Clinical Epidemiology, Risk Factors, and Outcomes of Encephalitis in Older Adults
Open accessAbstract
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: We performed a 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 (aged ≥17 years) patients with confirmed encephalitis were enrolled, and 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 82 (24%) patients, respectively. Furthermore, an arboviral serology was done in 169 (49%) patients and measurements of anti-N-methyl-D-aspartate receptor antibodies were taken in 49 (14%) patients. A total of 172 out of 323 patients (53%) had adverse clinical outcomes (ACOs) at discharge. Older individuals (>65 years of age) had a lower prevalence of human immunodeficiency virus, had a higher number of comorbidities, were less likely to receive adjuvant steroids, were more likely to have a positive arbovirus serology, were more likely to have a positive HSV PCR, were more likely to have abnormal computerized tomography findings, and were more likely to have to have an ACO (all P values < .05). Prognostic factors independently associated with an ACO were age ≥65, fever, Glasgow Coma Scale (GCS) score <13, and seizures (all P values ≤0.01). Conclusions: Encephalitis in adults remain with unknown etiologies and adverse clinical outcomes in the majority of patients. Independent prognostic factors include age ≥65 years, fever, GCS score <13, and seizures.
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Studies assessing prognosis using hard endpoints in the post-acyclovir era showed neurological impairment in 20-60% of VZV patients upon hospital discharge, 55% after one month, 51% after three months, and 71% after one year after the acute episode.
“Studies assessing prognosis using hard endpoints in the post-acyclovir era showed neurological impairment in 20–60% of patients upon hospital discharge [62–64], 55% after one month, 51% after three months and 71% after one year [62, 65] after the acute episode.”
From Cognitive decline following acute viral infections: literature review and projections for post-COVID-19 (2022) · cites this paper as [64]
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- Authors
- Hansen, M. A., Samannodi, M. S., Castelblanco, R. L., & Hasbun, R.
- Affiliations
- Baylor College of Medicine (US)
- The University of Texas Health Science Center at Houston (US)
- Corresponding author
- Hasbun, Rodrigo
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-07-10
- Volume
- 70
- Issue
- 11
- Pages
- 2377-2385
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2961604107
- Cited by
- 48
- References
- 25
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 5 · 2023: 5 · 2022: 10 · 2021: 6 · 2020: 6
- FWCI
- 4.24
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Infectious Diseases (publishedVersion)
- SSRN Electronic Journal (acceptedVersion)
- PubMed (publishedVersion)
- Funders
- A Starr Foundation
- Topics
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Health Sciences › Medicine › Neurology › Autoimmune Neurological Disorders and Treatments
- Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
- Keywords
- encephalitis, older adults, prognostic factors, adverse clinical outcomes, unknown etiology, herpes simplex virus, varicella-zoster virus, NMDA receptor antibodies, comorbidities, seizures, fever, Glasgow Coma Scale
- MeSH terms
- Aged, Encephalitis, Humans, Louisiana, Retrospective Studies, Risk Factors, Texas, Encephalitis, Herpes Simplex
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