Immune-mediated encephalitis for the infectious disease specialist

Area of Science:

• Neurology
• Immunology
• Infectious Diseases

Background:

• Autoimmune encephalitis (AE) incidence may rival infectious encephalitis.
• Distinguishing AE from infectious encephalitis is clinically challenging.
• Advances in understanding AE, particularly antibody-mediated forms, are significant.

Purpose of the Study:

• To highlight the increasing recognition of AE.
• To emphasize the need to differentiate AE from infectious encephalitis.
• To discuss infectious triggers and complications of AE treatment.

Main Methods:

• Review of recent epidemiological studies.
• Analysis of diagnostic criteria for AE.
• Examination of knowledge regarding antibodies to neuronal cell surface antigens.
• Assessment of infectious triggers and complications associated with AE therapies.

Main Results:

• AE incidence is comparable to infectious encephalitis.
• Anti-NMDA receptor and anti-LGI1 encephalitis have distinct clinical features.
• Herpes simplex encephalitis can trigger autoimmune neurologic relapse.
• AE therapies carry risks of infectious complications, including with newer agents like anakinra and tocilizumab.

Conclusions:

• Diagnosis and management of AE are complex.
• Awareness of diagnostic criteria and clinical syndromes is vital.
• Understanding infectious triggers and treatment complications is critical for optimal patient care.