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In search of encephalitis etiologies: diagnostic challenges in the California Encephalitis Project, 1998-2000
Carol A Glaser1, Sabrina Gilliam, David Schnurr
1Viral and Rickettsial Disease Laboratory, California Department of Health Services, Richmond 94804, USA. cglaser@dhs.ca.gov
Abstract:
The California Encephalitis Project was initiated in June 1998 to identify the causes and characterize the clinical and epidemiologic features of encephalitis in California. Testing for >or=13 agents, including herpesviruses, enteroviruses, arboviruses, Bartonella species, Chlamydia species, and Mycoplasma pneumoniae, was performed at the Viral and Rickettsial Disease Laboratory (Richmond, California). Epidemiologic and clinical information collected for each case guided further testing. From June 1998 through December 2000, 334 patients who met our case definition of encephalitis were enrolled. A confirmed or probable viral agent of encephalitis was found in 31 cases (9%), a bacterial agent was found in 9 cases (3%), and a parasitic agent was found in 2 cases (1%). A possible etiology was identified in 41 cases (12%). A noninfectious etiology was identified in 32 cases (10%), and a nonencephalitis infection was identified in 11 (3%). Despite extensive testing and evaluation, the etiology of 208 cases (62%) remained unexplained.
Insights
The California Encephalitis Project investigated encephalitis causes from 1998-2000. Infectious agents were identified in only 13% of cases, with most etiologies remaining unexplained.
Area of Science:
- Neuroscience
- Infectious Diseases
- Epidemiology
Background:
- Encephalitis presents a significant public health challenge, necessitating comprehensive etiological investigations.
- Understanding the diverse causes of encephalitis is crucial for effective diagnosis and treatment.
Purpose of the Study:
- To identify the causes of encephalitis in California.
- To characterize the clinical and epidemiologic features of encephalitis cases.
Main Methods:
- The California Encephalitis Project enrolled 334 patients between June 1998 and December 2000.
- Extensive laboratory testing was performed for viral, bacterial, and parasitic agents.
- Clinical and epidemiological data guided further diagnostic testing.
Main Results:
- An infectious etiology was confirmed or probable in 31 cases (9%).
- Bacterial and parasitic agents were identified in 9 (3%) and 2 (1%) cases, respectively.
- The etiology remained unexplained in 62% of cases (208 patients).
Conclusions:
- A significant proportion of encephalitis cases in California during the study period had an unexplained etiology.
- Further research is needed to identify novel pathogens and non-infectious causes of encephalitis.