To what extent can clinical characteristics be used to distinguish encephalitis from encephalopathy of other causes? Results from a prospective ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-12

AUTHORS

Else Quist-Paulsen, Anne-Marte Bakken Kran, Elisabeth S. Lindland, Katrine Ellefsen, Leiv Sandvik, Oona Dunlop, Vidar Ormaasen

ABSTRACT

BACKGROUND: Recognizing patients with encephalitis may be challenging. The cardinal symptom, encephalopathy, has a wide array of differential diagnoses. In this prospective study we aimed to explore the etiology of encephalitis and to assess the diagnostic accuracy of symptoms and clinical findings in patients with encephalitis in an encephalopathic population. METHODS: Patients with acute onset of encephalopathy (n = 136) were prospectively enrolled from January 2014-December 2015 at Oslo University Hospital, Ullevaal. Clinical and biochemical characteristics of patients who met the case definition of encephalitis were compared to patients with encephalopathy of other causes. RESULTS: Among 136 patients with encephalopathy, 19 (14%) met the case-definition of encephalitis. For 117 patients other causes of encephalopathy were found, infection outside the CNS was the most common differential diagnosis. Etiology of encephalitis was confirmed in 53% (4 bacterial, 4 viral, 1 parasitic, and 1 autoimmune). Personality change, nausea, fever, focal neurology, recent travel history, and low inflammation markers were significantly more abundant in patients with encephalitis, but the diagnostic accuracy for individual parameters were low (area under the curve (AUC) < 0.7). The combination of fever (OR = 6.6, 95% CI, 1.6-28), nausea (OR = 8.9, 95% CI, 1.7-46) and a normal level of ESR (erythrocyte sedimentation rate < 17 mm/hr, OR = 6.9, 95% CI, 1.5-33) was significant in multivariate analysis with an AUC (area under the curve) of 0.85 (95% CI, 0.76-0.94). Moderately increased pleocytosis in CSF (5-100 × 106/L) further increased the diagnostic accuracy of this combination, AUC 0.90 (95% CI, 0.81-0.98). CONCLUSIONS: There is a wide diversity in differential diagnoses in patients with encephalopathy, and no single symptom or finding can be used to predict encephalitis with high accuracy in this group. The combination of fever, nausea and a low ESR in an encephalopathic population, increased the diagnostic accuracy of encephalitis compared to solitary parameters. The triad could be a useful clinical tool for early diagnosis of encephalitis, and these patients should be considered for further diagnostics such as lumbar puncture (LP). More... »

PAGES

80

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12879-018-3570-2

DOI

http://dx.doi.org/10.1186/s12879-018-3570-2

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1111593812

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30669985


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    "description": "BACKGROUND: Recognizing patients with encephalitis may be challenging. The cardinal symptom, encephalopathy, has a wide array of differential diagnoses. In this prospective study we aimed to explore the etiology of encephalitis and to assess the diagnostic accuracy of symptoms and clinical findings in patients with encephalitis in an encephalopathic population.\nMETHODS: Patients with acute onset of encephalopathy (n\u2009=\u2009136) were prospectively enrolled from January 2014-December 2015 at Oslo University Hospital, Ullevaal. Clinical and biochemical characteristics of patients who met the case definition of encephalitis were compared to patients with encephalopathy of other causes.\nRESULTS: Among 136 patients with encephalopathy, 19 (14%) met the case-definition of encephalitis. For 117 patients other causes of encephalopathy were found, infection outside the CNS was the most common differential diagnosis. Etiology of encephalitis was confirmed in 53% (4 bacterial, 4 viral, 1 parasitic, and 1 autoimmune). Personality change, nausea, fever, focal neurology, recent travel history, and low inflammation markers were significantly more abundant in patients with encephalitis, but the diagnostic accuracy for individual parameters were low (area under the curve (AUC) <\u20090.7). The combination of fever (OR\u2009=\u20096.6, 95% CI, 1.6-28), nausea (OR\u2009=\u20098.9, 95% CI, 1.7-46) and a normal level of ESR (erythrocyte sedimentation rate\u2009<\u200917\u2009mm/hr, OR\u2009=\u20096.9, 95% CI, 1.5-33) was significant in multivariate analysis with an AUC (area under the curve) of 0.85 (95% CI, 0.76-0.94). Moderately increased pleocytosis in CSF (5-100\u2009\u00d7\u2009106/L) further increased the diagnostic accuracy of this combination, AUC 0.90 (95% CI, 0.81-0.98).\nCONCLUSIONS: There is a wide diversity in differential diagnoses in patients with encephalopathy, and no single symptom or finding can be used to predict encephalitis with high accuracy in this group. The combination of fever, nausea and a low ESR in an encephalopathic population, increased the diagnostic accuracy of encephalitis compared to solitary parameters. The triad could be a useful clinical tool for early diagnosis of encephalitis, and these patients should be considered for further diagnostics such as lumbar puncture (LP).", 
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282 schema:name Department of Acute Medicine, Oslo University Hospital, Ullevaal Hospital, Nydalen, P. O. Box 4956, N-0450, Oslo, Norway
283 Department of Infectious Diseases, Oslo University Hospital Ullevaal, Nydalen, P. O. Box 4956, N-0450, Oslo, Norway
284 Department of Microbiology, Oslo University Hospital, Nydalen, P.O. Box 4956, N0450, Oslo, Norway
285 Department of Neurology, Oslo University Hospital, Ullevaal Hospital, P.O. Box 4956, N-0450, Oslo, Norway
286 Faculty of Medicine, University of Oslo, Blindern, P.O Box 1078, 0316, Oslo, Norway
287 Institute of Clinical Medicine, University of Oslo, Blindern, P.O Box 1171, 0318, Oslo, Norway
288 rdf:type schema:Organization
 




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