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Published on: October 28, 2022
Early vs late diagnosis in infectious encephalitis: a population-based cohort study
Lærke Storgaard Duerlund1, Lykke Larsen2, Merete Storgaard3
1Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.
Late diagnosis of infectious encephalitis is common, especially in older patients. Delays over 24 hours significantly increase mortality risk, highlighting the need for timely diagnosis in infectious encephalitis cases.
Area of Science:
- Neurology
- Infectious Diseases
- Epidemiology
Background:
- Infectious encephalitis is a serious neurological condition.
- Timely diagnosis is crucial for effective treatment and improved patient outcomes.
- Understanding factors influencing diagnostic delays is essential for optimizing care.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of patients with early versus late diagnosis of infectious encephalitis in Denmark.
- To identify factors associated with delayed diagnosis and their impact on patient prognosis.
Main Methods:
- Nationwide, prospective, population-based cohort study (2015-2023).
- Inclusion of all adults hospitalized with infectious encephalitis.
- Definition of late diagnosis (>6 hours) and very late diagnosis (>24 hours) based on lumbar puncture or acyclovir initiation.
- Assessment of relative risks (RR) and 95% confidence intervals (CI) using modified multivariable Poisson regression.
Main Results:
- 37% of 495 patients had early diagnosis; 63% had late diagnosis.
- Late diagnosis was associated with older age (median 72 vs 65 years).
- Diagnosis >24 hours after admission increased 30-day (Adj. RR 2.20) and 6-month mortality (Adj. RR 1.59).
Conclusions:
- Late diagnosis of infectious encephalitis is prevalent, particularly in older individuals and those without altered mental status.
- Diagnosis exceeding 24 hours post-admission is linked to significantly higher mortality rates.
- Prompt diagnosis and treatment are critical for improving survival in infectious encephalitis.
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