Diagnosis and Management of Infectious Encephalitis in Adults: Guidelines From the European Academy of Neurology and European Society of Clinical Microbiology and Infectious Diseases.
完整摘要 · 中文译文
背景：脑炎难以诊断和管理，给临床医生带来挑战。自2010年上一版欧洲指南发布以来，出现了新的病因，诊断流程有所发展，治疗方法得到评估，这些都需要在更新版指南中体现。 目的：我们旨在基于当前证据，为成人感染性脑炎的诊断和管理提出建议，使临床医生能够改善患者预后。 方法：本指南在两个欧洲专业医学组织的支持下联合制定。临床问题经过优先排序并以PICO格式表述。针对每个问题进行了系统性文献检索，并使用标准化工具评估证据质量。建议根据推荐分级的评估、制定与评价（GRADE）方法制定。在仅有间接证据的情况下，制定了良好实践声明。 结果：共考虑16个问题，达成两项建议：一是在怀疑脑炎时尽快开始静脉注射阿昔洛韦；二是不以脑脊液多重PCR panel替代脑脊液病原体特异性聚合酶链反应（PCR）检测来诊断疑似感染性脑炎的成人患者。对于确诊HSV脑炎的成人患者，我们无法推荐或反对使用糖皮质激素。另有13项关于何时应在临床上怀疑感染性脑炎的良好实践声明 、微生物学检查、进一步检查、治疗以及持续护理和康复方面达成了一致。 结论：鉴于该疾病的临床严重性和公共卫生重要性，高质量证据的匮乏令人瞩目。鼓励开展感染性脑炎方面的跨国大规模研究。
完整摘要 · 英文原文
BACKGROUND: Encephalitis is difficult to diagnose and manage, posing a challenge to clinicians. Since the last European guidelines were published in 2010, novel causes have emerged, diagnostic processes have evolved and treatments assessed which need to be reflected in updated guidelines. OBJECTIVE: We aimed to produce recommendations for the diagnosis and management of infectious encephalitis in adults based on current evidence to equip clinicians to improve patient outcomes. METHODS: These guidelines were developed jointly with the support of two European specialist medical organisations. Clinical questions were prioritised and formulated in PICO format. A systematic literature search was conducted for each question, and the quality of evidence was assessed using standardised tools. Recommendations were developed according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Where only indirect evidence was available, a good practice statement was made. RESULTS: Sixteen questions were considered, with two recommendations reached: for initiation of intravenous aciclovir as soon as possible upon suspicion of encephalitis and against replacing pathogen-specific polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) with multiplex CSF PCR panels for diagnosis of adult patients with suspected infectious encephalitis. For adults with proven HSV encephalitis, we were unable to recommend for or against the use of corticosteroids. A further 13 good practice statements regarding when to clinically suspect infectious encephalitis, microbiological investigations, additional investigations, treatment and ongoing care and rehabilitation were agreed. CONCLUSIONS: Given the clinical severity and public health importance of this condition, the paucity of high-quality evidence is striking. Transnational, large-scale research in infective encephalitis is encouraged.
摘要 待译
BACKGROUND: Encephalitis is difficult to diagnose and manage, posing a challenge to clinicians. Since the last European guidelines were published in 2010, novel causes have emerged, diagnostic processes have evolved and treatments assessed which need to be reflected in updated guidelines. OBJECTIVE: We aimed to produce recommendations for the diagnosis and management of infectious encephalitis in adults based on current evidence to equip clinicians to improve patient outcomes. METHODS: These guidelines were developed jointly with the support of two European specialist medical organisations.…