Title: Enhanced Diagnostic and Management Strategies to Improve the Identification and Outcome of Individuals with Encephalitis
Funder: Department of Health (England)

Abstract: BACKGROUND We have recently completed a DH-funded Prospective Aetiological Study of Encephalitis which has important implications for clinical and laboratory practice (Granerod 2010; Ambrose 2011): 1. Rigorously implemented and standardised first-line investigations significantly reduced the proportion of cases of unknown aetiology, which directly affects management. This supports the need for consistent implementation of standardised diagnostic algorithms 2. A significant proportion of encephalitis was found to be immune-mediated; cases of antibody-associated encephalitis were shown to have the worst outcome of all aetiological groups. The importance of early recognition of these cases needs to be highlighted as treatment is available and effective, and delayed treatment leads to worse outcomes. AIMS 1. To devise a standard diagnostic algorithm for the laboratory investigation of encephalitis across the UK; 2. To establish how improved access to intrathecal and autoantibody testing will contribute to better management of cases; 3. To collaborate with the UK Clinical Virology Network on optimising the molecular diagnostic assays available across the UK; 4. To establish a communications strategy for general physicians, general practitioners and the general public to raise awareness of encephalitis and contribute to rapid neurological referral; 5. To establish a bio-bank for further work on the aetiology of encephalitis cases; 6. To define the role of diagnostic imaging in the early management of encephalitis cases; 7. To define and quantify the clinical sequelae post-encephalitis. PLAN OF INVESTIGATION We will build on existing databases of encephalitis cases in England and clinical/laboratory networks to collect further epidemiological information and clinical samples to develop/refine the encephalitis diagnosis and treatment algorithms Imaging will be assessed in the early diagnosis of encephalitis. Post-encephalitis complications will be assessed by analysing anonymised health records from a historical cohort of UK individuals to estimate clinical impact. This will be used in active networking with professional medical/laboratory groups to increase awareness of encephalitis and need for rapid diagnosis and treatment. A biobank will be established to provide material for current/future investigations into the causes of encephalitis and for risk assessment of emerging infection. POTENTIAL IMPACT This project will contribute to capability and preparedness for responding to new and emerging diseases and as such addresses a key overarching aim to improve and protect the nation’s health (the Outcomes Framework). The proposed biobank, networks, and algorithms for clinicians and diagnostic laboratories will enable rapid response to unknown encephalitides. This responds to the Government’s undertaking to make the NHS resilient and able to be mobilised during any emergency it faces, or as part of a national response to threats external to the NHS. The study will improve the evidence base for the identification and treatment of encephalitis and in doing so improve the outcomes at the national level as well as with patient-reported and patient experience measures.


Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;1.5 RESOURCES AND INFRASTRUCTURE (UNDERPINNING);4.2 EVALUATION OF MARKERS AND TECHNOLOGIES;5.3 MEDICAL DEVICES
Health categories: GENERIC HEALTH RELEVANCE;RESPIRATORY;METABOLIC AND ENDOCRINE;CARDIOVASCULAR