ArticleJournal of clinical microbiology2011
Diagnostic strategy used to establish etiologies of encephalitis in a prospective cohort of patients in England.
Article in Journal of clinical microbiology, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 65 citations in OpenAlex.
- Diagnosis and Management of Infectious Encephalitis in Adults: Guidelines From the European Academy of Neurology and European Society of Clinical Microbiology and Infectious Diseases.European journal of neurology · 2026Guideline
- Detection of central nervous system viral infections in adults in Manado, North Sulawesi, Indonesia.PloS one · 2018Trial
- Encephalitis: Predictive Role of Clinical and Diagnostic Data on Outcome-A Monocentric Study.Life (Basel, Switzerland) · 2025Article
- A case report of the metagenomics next-generation sequencing for early detection of central nervous system mucormycosis with successful rescue in patient with recurrent chronic lymphocytic leukemia.Annals of translational medicine · 2022Article
- Herpesvirus-Associated Encephalitis: an Update.Current tropical medicine reports · 2022Review
- Misdiagnosed tuberculosis being corrected as Nocardia farcinica infection by metagenomic sequencing: a case report.BMC infectious diseases · 2021Article
- Prevalence and clinical manifestations of herpes simplex virus infection among suspected patients of herpes simplex encephalitis in Shiraz, Iran.Virusdisease · 2021Article
- Precision Pandemic Preparedness: Improving Diagnostics with Metagenomics.Journal of clinical microbiology · 2021Article
- Surveillance of hemorrhagic fever and/or neuroinvasive disease: challenges of diagnosis.Revista de saude publica · 2021Article
- STROBE-metagenomics: a STROBE extension statement to guide the reporting of metagenomics studies.The Lancet. Infectious diseases · 2020Review
- Diminished toll-like receptor response in febrile infection-related epilepsy syndrome (FIRES).Biomedical journal · 2020Article
- Enhanced Detection of DNA Viruses in the Cerebrospinal Fluid of Encephalitis Patients Using Metagenomic Next-Generation Sequencing.Frontiers in microbiology · 2020Article
- DifferentialmBio · 2019Article
- Mutations in RNA Polymerase III genes and defective DNA sensing in adults with varicella-zoster virus CNS infection.Genes and immunity · 2019Article
- Infection and Propagation of Astrovirus VA1 in Cell Culture.Current protocols in microbiology · 2019Article
- Metagenomic Approach to Characterizing Disease Epidemiology in a Disease-Endemic Environment in Northern Thailand.Frontiers in microbiology · 2019Article
- Encephalitis diagnosis using metagenomics: application of next generation sequencing for undiagnosed cases.The Journal of infection · 2018Review
- Epidemiological Profile of Acute Viral Encephalitis in a Sample of Egyptian Children.Open access Macedonian journal of medical sciences · 2018Article
- Increased serum vascular endothelial growth factor is associated with acute viral encephalitis in Bangladeshi children.Scientific reports · 2017Article
- Diagnostics of autoimmune encephalitis associated with antibodies against neuronal surface antigens.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2017Review
Corrections and comments
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Authors and funding
13 authors at 3 institutions in 1 country.
Funding
Abstract
The laboratory diagnostic strategy used to determine the etiology of encephalitis in 203 patients is reported. An etiological diagnosis was made by first-line laboratory testing for 111 (55%) patients. Subsequent testing, based on individual case reviews, resulted in 17 (8%) further diagnoses, of which 12 (71%) were immune-mediated and 5 (29%) were due to infection. Seventy-five cases were of unknown etiology. Sixteen (8%) of 203 samples were found to be associated with either N-methyl-d-aspartate receptor or voltage-gated potassium channel complex antibodies. The most common viral causes identified were herpes simplex virus (HSV) (19%) and varicella-zoster virus (5%), while the most important bacterial cause was Mycobacterium tuberculosis (5%). The diagnostic value of testing cerebrospinal fluid (CSF) for antibody was assessed using 139 samples from 99 patients, and antibody was detected in 46 samples from 37 patients. Samples collected at 14 to 28 days were more likely to be positive than samples taken 0 to 6 days postadmission. Three PCR-negative HSV cases were diagnosed by the presence of virus-specific antibody in the central nervous system (CNS). It was not possible to make an etiological diagnosis for one-third of the cases; these were therefore considered to be due to unknown causes. Delayed sampling did not contribute to these cases. Twenty percent of the patients with infections with an unknown etiology showed evidence of localized immune activation within the CNS, but no novel viral DNA or RNA sequences were found. We conclude that a good standard of clinical investigation and thorough first-line laboratory testing allows the diagnosis of most cases of infectious encephalitis; testing for CSF antibodies allows further cases to be diagnosed. It is important that testing for immune-mediated causes also be included in a diagnostic algorithm.
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