Abstract
Purpose
Data on encephalitis in elderly patients are scarce. We aimed to describe the characteristics, aetiologies, management, and outcome of encephalitis in patients older than 65 years.
Methods
We performed an ancillary study of ENCEIF, a prospective cohort that enrolled all cases of encephalitis managed in 46 clinical sites in France during years 2016–2019. Cases were categorized in three age groups: (1) 18–64; (2) 65–79; (3) ≥ 80 years.
Results
Of the 494 adults with encephalitis enrolled, 258 (52%) were ≥ 65 years, including 74 (15%) ≥ 80 years. Patients ≥ 65 years were more likely to present with coma, impaired consciousness, confusion, aphasia, and rash, but less likely to present with fever, and headache (P < 0.05 for each). Median cerebrospinal fluid (CSF) white cells count was 61/mm3[13–220] in 65–79 years, 62 [17–180] in ≥ 80 years, vs. 114 [34–302] in < 65 years (P = 0.01). The proportion of cases due to Listeria monocytogenes and VZV increased after 65 years (P < 0.001), while the proportion of tick-borne encephalitis and Mycobacterium tuberculosis decreased with age (P < 0.05 for each). In-hospital mortality was 6/234 (3%) in < 65 years, 18/183 (10%) in 65–79 years, and 13/73 (18%) in ≥ 80 years (P < 0.001). Age ≥ 80 years, coma on admission, CSF protein ≥ 0.8 g/L and viral encephalitis were independently predictive of 6 month mortality.
Conclusion
Elderly patients represent > 50% of adults with encephalitis in France, with higher proportion of L. monocytogenes and VZV encephalitis, increased risk of death, and sequels. The empirical treatment currently recommended, aciclovir and amoxicillin, is appropriate for this age group.
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Data availability
Data may be available on request.
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Acknowledgements
The authors would like to thank the investigators’ group and the scientific committee of ENCEIF.
Sophie Abgrall, Laurent Argaud, Xavier Argemi, Nathalie Asseray, Guillaume Baille, Aurélie Baldolli, Julien Biberon, Charlotte Biron, Geneviève Blanchet-Fourcade, Mathieu Blot, Anne Bonnetain, Elisabeth Botelho-Nevers, Frédéric Bourdain, David Boutoille, Hélène Brasme, Cédric Bruel, Fabrice Bruneel, Rodolphe Buzele, Etienne Canouï, Philippe Casenave, Bernard Castan, Charles Cazanave, Céline Cazorla, Thibault Challan-Belval, Pascal Chavanet, Catherine Chirouze, Tomasz Chroboczek, Johan Courjon, Thomas De Broucker, Arnaud De La Blanchardière, Etienne de Montmollin, Thècle Degroote, Marine Delaroche, Eric Denes, Colin Deschanvres, Capucine Diard-Detoeuf, Aurélien Dinh, Olivier Epaulard, Pierre Fillatre, Emmanuel Forestier, Thibault Fraisse, Marie Froidure, Benjamin Gaborit, Amandine Gagneux-Brunon, Nicolas Gaillard, Arnaud Galbois, Mathieu Godement, François Goehringer, Simon Gravier, Valentin Greigert, Isabelle Gueit, Thomas Guimard, Carole Henry, Maxime Hentzien, Jean-Etienne Herbrecht, Pierre Jaquet, Fanny Jommier, Lydie Katchatourian, Solene Kerneis, Jessica Krause, Manuela Le Cam, Marion Le Maréchal, Gwenael Le Moal, Paul Le Turnier, Raphael Lecomte, Anne-Sophie Lecompte, Romain Lefaucheur, Stéphanie Lejeune, Xavier Lescure, Olivier Lesieur, Philippe Lesprit, Guillaume Louis, Christelle Lucas, Rafael Mahieu, Alain Makinson, Guillaune Marc, Alexandre Maria, Nathalie Marin, Aurélie Martin, Guillaume Martin-Blondel, Martin Martinot, Alexandre Mas, Philippe Mateu, Morgan Matt, Laurence Maulin, Frédéric Mechai, Jean-Paul Mira, Eugénie Mutez, Jérémie Orain, Anne Schieber-Pachart, Nathalie Pansu, Solene Patrat-Delon, Patricia Pavese, Hélène Pelerin, Véronique Pelonde-Erimée, Isabelle Pierre, Diane Ponscarme, Dimitri Psimaras, Mathilde Puges, Mathilde Reveillon-Istin, Sylvain Rheims, Aurélie Richard-Mornas, Agnès Riché, Vincent Roubeau, Yvon Ruch, Isabelle Runge, Hélène Savini, Romain Sonneville, Jean-Paul Stahl, Pierre Tattevin, Kelly Tiercelet, Saber Touati, Jean-Marie Turmel, Isabelle Tyvaert, Marc-Olivier Vareil, Magalie Vidal-Roux, Virginie Vitrat, Heidi Wille, Mathieu Zuber, Laurent Almoyna-Martinez, Olivier Bouchaud, Thomas de Broucker, Fabrice Bruneel, Bernard Castan, Eric Denes, Olivier Epaulard, Nadine Girard, Jean-Louis Herrmann, Jérome Honnorat, Alexandra Mailles, Patrice Morand, François Raffi, France Roblot, Jean-Paul Stahl, Romain Sonneville, Pierre Tattevin
Funding
French Infectious Diseases Society (Société de pathologie infectieuse de langue française, SPILF).
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AM and JPS: planned and designed the ENCEIF study, obtained funding, and coordinated patients enrolment. AM, PF and PP: performed primary analysis. PT: contributed to the analysis and wrote the first draft of the manuscript. All authors contributed to the final version and approved the revised manuscript.
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Patients or their close relatives received oral and written information about the study, and could refuse to be enrolled, but no written consent was required according to the French regulations for observational studies. This study was authorized by French Commission for Data Protection, the “Commission Nationale Informatique et Liberté” (CNIL, DR-2015-300) and was approved by the Advisory Committee on Research Information Processing, the “Comité Consultatif sur le Traitement de l'Information en matière de Recherche dans le domaine de la Santé” (CCTIRS).
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Petitgas, P., Tattevin, P., Mailles, A. et al. Infectious encephalitis in elderly patients: a prospective multicentre observational study in France 2016–2019. Infection 51, 859–867 (2023). https://doi.org/10.1007/s15010-022-01927-3
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DOI: https://doi.org/10.1007/s15010-022-01927-3