Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study
Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study
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DOI：
10.1016/s1473-3099(10)70222-x
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发表时间：
2010-12-01
影响因子：
56.3
通讯作者：
Crowcroft, Natasha S.
中科院分区：
文献类型：
--
作者：
Granerod, Julia;Ambrose, Helen E.;Crowcroft, Natasha S.
背景脑炎有许多原因，但大多数患者的原因是未知的。我们的目的是建立的原因，并确定在脑炎患者在England.Methods的原因之间的临床差异积极招募2年（2005年10月和2006年11月之间的阶段开始）从24家医院的临床工作人员的所有年龄和症状提示脑炎的患者。系统性实验室检测包括PCR和抗体检测，用于检测所有常见的传染性脑炎病因，对免疫功能低下患者中不太常见的病因进行调查，并检测旅行相关病因（如有指征）。我们还测试了急性脑炎的非感染性原因，包括自身免疫。一个多学科专家小组审查了临床表现和医院检查，并指导进一步调查。患者出院后随访6个月。结果我们确定了203例脑炎。中位年龄为30岁（范围0-87岁）。86例患者（42%，95%CI 35-49）有感染原因，包括38例（19%，14-25）单纯疱疹病毒，10例（5%，2-9）水痘带状疱疹病毒和10例（5%，2-9）结核分枝杆菌; 75例（37%，30-44）原因不明。42例患者（21%，15-27）患有急性免疫介导的脑炎。24例患者（12%，8-17）死亡，结核分枝杆菌（3例患者; 30%，7-65）和水痘带状疱疹病毒（2例患者; 20%，2-56）感染的病死率较高。16例抗体相关性脑炎患者在所有组中结局最差，9例（56%，30-80）死亡或严重残疾。死亡的患者比存活的患者更有可能免疫功能低下（OR=3.44）。解释脑炎的早期诊断对于确保及时给予正确的治疗至关重要。广泛的检测大大降低了不明原因的比例，但不明原因的病例比例高于任何特定原因。
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, induding 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.