的脑炎的方法。确定脑炎病因的方法和更好的抗菌药物的最新进展提高了成功治疗的可能性。
BACKGROUND- Encephalitis is the second most common type of infection of the central nervous system and continues to be an important cause of mortality and morbidity.REVIEW SUMMARY- In a patient who is suspected of having encephalitis, one must distinguish between encephalitis and encephalopathy and between infectious encephalitis and acute disseminated encephalomyelitis. Once infectious encephalitis has been diagnosed, one should determine whether the patient has herpes simplex encephalitis, because treatment with antiviral drugs such as acyclovir greatly improve outcome. Most cases of infectious encephalitis are due to viruses, but bacteria, fungi, and parasites also can be the cause, especially in immunosuppressed individuals. The rapid determination of the cause of infectious encephalitis remains difficult, but newer assays to detect IgM antibody to the infectious agent in CSF or serum and polymerase chain reaction assays for nucleic acid fragments of the infectious agent in CSF are enabling faster and more accurate diagnoses. Antimicrobial drugs now are available for many of the infectious agents and some DNA viruses, but excellent treatment of the patient's symptoms remains very important.CONCLUSIONS- This review provides an approach to diagnosing possible encephalitis through asking and answering several key questions. Recent advances in methods of determining the cause of the encephalitis and better antimicrobial drugs improve the likelihood of successful treatment.