Negative HIV encephalitis and meningoencephalitis management algorithm Decision-making

Abstract

Meningoencephalitis is a serious, relatively frequent infection, with a worldwide incidence of 3.5 to 7.4 per 100,000 inhabitants per year and a high mortality rate (10 to 12%). The objective of our work was to determine the etiologies of encephalitis and meningoencephalitis using the most modern microbiological diagnostics and to propose a management algorithm diagnosis. Materials and methods: This is a prospective descriptive study of 141 patients aged over 28 days with symptoms suggestive of HIV-negative encephalitis and meningoencephalitis during the period from April 1, 2012 to August 31, 2015. Several types of analyzes of the various samples (LCS, serum, nasopharyngeal samples) were carried out, including 2671 by PCR, 404 direct examinations and bacterial culture, 219 viral cultures and 380 serologies. The number of pathogens screened for the patients included in this study varied from 1 to 31 pathogens. Results: In Batna, a wide range of pathogens cause acute encephalitis. Of the 141 patients, 111 (78.7%) had at least one etiological diagnosis (63 certain, 80 probable and 32 possible). Diagnosis was confirmed for 58 (41.2%) patients, probable for 41 (29.1%), and possible for 12 (8.5%). The overall incidence of encephalitis in our region is 2.15 / 100,000 inhabitants with an average age of 30.8 years (standard deviation = 21.5 years). The most frequently identified etiological pathogen was KB 30 (21.3%), followed by EBV 20 (14.2%), HSV 14 (9.9%), CMV 11 (7.8%), Coronavirus 18 (12.5), and Adenovirus 6 (4.3%).The search for patients with a confirmed and/or probable monomicrobial agent, numbering 53 (37.6%), was essential to come out with a decision-making algorithm regarding the diagnostic approach. Coinfections were identified for 48 patients (34%), of whom 12 (8.5%) had more than 2 pathogens found. 21.3% of cases remained of undetermined cause. Evolution was unfavorable for 67 or 47.2%. There were 43 cases of death (30.5%), with 20 cases of after-effects. Conclusion: This study made it possible to highlight for the first time the etiologies of encephalitis and meningoencephalitis with their clinical and para-clinical particularities, in the region of eastern Algeria (Batna), which allowed the development of a decision-making algorithm for the diagnostic approach allowing rapid and appropriate care for our patients.