Méningoencéphalites infectieuses de l’adulte non immunodéprimé

Abstract: Meningoencephalitis is a disease with many drawbacks: it is usually severe and its etiology will frequently remain unsolved even with thorough investigations. Pathogen diversities and the wide range of differential diagnosis are further limitations, while there are neither guidelines nor conferences consensus available, in France and elsewhere. However, there are many valuable data in the literature and major advances have already been obtained, the most striking being advances in imaging techniques and molecular biology, as illustrated by the significant impact of HSV PCR advent in patient management. On emergency settings, physicians have to recognize and initiate appropriate treatment for patients who may have herpes simplex meningoencephalitis, and to consider bacteria for which prompt treatment has a positive prognostic impact. At this stage, intravenous acyclovir and amoxicillin should be widely prescribed, even with limited suspicion. Then, physicians will have to collect pertinent information and diagnostic tests results, and may seek expertise from other specialties when needed. Continuous improvements in diagnostic tests should allow significant progress in pathogen identification in meningoencephalitis, thus leading to better patients management. We also have to be prepared for changes, as the recent emergence of four agents of encephalitis reminded us (West Nile, Nipah, Hendra and Japanese encephalitis). [Copyright &y& Elsevier]