Developing Standarised Algorithms for the Investigation and Management of Encephalitis in Adults and Children

Human encephalitis in Australia causes substantial mortality and morbidity, with frequent severe neurological sequelae and long term cognitive impairment. The diagnosis of encephalitis is generally based on clinical features, neurological tests and neuroradiological imaging. Previously in Australia, no standard diagnostic algorithm has been available for suspected encephalitis, however, algorithms have been developed and used in other countries. 
 
In 2011, Professor David Durrheim and Dr Beverley Paterson secured a Hunter Medical Research Institute Grant to research What causes unexplained encephalitis? A pilot adult encephalitis hospital-based surveillance system. During the research process the team, led by Dr Keith Eastwood, identified the importance of developing a structured approach to diagnosing encephalitis and commenced work with international and Australian researchers with a similar interest. The multi-disciplinary team included all the key clinical areas and local clinical leaders directly involved in adult encephalitis diagnosis, including infectious disease physicians, neurologists, microbiologists, emergency physicians, and epidemiologists.
  
The local team was invited to join an international encephalitis consortium that refined tools for diagnosis and management based on best international evidence. 
  
In 2014/2015, this collaboration and Professor Cheryl Jones of PAEDS (enhanced surveillance in selected paediatric hospitals across Australia) coordinated a national expert group, including key representatives of the Australian Society for Infectious Diseases and Public Health Association of Australia, to develop a standardised diagnostic algorithm specifically for use across Australia to improve the diagnosis of encephalitis cases and assist in choosing the best therapeutic and diagnostic approaches for suspected cases of infectious encephalitis.
  
The guidelines were reviewed and officially endorsed by the Australian Society for Infectious Diseases, the Australian and New Zealand Association of Neurology, and the Australasian College of Emergency Medicine.
  
This algorithm has now been implemented across Australia and New Zealand, providing clinicians with a standardised approach to diagnosing encephalitis. This will benefit patients as a confirmed diagnosis is important in tailoring the most appropriate treatment. It will also provide unique information about the aetiology of infectious encephalitis in Australia; new infectious diseases may be discovered through pathogen discovery; and it will lead to an improvement in the understanding of the epidemiology of encephalitis for the purpose of improving public health response and the detection of emerging infectious disease. Three articles relating to this work have been published in the peer reviewed literature and widely disseminated to clinicians. 
 

Relevant publications from the research

  • Britton PN, Eastwood K, Brew BJ, Nagree Y, Jones CA. Consensus guidelines for the investigation and management of encephalitis. Medical J Aust 2015;202(11):576-7.
  • Britton PN, Eastwood K, Paterson B, Durrheim DN, Dale RC, Cheng AC et al. Consensus guidelines for the investigation and management of encephalitis in adults and children in Australia and New Zealand. Intern Med J 2015;45(5):563-76. doi:10.1111/imj.12749.
  • Eastwood K, Paterson BJ, Levi C, Givney R, Loewenthal M, T DEM et al. Adult encephalitis surveillance: experiences from an Australian prospective sentinel site study. Epidemiology and Infection 2015:1-8. doi:10.1017/s0950268815000527.
Current as at: Friday 1 April 2016
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