Epidemiology and Infection

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Epidemiology and Infection (2010), 138:783-800 Cambridge University Press
Copyright © Cambridge University Press 2010
doi:10.1017/S0950268810000725

Review Article

Causality in acute encephalitis: defining aetiologies


J. GRANERODa1 c1, R. CUNNINGHAMa2, M. ZUCKERMANa3, K. MUTTONa4, N. W. S. DAVIESa5, A. L. WALSHa1, K. N. WARDa6, D. A. HILTONa2, H. E. AMBROSEa1, J. P. CLEWLEYa1, D. MORGANa1, M. P. LUNNa7, T. SOLOMONa8, D. W. G. BROWNa1 and N. S. CROWCROFTa1a9

a1 Health Protection Agency Centre for Infections, London, UK
a2 Plymouth Hospitals NHS Trust, Plymouth, UK
a3 King's College Hospital, London, UK
a4 Manchester Royal Infirmary, Manchester, UK
a5 St Vincent's Hospital & University of New South Wales, Sydney, Australia
a6 University College Hospital, London, UK
a7 National Hospital for Neurology and Neurosurgery, London, UK
a8 Brain Infections Group, University of Liverpool, Liverpool, UK
a9 Ontario Agency for Health Protection and Promotion, Toronto, Canada
Article author query
granerod j [PubMed]  [Google Scholar]
cunningham r [PubMed]  [Google Scholar]
zuckerman m [PubMed]  [Google Scholar]
mutton k [PubMed]  [Google Scholar]
davies nws [PubMed]  [Google Scholar]
walsh al [PubMed]  [Google Scholar]
ward kn [PubMed]  [Google Scholar]
hilton da [PubMed]  [Google Scholar]
ambrose he [PubMed]  [Google Scholar]
clewley jp [PubMed]  [Google Scholar]
morgan d [PubMed]  [Google Scholar]
lunn mp [PubMed]  [Google Scholar]
solomon t [PubMed]  [Google Scholar]
brown dwg [PubMed]  [Google Scholar]
crowcroft ns [PubMed]  [Google Scholar]

SUMMARY

Defining the causal relationship between a microbe and encephalitis is complex. Over 100 different infectious agents may cause encephalitis, often as one of the rarer manifestations of infection. The gold-standard techniques to detect causative infectious agents in encephalitis in life depend on the study of brain biopsy material; however, in most cases this is not possible. We present the UK perspective on aetiological case definitions for acute encephalitis and extend them to include immune-mediated causes. Expert opinion was primarily used and was supplemented by literature-based methods. Wide usage of these definitions will facilitate comparison between studies and result in a better understanding of the causes of this devastating condition. They provide a framework for regular review and updating as the knowledge base increases both clinically and through improvements in diagnostic methods. The importance of new and emerging pathogens as causes of encephalitis can be assessed against the principles laid out here.

(Accepted March 09 2010)

(Online publication April 14 2010)

Key Words:Aetiology; case definition; encephalitis; infection

Correspondence:

c1 Author for correspondence: Miss J. Granerod, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK. (Email: Julia.granerod@hpa.org.uk)


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