Abstract
BackgroundDepending on geographic location, causes of encephalitis, meningoencephalitis and meningitis vary substantially. We aimed to identify the most frequent causes, clinical presentation and long-term outcome of encephalitis, meningoencephalitis and meningitis cases treated in the Inselspital University Hospital Bern, Switzerland.MethodsIn this monocentric, observational study, we performed a retrospective review of clinical patient records for all patients treated within a 3-year period. Patients were contacted for a telephone follow-up interview and to fill out questionnaires, especially related to disturbances of sleep and wakefulness.ResultsWe included 258 patients with the following conditions: encephalitis (18%), nonbacterial meningoencephalitis (42%), nonbacterial meningitis (27%) and bacterial meningoencephalitis/meningitis (13%). Herpes simplex virus (HSV) was the most common cause of encephalitis (18%); tick-borne encephalitis virus (TBEV) was the most common cause of nonbacterial meningoencephalitis (46%), enterovirus was the most common cause of nonbacterial meningitis (21%) and Streptococcus pneumoniae was the most common cause of bacterial meningoencephalitis/meningitis (49%). Overall, 35% patients remained without a known cause. After a median time of 16 months, 162 patients participated in the follow-up interview; 56% reported suffering from neurological long-term sequelae such as fatigue and/or excessive daytime sleepiness (34%), cognitive impairment and memory deficits (22%), headache (14%) and epileptic seizures (11%).ConclusionsIn the Bern region, Switzerland, TBEV was the overall most frequently detected infectious cause, with a clinical manifestation of meningoencephalitis in the majority of cases. Long-term neurological sequelae, most importantly cognitive impairment, fatigue and headache, were frequently self-reported not only in encephalitis and meningoencephalitis survivors but also in viral meningitis survivors up to 40 months after acute infection.
Highlights
Depending on geographic location, causes of encephalitis, meningoencephalitis and meningitis vary substantially
Full list of author information is available at the end of the article
The first part comprised a retrospective analysis of medical records from all patients diagnosed with any acute encephalitis, meningoencephalitis or meningitis treated in the Inselspital in Bern, Switzerland, a tertiary care university hospital with a population base of 1.5 million inhabitants
Summary
Causes of encephalitis, meningoencephalitis and meningitis vary substantially. We aimed to identify the most frequent causes, clinical presentation and long-term outcome of enceph‐ alitis, meningoencephalitis and meningitis cases treated in the Inselspital University Hospital Bern, Switzerland. Considering significant geographic variation, Ungureanu et al BMC Neurology (2021) 21:474 encephalitis has a worldwide incidence between 1 and 13 cases/100.000/year [6, 7]. In Switzerland, tick-borne encephalitis virus (TBEV) is one of the most frequent causes of meningoencephalitis [8], whereas in the United Kingdom, herpes simplex virus (HSV) is the most common infectious cause of encephalitis [3]. In a large observational cohort study from the United Kingdom of nonbacterial meningitis cases, 42% remained without known cause, whereas enterovirus was the most common pathogen [1]
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