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      Consecuencias de la encefalitis aguda infecciosa que determinan la discapacidad y mortalidad de los pacientes Translated title: Consequences of acute infectious encephalitis that determine the disability and mortality of patients

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          Abstract

          Resumen La encefalitis aguda es un síndrome caracterizado por alteración del estado de consciencia e inflamación del parénquima encefálico; se asocia con múltiples causas, entre ellas las infecciosas, y entre estas las virales son las más comúnmente identificadas. Para el abordaje de estos pacientes es fundamental realizar una historia clínica y un examen físico detallados, estudios del líquido cefalorraquídeo e, idealmente, una resonancia magnética cerebral. Con estos hallazgos se puede efectuar una aproximación etiológica. De acuerdo con la disponibilidad de estudios diagnósticos, en el 20% o más de los pacientes no se logra establecer la causa. La estabilización inicial y el tratamiento empírico precoz con aciclovir a dosis altas tienen impacto en mortalidad y discapacidad.

          Translated abstract

          Abstract Acute encephalitis is a syndrome characterized by an altered state of consciousness and inflammation of the brain parenchyma. It is associated with multiple causes, including infectious ones, with viral ones being the most commonly identified. To approach these patients, it is essential to perform a detailed clinical history and physical examination, studies of the cerebrospinal fluid, and ideally, a brain MRI. With these findings, an etiological approach can be made. According to the availability of diagnostic studies, in 20% or more of patients the cause cannot be established. Initial stabilization and early empirical treatment with high-dose acyclovir have an impact on mortality and disability.

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          Most cited references18

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          Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis

          Objectives We evaluate incidence and prevalence of autoimmune encephalitis and compare the epidemiology of autoimmune and infectious encephalitis. Methods We performed a population-based comparative study of the incidence and prevalence of autoimmune and infectious encephalitis in Olmsted County, USA. Autoimmune encephalitis diagnosis and subgroups were defined by 2016 diagnostic criteria and infectious encephalitis diagnosis required a confirmed infectious pathogen. Age- and sex-adjusted prevalence and incidence rates were calculated. Patients with encephalitis of uncertain etiology were excluded. Results The prevalence of autoimmune encephalitis on January 1, 2014 of 13.7/100,000 was not significantly different from that of all infectious encephalitides (11.6/100,000; p=0.63) or the viral subcategory (8.3/100,000; p=0.17). The incidence rates (1995–2015) of autoimmune and infectious encephalitis were 0.8/100,000 and 1.0/100,000 person-years respectively (p=0.58). The number of relapses or recurrent hospitalizations was higher for autoimmune than infectious encephalitis (p=0.03). The incidence of autoimmune encephalitis increased over time from 0.4/100,000 person-years (1995–2005) to 1.2/100,000 person-years (2006–2015) (p=0.02), attributable to increased recognition of autoantibody-positive cases. The incidence (2.8 vs 0.7/100,000 person-years; p=0.01) and prevalence (38.3 vs 13.7/100,000; p=0.04) of autoimmune encephalitis was higher among African-Americans than Caucasians. The prevalence of specific neural autoantibodies was: myelin-oligodendrocyte-glycoprotein (MOG) (1.9/100,000); glutamic acid decarboxylase-65 (GAD65) (1.9/100,000); unclassified neural autoantibody (1.4/100,000); leucine-rich glioma-inactivated-protein-1 (LGI1) (0.7/100,000); collapsin response-mediator protein-5 (CRMP5) (0.7/100,000); N-methyl-D-aspartate-receptor (NMDAR) (0.6/100,000); anti-neuronal nuclear antibody-2 (ANNA-2/anti-Ri) (0.6/100,000) and glial fibrillary acidic protein-α (GFAPα) (0.6/100,000). Interpretation This study shows that the prevalence and incidence of autoimmune encephalitis is comparable to infectious encephalitis and its detection is increasing over time.
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            Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicenter study.

            Management of herpes simplex encephalitis (HSE) has been considerably improved by the availability of acyclovir therapy and rapid polymerase chain reaction (PCR)-based diagnostic assays. Prognostic factors for this rare affliction are, however, misestimated. We conducted a large retrospective multicenter study that included 93 adult patients in whom HSE was diagnosed by PCR from 1991 through 1998 and who were treated with intravenous acyclovir. Among the 85 patients assessed at 6 months, 30 (35%) had a poor outcome, which led to death in 13 patients (15%) and severe disability in 17 (20%). The outcome was favorable for 55 patients (65%). A multivariate analysis identified 2 factors that were found to be independently associated with poor outcome: a Simplified Acute Physiology Score II >/=27 at admission and a delay of >2 days between admission to the hospital and initiation of acyclovir therapy. Early administration of antiviral therapy is the only parameter that can be modified to improve the prognosis of patients with HSE.
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              Encephalitis Hospitalization Rates and Inpatient Mortality in the United States, 2000-2010

              Background Encephalitis rates by etiology and acute-phase outcomes for encephalitis in the 21st century are largely unknown. We sought to evaluate cause-specific rates of encephalitis hospitalizations and predictors of inpatient mortality in the United States. Methods Using the Nationwide Inpatient Sample (NIS) from 2000 to 2010, a retrospective observational study of 238,567 patients (mean [SD] age, 44.8 [24.0] years) hospitalized within non-federal, acute care hospitals in the U.S. with a diagnosis of encephalitis was conducted. Hospitalization rates were calculated using population-level estimates of disease from the NIS and population estimates from the United States Census Bureau. Adjusted odds of mortality were calculated for patients included in the study. Results In the U.S. from 2000–2010, there were 7.3±0.2 encephalitis hospitalizations per 100,000 population (95% CI: 7.1–7.6). Encephalitis hospitalization rates were highest among females (7.6±0.2 per 100,000) and those 65 years of age with rates of 13.5±0.9 and 14.1±0.4 per 100,000, respectively. Etiology was unknown for approximately 50% of cases. Among patients with identified etiology, viral causes were most common (48.2%), followed by Other Specified causes (32.5%), which included predominantly autoimmune conditions. The most common infectious agents were herpes simplex virus, toxoplasma, and West Nile virus. Comorbid HIV infection was present in 7.7% of hospitalizations. Average length of stay was 11.2 days with mortality of 5.6%. In regression analysis, patients with comorbid HIV/AIDS or cancer had increased odds of mortality (odds ratio [OR]  = 1.70; 95% CI: 1.30–2.22 and OR = 2.26; 95% CI: 1.88–2.71, respectively). Enteroviral, postinfectious, toxic, and Other Specified causes were associated with lower odds vs. herpes simplex encephalitis. Conclusions While encephalitis and encephalitis-related mortality impose a considerable burden in the U.S. in the 21st Century, the reported demographics of hospitalized encephalitis patients may be changing.
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                Author and article information

                Journal
                siic
                Salud(i)Ciencia
                Salud(i)Ciencia
                Sociedad Iberoamericana de Informaciòn cientìfica (Ciudad autonoma de Buenos Aires, , Argentina )
                1667-8682
                1667-8990
                June 2024
                : 25
                : 8
                : 449-456
                Affiliations
                [1] orgname
                [2] orgname
                Article
                S1667-89902024000100449 S1667-8990(24)02500800449
                10.21840/siic/173839
                4d4284b0-0571-412e-ba49-6cf529e9ae0f

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 20 November 2024
                : 07 January 2024
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 8
                Product

                SciELO Argentina

                Categories
                Revisiòn

                acute febrile encephalopathy,infection,encephalitis,meningitis,herpes simplex encephalitis,infección,encefalitis,encefalitis por herpes simple,encefalopatía aguda febril

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