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Diagnosing infectious encephalitis: a narrative review

Sabine E Olie1, Steven L Staal1, Diederik van de Beek1

  • 1Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|November 24, 2024
PubMed
Abstract

Insights

Diagnosing infectious encephalitis remains challenging, with current methods confirming the cause in only about half of patients. Novel diagnostic techniques show promise but are not yet ready for widespread clinical use.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Diagnostic Medicine

Background:

  • Infectious encephalitis diagnosis is complex due to diverse pathogens, primarily viruses.
  • A significant number of patients lack a pathogen identification despite clinical diagnosis.
  • Advancements in diagnostic testing aim to improve pathogen detection and address diagnostic challenges.

Purpose of the Study:

  • To present a comprehensive clinical approach for diagnosing infectious encephalitis.
  • To explore novel diagnostic methods for identifying causative agents of encephalitis.

Main Methods:

  • Literature search of PubMed and author-known articles up to September 1, 2024.
  • Review of clinical characteristics, cerebrospinal fluid (CSF) analysis, and neuroimaging.
  • Evaluation of emerging techniques like next-generation sequencing and unbiased serology.

Main Results:

  • Cerebrospinal fluid (CSF) examination is crucial, with leucocyte count being a key indicator.
  • Microbiological or histopathological tests confirm the cause in approximately 50% of cases.
  • Neuroimaging and electroencephalography support diagnosis but are primarily adjunctive.

Conclusions:

  • Microbiological confirmation is essential but achieved in only half of infectious encephalitis cases.
  • Emerging diagnostic techniques offer potential but face limitations in practicality (complexity, time, cost).
  • Continued development of advanced diagnostic methods is necessary to improve cause-specific diagnoses.
Keywords:
CNS infectionCerebrospinal fluidDiagnosticsEncephalitisMetagenomics

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