Management of suspected viral encephalitis. Professionals guidelines

In the 1980s the outcome of patients with herpes simplex virus (HSV) encephalitis was shown to be dramatically improved with aciclovir treatment. Delays in starting treatment, particularly beyond 48 hours after hospital admission, are associated with a worse prognosis. Several comprehensive reviews of the investigation and management of encephalitis have been published. However, their impact on day-to day clinical practice appears to be limited.

In February 2008 a group of clinicians met in Liverpool to begin the development process for clinical care guidelines based around a simple algorithm, supported by an evidence base, whose implementation is hoped would improve the management of patients with suspected encephalitis.

The scope of the guideline is to cover the initial management of all patients with suspected encephalitis, up to the point of diagnosis, in an acute care setting such as acute medical unit or emergency department. They are thus intended as a ready reference for clinicians encountering the more common causes of encephalitis, rather than specialists managing rarer causes. The guidelines also cover the specific treatments and further management of patients for whom a diagnosis of viral encephalitis is made, particularly that due to HSV, varicella zoster virus (VZV) and enteroviruses.

At the end of the guidelines the special circumstances of returned travellers, immunocompromised patients and antibody-associated encephalitis are discussed.

Many patients with suspected viral encephalitis ultimately prove to have another infectious or non-infectious cause for their illness. The further management and treatment of such patients is beyond the scope of this guideline, but the authors have included a section on follow-up and support for encephalitis patients in both the healthcare and voluntary sectors after discharge from hospital. 

Download a PDF of the Management of suspected viral encephalitis in adults. Professional guidelines

Download a PDF of the Management of suspected viral encephalitis in children. Professionals guidelines

Download a PDF of the Management of suspected viral encephalitis in adults and children. Lay copy