Clinical Epidemiology, Risk Factors, and Outcomes of Encephalitis in Older Adults.

Link to article at PubMed

Clinical Epidemiology, Risk Factors, and Outcomes of Encephalitis in Older Adults.

Clin Infect Dis. 2019 Jul 10;:

Authors: Hansen MA, Samannodi MS, Castelblanco RL, Hasbun R

BACKGROUND: Encephalitis is associated with significant morbidity and mortality with unknown etiologies in the majority of patients. Large prognostic studies evaluating elderly patients are currently lacking.
METHODS: Retrospective cohort of encephalitis cases in 19 hospitals from New Orleans, Louisiana and Houston, Texas between the years 2000 and 2017.
RESULTS: A total of 340 adult (age ≥ 17 years) patients with confirmed encephalitis were enrolled, 194 (57%) had unknown etiologies. A cerebrospinal fluid polymerase chain reaction (PCR) for Herpes Simplex Virus (HSV) and Varicella Zoster Virus was done in 237 (69%) and in 82 (24%) of patients, respectively. Furthermore, an arboviral serology was done in 169 (49%) and measurements of anti-N-methyl-D-aspartate receptor antibodies in 49 (14%) of patients. A total of 172 out of 323 (53%) had adverse clinical outcomes (ACO) at discharge. Older individuals (>65 years of age) had a lower prevalence of HIV, higher number of comorbidities, were less likely to receive adjuvant steroids, and more likely to have a positive arbovirus serology, a positive HSV PCR, an abnormal computerized tomography findings and to have ACO (all P values < 0.05). Prognostic factors independently associated with an ACO were age ≥ 65, fever, Glasgow coma scale (GCS) < 13, and seizures (all P values ≤ 0.01).
CONCLUSION: Encephalitis remains with adverse clinical outcomes and unknown etiologies in the majority of patients in the molecular diagnostic era. Independent prognostic factors include age >65 years, fever, GCS <13 and seizures.

PMID: 31294449 [PubMed - as supplied by publisher]

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