Paediatric and Adult Causes of Encephalitis and Meningitis: The PACEM study.

Meningitis (inflammation of the meninges) and encephalitis (inflammation of the
brain in association with clinical evidence of neurologic dysfunction) are
potential life-threatening conditions that can rapidly progress to permanent
brain damage, neurologic problems, and even death. Since vaccination against
the most common causative bacteria (H. influenza type b, S. pneumonia, N.
meningitidis serogroup C), the incidence of bacterial meningitis has dropped
significantly. Therefore, non-bacterial pathogens, such as viruses and
tick-born pathogens are increasingly recognized as important causes of central
nervous system (CNS) infections. In addition, immune-mediated processes (like
ADEM and antibody associated encephalitis) seem to play an important role. For
example, in a study in the UK, immune mediated processes were found in 20
percent of patients with encephalitis.
In contrast with bacterial meningitis, for which an extensive surveillance
system has been set up in many countries, viral or non-bacterial CNS infection
is not monitored systematically and proper incidence numbers of the different
causative agents and mortality and morbidity rates are missing. Recently it has
been propagated that it is important to optimize the surveillance for viral
encephalitis/meningitis in Europe to gain more insight in the aetiological
pattern as well as to optimize therapy to improve survival and reduce brain
injury.

The aim of this project is to set up a regional pilot survey study that will
systematically register both clinical and laboratory findings of adults and
children with meningitis and/or encephalitis in the Netherlands to gain more
insight in the causes and pathogenesis of these diseases. After one year, the
results of the pilot survey will be evaluated to assess if the study will be
set up nationwide (in the Netherlands).

To evaluate the incidence, causes and characteristics of meningitis and/or
encephalitis in patients of all ages:
1. To determine the causes of meningitis and/or encephalitis in children and
adults
2. To evaluate the clinical signs and symptoms and CSF (and other material)
laboratory characteristics of children and adults with a diagnosis of
meningitis and/or encephalitis
3. To determine what materials (CSF, blood, faeces/rectal swab, nasopharyngeal
aspirate/swab or throat swab) are most suitable for the detection of
meningitis/encephalitis in children and adults.
4. To determine the impact of meningitis and/or encephalitis on the health care
systems in terms of costs, antibiotic use, morbidity and mortality.

This is a prospective observational study. A pilot (duration 1 year) will be
initiated in 3 regional hospitals in Amsterdam and Almere, the Netherlands. If
this pilot is successfull, the study will be extended to the whole country.

The burden consists of the collection of one bloodsample, one throatswab or
nasopharyngeal aspirate and one faecessample or rectal swab.
The extent of this burden is estimated as low. As far as we know, there are no
risks of the above mentioned collection of materials.