Compliance with international guidelines in adults with encephalitis
| Autor: | Ambreen Allana, Mohammed Samannodi, Rodrigo Hasbun, Michael A. Hansen |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Adult Male medicine.medical_specialty Internationality medicine.drug_class 030106 microbiology Antibiotics medicine.disease_cause Article law.invention 03 medical and health sciences 0302 clinical medicine Cerebrospinal fluid law Virology Internal medicine Medicine Humans 030212 general & internal medicine Retrospective Studies biology business.industry Varicella zoster virus Brain Disease Management Middle Aged medicine.disease United States Infectious Diseases Gram staining Multicenter study biology.protein Etiology Exposure and outcome Encephalitis Female Guideline Adherence Antibody business Tomography X-Ray Computed Compliance |
| Zdroj: | Journal of Clinical Virology |
| ISSN: | 1873-5967 |
| Popis: | Background Encephalitis is associated with significant neurological disability and mortality. Many guidelines are published for encephalitis management but compliance with them is unknown. Objectives To evaluate the appropriate management and compliance to the current guidelines in adults with encephalitis. Study design A retrospective multicenter study at 17 hospitals in the Greater Houston area from August 1, 2008 through September 30, 2017. All cases met the definition for possible or probable encephalitis as per the international encephalitis consortium guidelines. Results A total of 241 adults (age >17 years) with encephalitis were enrolled. The most common etiologies were unknown (41.9 %), viral (27.8 %) and autoimmune (21.2 %). An adverse clinical outcome was seen in 49 % with 12.4 % in hospital mortality. A high compliance with guidelines (>90 %) was only seen in obtaining a brain computerized tomography (CT) scan, blood cultures and cerebrospinal fluid (CSF) gram stain and culture. A CSF herpes virus simplex (HSV) polymerase chain reaction (PCR) was done in 84 % and only repeated in 14.2 % of patients with an initial negative result. Furthermore, only two-thirds of patients were started empirically on intravenous acyclovir and antibiotics. Evaluation for other etiologies were not uniformly performed: arboviral serologies (57.3 %), CSF anti-N-Methyl- d -Aspartate Receptor (NMDA) receptor antibody (35.7 %), and CSF varicella zoster virus (VZV) PCR (32 %). The highest yield for the tests were arboviral serologies (42 %), anti-NMDA antibodies (41.2 %) and VZV PCR (16.4 %). Conclusion The management of encephalitis as per current guidelines is suboptimal leading to underutilization of currently available diagnostic tests and empirical therapy. |
| Databáze: | OpenAIRE |
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