Therapy of meningoencephalitis

In the therapy of meningoencephalitis, which is mostly caused by a virus, the treating physician has only a few drugs at his disposal. Since there are only a few drugs that are effective against viruses (antiviral), most viral infections must be eliminated. Only a symptomatic treatment is recommended.

In case of meningoencephalitis herpetica, the acyclovir, which is effective against the herpes simplex virus I, can be used. The administration of this antiviral drug may save the life of the patient under certain circumstances. The possibilities of drug therapy are significantly better in bacterial meningoencephalitis.

However, care must be taken to ensure that the antibiotics also reach the brain.This is known as cerebrospinal fluid (CSF = cerebrospinal fluid surrounding the brain) and describes how well the drug passes from the blood through the blood-cerebrospinal fluid barrier to its site of action. Ceftriaxone has a high cerebrospinal fluid permeability, which can be used universally for many different pathogens. If an infection with Listeria is assumed, an additional administration of Ampicillin is necessary.

The treatment of fungal infections of the brain is difficult due to the poor cerebrospinal fluid permeability of the antifungal agents (antimycotics). Although voriconazole has the greatest effect, it often has to be combined with other antifungal drugs to achieve adequate treatment. The use of corticoids such as cortisone has a positive and a negative aspect. On the one hand, the late effects are reduced by less scarring of the inflamed tissue, on the other hand the patient’s immune system is impaired, which makes it much more difficult to defend against the infection and can prolong the healing process.

What are the possible consequences of meningoencephalitis?

Consequential damage is absent in the majority of all cases of meningoencephalitis if treatment is given in time. Inflammation of the meninges in particular influences the prognosis and varies in severity depending on the pathogen. However, the most dangerous meningitis pathogens do not infect the brain, which is why a confirmed bacterial meningoencephalitis often heals without consequences.

If the cause is viral, the prognosis also depends on the virus strain. For example, while a measles infection heals in most cases without any consequences for the patient, meningoencephalitis herpetica can cause severe damage. The mortality rate of untreated cases is 70% (treated cases 20%) and a quarter of patients whose lives can be saved have severe sequelae such as paralysis, mental retardation or accompanying blindness due to retinal detachment.