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- Empiric antimicrobial therapy[1]
- Preferred regimen: Acyclovir 10 mg/kg IV q8h for 14–21 days
- Note (1): Acyclovir should be initiated in all patients with suspected encephalitis, pending results of diagnostic studies.
- Note (2): Other empiric antimicrobial agents should be administered on the basis of specific epidemiologic or clinical clues.
- Specific epidemiologic considerations[2]
- Agammaglobulinemia — Enteroviruses, Mycoplasma pneumoniae
- Age
- Neonates — Herpes simplex virus type 2, cytomegalovirus, rubella virus, Listeria monocytogenes, Treponema pallidum, Toxoplasma gondii
- Infants and children — Eastern equine encephalitis virus, Japanese encephalitis virus, Murray Valley encephalitis virus, influenza virus, La Crosse virus
- Elderly persons — Eastern equine encephalitis virus, St. Louis encephalitis virus, West Nile virus, sporadic CJD, L. monocytogenes
- Animal contact
- Bats — Rabies virus, Nipah virus
- Birds — West Nile virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, Murray Valley encephalitis virus, Japanese encephalitis virus, Cryptococcus neoformans (bird droppings)
- Cats — Rabies virus, Coxiella burnetii, Bartonella henselae, T. gondii
- Dogs — Rabies virus
- Horses — Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, Hendra virus
- Old World primates — B virus
- Raccoons — Rabies virus, Baylisascaris procyonis
- Rodents — Eastern equine encephalitis virus (South America), Venezuelan equine encephalitis virus, tickborne encephalitis virus, Powassan virus (woodchucks), La Crosse virus (chipmunks and squirrels), Bartonella quintana
- Sheep and goats — C. burnetii
- Skunks — Rabies virus
- Swine — Japanese encephalitis virus, Nipah virus
- White-tailed deer — Borrelia burgdorferi
- Immunocompromised persons — Varicella zoster virus, cytomegalovirus, human herpesvirus 6, West Nile virus, HIV, JC virus, L. monocytogenes, Mycobacterium tuberculosis, C. neoformans, Coccidioides species, Histoplasma capsulatum, T. gondii
- Ingestion
- Raw or partially cooked meat — T. gondii
- Raw meat, fish, or reptiles — Gnanthostoma species
- Unpasteurized milk — Tickborne encephalitis virus, L. monocytogenes, C. burnetii
- Insect contact
- Mosquitoes — Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, Murray Valley encephalitis virus, Japanese encephalitis virus, West Nile virus, La Crosse virus, Plasmodium falciparum
- Sandflies — Bartonella bacilliformis
- Ticks — Tickborne encephalitis virus, Powassan virus, Rickettsia rickettsii, Ehrlichia chaffeensis, Anaplasma phagocytophilum, C. burnetii (rare), B. burgdorferi
- Tsetse flies — Trypanosoma brucei gambiense, Trypanosoma brucei rhodesiense
- Occupation
- Exposure to animals — Rabies virus, C. burnetii, Bartonella species
- Exposure to horses — Hendra virus
- Exposure to Old World primates — B virus
- Laboratory workers — West Nile virus, HIV, C. burnetii, Coccidioides species
- Physicians and health care workers — Varicella zoster virus, HIV, influenza virus, measles virus, M. tuberculosis
- Veterinarians — Rabies virus, Bartonella species, C. burnetii
- Person-to-person transmission — Herpes simplex virus (neonatal), varicella zoster virus, Venezuelan equine encephalitis virus (rare), poliovirus, nonpolio enteroviruses, measles virus, Nipah virus, mumps virus, rubella virus, Epstein-Barr virus, human herpesvirus 6, B virus, West Nile virus (transfusion, transplantation, breast feeding), HIV, rabies virus (transplantation), influenza virus, M. pneumoniae, M. tuberculosis, T. pallidum
- Recent vaccination — Acute disseminated encephalomyelitis
- Recreational activities
- Camping/hunting — Agents transmitted by mosquitoes and ticks
- Sexual contact — HIV, T. pallidum
- Spelunking — Rabies virus, H. capsulatum
- Swimming — Enteroviruses, Naegleria fowleri
- Season
- Late summer/early fall — Agents transmitted by mosquitoes and ticks, enteroviruses
- Winter — Influenza virus
- Transfusion and transplantation — Cytomegalovirus, Epstein-Barr virus, West Nile virus, HIV, tickborne encephalitis virus, rabies virus, iatrogenic CJD, T. pallidum, A. phagocytophilum, R. rickettsii, C. neoformans, Coccidioides species, H. capsulatum, T. gondii
