123 Management and Prevention Challenges Rodrigo Hasbun Editor Meningitis and Encephalitis Meningitis and Encephalitis Rodrigo Hasbun Editor Meningitis and Encephalitis Management and Prevention Challenges Editor Rodrigo Hasbun UT Health-McGovern Medical School Houston, TX USA ISBN 978-3-319-92677-3 ISBN 978-3-319-92678-0 (eBook) https://doi.org/10.1007/978-3-319-92678-0 Library of Congress Control Number: 2018949325 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland v Preface Meningitis and encephalitis continue to be associated with high rates of mortality and neurological sequelae, and despite the availability of molecular diagnostic tech- niques, the majority of patients have unknown causes. The differential diagnosis is broad and includes a wide spectrum of infectious and noninfectious etiologies, some requiring urgent therapy for survival. Some of the most common challenges clinicians face include the low sensitivity of meningeal signs, overutilization of unnecessary screening cranial imaging in suspected meningitis, delays in the diag- nosis of urgent treatable causes, emerging causes of meningitis and encephalitis, large proportion of unknown etiologies, low sensitivity of current microbiological techniques especially in the setting of previous antibiotic therapy, underutilization of available molecular diagnostic tests, and empiric antibiotic therapy and hospital- ization for viral meningitis cases. Even though there are published guidelines, com- pliance with them is not optimal and physicians do not follow standardized algorithms in their empirical approach. Due to the high rate of adverse clinical outcomes, prevention when feasible is of utmost importance. The use of conjugate vaccines for the three most common men- ingeal pathogens has dramatically changed the current epidemiology of bacterial meningitis, prenatal screening for Group B streptococcus in pregnancy has decreased early-onset neonatal meningitis, and vaccination for Japanese encephalitis has had a dramatic impact in the countries where it has been implemented. Adherence to protocols to prevent health-care associated meningitis and ventriculitis is effective, but compliance with them is not uniformly performed. Finally, this book will serve to guide current and future researchers in the field to address the gaps in knowledge that currently exist in the diagnosis, management, and prevention of the most important causes of meningitis and encephalitis in the world with the ultimate goal to improve the outcomes of these devastating clinical syndromes. Houston, TX, USA Rodrigo Hasbun