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July 2008
Volume 18, Number 7
New Encephalits Guidelines Published

IDSA has published its first set of guidelines for the management of encephalitis.

The guidelines state that the best approach to management of a patient with encephalitis is early recognition of the syndrome, appropriate diagnostic evaluation based on likely etiologic agents, neuroimaging, and cerebrospinal fluid (CSF) analysis with specialized tests to attempt to identify the cause.  However, despite extensive testing to identify an etiologic agent, most cases of presumed infectious encephalitis remain unexplained.  Identifying epidemiologic and clinical clues is recommended and may suggest the likely cause. Such clues may include geographic locale, season, insect or animal contacts, prevalence of the disease in the local community, rash, or upper respiratory findings. 

The guidelines emphasize that one of the key components in managing patients with encephalitis is to perform proper diagnostic tests.  Appropriate diagnostic evaluation includes, but is not limited to, evaluation of blood and CSF by serologic studies and nucleic acid amplification tests (such as PCR), and neuroimaging.

Once the diagnosis of encephalitis is suspected, the guidelines recommend empirical therapy with acyclovir, pending results of diagnostic studies.  Other empirical therapy should be initiated based on epidemiologic or clinical factors, including therapy for presumed bacterial meningitis (if clinically indicated) and administration of doxycycline, during the appropriate season, for possible rickettsial or ehrlichial infection. 

The guidelines’ performance measures emphasize that if the etiologic agent of encephalitis is identified, antimicrobial therapy should be targeted to the infectious agent or discontinued if treatment against the etiologic agent is not available.

The encephalitis guidelines are available online. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our web site.
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