- Travel
- Africa — Rabies virus, West Nile virus, P. falciparum, T. brucei gambiense, T. brucei rhodesiense
- Australia — Murray Valley encephalitis virus, Japanese encephalitis virus, Hendra virus
- Central America — Rabies virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, R. rickettsii, P. falciparum, Taenia solium
- Europe — West Nile virus, tickborne encephalitis virus, A. phagocytophilum, B. burgdorferi
- India, Nepal — Rabies virus, Japanese encephalitis virus, P. falciparum
- Middle East — West Nile virus, P. falciparum
- Russia — Tickborne encephalitis virus
- South America — Rabies virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, R. rickettsii, B. bacilliformis (Andes mountains), P. falciparum, T. solium
- Southeast Asia, China, Pacific Rim — Japanese encephalitis virus, tickborne encephalitis virus, Nipah virus, P. falciparum, Gnanthostoma species, T. solium
- Unvaccinated status — Varicella zoster virus, Japanese encephalitis virus, poliovirus, measles virus, mumps virus, rubella virus
- Specific clinical considerations[3]
- General findings
- Hepatitis — Coxiella burnetii
- Lymphadenopathy — HIV, Epstein-Barr virus, cytomegalovirus, measles virus, rubella virus, West Nile virus, Treponema pallidum, Bartonella henselae and other Bartonella species, Mycobacterium tuberculosis, Toxoplasma gondii, Trypanosoma brucei gambiense
- Parotitis — Mumps virus
- Rash — Varicella zoster virus, B virus, human herpesvirus 6, West Nile virus, rubella virus, some enteroviruses, HIV, Rickettsia rickettsii, Mycoplasma pneumoniae, Borrelia burgdorferi, T. pallidum, Ehrlichia chaffeensis, Anaplasma phagocytophilum
- Respiratory tract findings — Venezuelan equine encephalitis virus, Nipah virus, Hendra virus, influenza virus, adenovirus, M. pneumoniae, C. burnetii, M. tuberculosis, Histoplasma capsulatum
- Retinitis — Cytomegalovirus, West Nile virus, B. henselae, T. pallidum
- Urinary symptoms — St. Louis encephalitis virus
- Neurologic findings
- Cerebellar ataxia — Varicella zoster virus (children), Epstein-Barr virus, mumps virus, St. Louis encephalitis virus, Tropheryma whipplei, T. brucei gambiense
- Cranial nerve abnormalities — Herpes simplex virus, Epstein-Barr virus, Listeria monocytogenes, M. tuberculosis, T. pallidum, B. burgdorferi, T. whipplei, Cryptococcus neoformans, Coccidioides species, H. capsulatum
- Dementia — HIV, human transmissible spongiform encephalopathies (sCJD and vCJD), measles virus (SSPE), T. pallidum, T. whipplei
- Myorhythmia — T. whipplei (oculomasticatory)
- Parkinsonism — Japanese encephalitis virus, St. Louis encephalitis virus, West Nile virus, Nipah virus, T. gondii, T. brucei gambiense
- Poliomyelitis-like flaccid paralysis — Japanese encephalitis virus, West Nile virus, tickborne encephalitis virus; enteroviruses (enterovirus-71, coxsackieviruses), poliovirus
- Rhombencephalitis — Herpes simplex virus, West Nile virus, enterovirus 71, L. monocytogenes
- ↑ Tunkel, Allan R.; Glaser, Carol A.; Bloch, Karen C.; Sejvar, James J.; Marra, Christina M.; Roos, Karen L.; Hartman, Barry J.; Kaplan, Sheldon L.; Scheld, W. Michael; Whitley, Richard J.; Infectious Diseases Society of America (2008-08-01). "The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (3): 303–327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.
- ↑ Tunkel, Allan R.; Glaser, Carol A.; Bloch, Karen C.; Sejvar, James J.; Marra, Christina M.; Roos, Karen L.; Hartman, Barry J.; Kaplan, Sheldon L.; Scheld, W. Michael; Whitley, Richard J.; Infectious Diseases Society of America (2008-08-01). "The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (3): 303–327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.
- ↑ Tunkel, Allan R.; Glaser, Carol A.; Bloch, Karen C.; Sejvar, James J.; Marra, Christina M.; Roos, Karen L.; Hartman, Barry J.; Kaplan, Sheldon L.; Scheld, W. Michael; Whitley, Richard J.; Infectious Diseases Society of America (2008-08-01). "The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (3): 303–327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.