Infectious encephalitis: Management without etiological diagnosis 48 hours after onset

Introduction. The etiological diagnosis of infectious encephalitis is often not established 48 hours after onset. We aimed to review existing literature data before providing management guidelines. Method. We performed a literature search on PubMed using filters such as ``since 01/01/2000'', ``human'', ``adults'', ``English or French'', and ``clinical trial/review/guidelines''. We also used the Mesh search terms ``encephalitis/therapy'' and ``encephalitis/diagnosis''. Results. With Mesh search terms ``encephalitis/therapy'' and ``encephalitis/diagnosis'', we retrieved 223 and 258 articles, respectively. With search terms ``encephalitis and corticosteroid'', we identified 38 articles, and with ``encephalitis and doxycycline'' without the above-mentioned filters we identified 85 articles. A total of 210 articles were included in the analysis. Discussion. Etiological investigations must focus on recent travels, animal exposures, age, immunodeficiency, neurological damage characteristics, and potential extra-neurological signs. The interest of a diagnosis of encephalitis for which there is no specific treatment is also to discontinue any empirical treatments initially prescribed. Physicians must consider and search for autoimmune encephalitis. (C) 2017 Elsevier Masson SAS. All rights reserved.