European Encephalitis Guidelines Recommend Prompt Intravenous Aciclovir and Pathogen-Specific CSF PCR

The European Academy of Neurology and European Society of Clinical Microbiology and Infectious Diseases have issued updated guidelines on diagnosing and managing infectious encephalitis in adults, following previous European guidance published in 2010. Published in the European Journal of Neurology, the guidelines addressed 16 prioritised clinical questions through systematic literature searches, standardised evidence assessment and the GRADE approach.

Two recommendations were reached: initiate intravenous aciclovir as soon as possible when encephalitis is suspected, and do not replace pathogen-specific cerebrospinal fluid (CSF) polymerase chain reaction (PCR) testing with multiplex CSF PCR panels in adults with suspected infectious encephalitis. For adults with proven herpes simplex virus encephalitis, the panel could not recommend for or against corticosteroid use.

A further 13 good practice statements covered clinical suspicion, microbiological and additional investigations, treatment, ongoing care and rehabilitation. Such statements were used where only indirect evidence was available. The guidance supports prompt antiviral treatment and retaining pathogen-specific testing, while emphasising the scarcity of high-quality evidence. This report is based on the abstract; the full recommendations and their supporting evidence were not available for review.