Diagnosis and Management of Infectious Encephalitis in Adults: Guidelines From the European Academy of Neurology and European Society of Clinical Microbiology and Infectious Diseases
EAN/ESCMID · 2026 · Europe
Source and licence
- Authors
- Julia Granerod, Johann Sellner, Jean‐Paul Stahl et al.
- Title
- Diagnosis and Management of Infectious Encephalitis in Adults: Guidelines From the European Academy of Neurology and European Society of Clinical Microbiology and Infectious Diseases
- Journal
- European Journal of Neurology, 2026
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC13650609
Licence statement of the original publication
This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Microbiological Investigations
- We conditionally recommend against replacing pathogen‐specific PCR testing of CSF with multiplex CSF PCR panels for diagnosis of adult patients with suspected infectious encephalitisConditional recommendation; low certainty in the evidence
Abstract
Background: Encephalitis is difficult to diagnose and manage, posing a challenge to clinicians. Since the last European guidelines were published in 2010, novel causes have emerged, diagnostic processes have evolved and treatments assessed which need to be reflected in updated guidelines.
Objective: We aimed to produce recommendations for the diagnosis and management of infectious encephalitis in adults based on current evidence to equip clinicians to improve patient outcomes.
Methods: These guidelines were developed jointly with the support of two European specialist medical organisations. Clinical questions were prioritised and formulated in PICO format. A systematic literature search was conducted for each question, and the quality of evidence was assessed using standardised tools. Recommendations were developed according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Where only indirect evidence was available, a good practice statement was made.
Results: Sixteen questions were considered, with two recommendations reached: for initiation of intravenous aciclovir as soon as possible upon suspicion of encephalitis and against replacing pathogen‐specific polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) with multiplex CSF PCR panels for diagnosis of adult patients with suspected infectious encephalitis. For adults with proven HSV encephalitis, we were unable to recommend for or against the use of corticosteroids. A further 13 good practice statements regarding when to clinically suspect infectious encephalitis, microbiological investigations, additional investigations, treatment and ongoing care and rehabilitation were agreed.
Conclusions: Given the clinical severity and public health importance of this condition, the paucity of high‐quality evidence is striking. Transnational, large‐scale research in infective encephalitis is encouraged.
Contents of the original publication
The section headings of the original.
- Background
- Objectives and Scope
- Methods
- Questions
- Search for Studies
- Study Selection and Data Extraction
- Data Synthesis and Certainty in the Evidence
- Formulation of Recommendations
- Results
- When to Suspect Encephalitis
- Microbiological Investigations
- Additional Investigations
- Treatment
- Ongoing Care and Rehabilitation
- Discussion
- Supporting information
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