From the Guidelines
Meningoencephalitis symptoms typically include fever, headache, altered level of consciousness, acute cognitive dysfunction, behavioral changes, focal neurologic signs, and seizures, as outlined in the clinical practice guidelines by the Infectious Diseases Society of America 1. These symptoms can vary widely among patients and may include nausea, vomiting, photophobia, and phonophobia, as well as various neurological deficits. The presentation of meningoencephalitis can be subtle, especially in children and the elderly, with symptoms such as irritability, poor feeding, and mild confusion or behavioral changes. Key characteristics of meningoencephalitis include:
- Inflammation of both the meninges and the brain tissue itself
- Disruption of normal brain function
- Increased intracranial pressure
- Potential for rapid progression and life-threatening outcomes without prompt treatment It is crucial to distinguish meningoencephalitis from other conditions such as postinfectious or postimmunization encephalitis, encephalomyelitis, and encephalopathy, as the management approach differs significantly 1. The diagnosis and management of meningoencephalitis involve early recognition of the clinical syndrome, appropriate diagnostic evaluation, and emergent administration of antimicrobial agents, as recommended by the Infectious Diseases Society of America 1.
From the Research
Symptoms of Meningoencephalitis
- Meningoencephalitis is a critical medical condition characterized by inflammation in both the meninges and brain parenchyma 2
- The condition can be caused by bacterial, viral, or fungal infections, as well as noninfectious factors such as autoimmune causes 2
- Symptoms of meningoencephalitis can include encephalopathy, fever, seizures, focal neurological deficit, abnormal neuroimaging, and/or electroencephalogram 3
- Patients with meningoencephalitis may experience a range of neurological sequelae, including hemiparesis/hemiplegia, respiratory failure, and cardiovascular failure 3
Clinical Features and Outcomes
- Meningoencephalitis is associated with a severe prognosis, including mortality rates ranging from 11 to 25% and functional disability in 15-25% of survivors 2
- Variables independently associated with a poor functional outcome include age > 60 years, immunodepression, time between hospital and ICU admission > 1 day, and presence of motor component on the Glasgow Coma Scale 3
- Administration of a third-generation cephalosporin and acyclovir on ICU admission have been shown to be protective against poor functional outcomes 3
Treatment and Management
- The use of new multiplex PCR techniques for diagnosis has generated debate based on recent data 2
- Investigation is still needed to determine the effectiveness of adjunctive therapies, including seizure prophylaxis, and adjunctive steroids for nonbacterial causes 2
- Meropenem has been shown to be an effective and well-tolerated antibiotic for the treatment of bacterial meningitis in adults 4
- Combination treatment including cefotaxim or ceftriaxone and vancomycine remains the standard first line therapy for bacterial meningitis in infants and children 5