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Peer-reviewedCC BY 4.0Frontiers in Neurology

Early differentiation of viral encephalitis and autoimmune encephalitis by clinical and basic laboratory data

  • Tim Steinberg1,2
  • Andreas Hierl1,3
  • David Freudenstein1
  • De-Hyung Lee1
  • Ralf A. Linker1
  • Markus Bauswein4
  • Hendrik Hartmann5
  • Barbara Schmidt4
  • Klemens Angstwurm1
5 affiliations
  1. 1Department of Neurology, University Hospital Regensburg
  2. 2Department of Neurology and Neurophysiology, University Hospital Augsburg
  3. 3Department of Psychiatry, Bezirksklinikum Wöllershof
  4. 4Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg
  5. 5Center for Clinical Studies, University Hospital Regensburg
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Abstract

Background and Objectives: Timely differentiation between autoimmune and viral causes of encephalitis is critical for guiding disease-specific treatment. This study aimed to develop a scoring system to facilitate early (< 6 h after presentation) differentiation between viral encephalitis (VE) and autoimmune encephalitis (AE).

Methods: We performed a retrospective, single-center analysis of all patients diagnosed with encephalitis for any etiology at the University Hospital Regensburg between January 1st, 2004 and December 31st, 2020. Based on patient history, clinical findings, and cerebrospinal fluid (CSF) parameters, we developed a scoring system to differentiate between VE and AE.

Results: A total of 434 cases with encephalitis were included, of which 171 had Herpes simplex virus encephalitis, V aricella zoster virus encephalitis, tick-borne encephalitis or autoimmune encephalitis. Based on a homogeneous subgroup of 108 cases of VE and 44 cases of AE, we used a logistic regression model to derive a score including fever, headache, CSF white blood cell count, CSF lactate concentration, and CSF protein concentration for early differentiation. The score showed very good discrimination (AUC 0.94, 95% confidence interval (CI): 0.90–0.99), with a specificity of 87.0% and sensitivity of 88.6% in our cohort.

Discussion and conclusion: Our scoring system might help to identify patients with VE or AE at presentation. Further validation is needed.

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Cite

BibTeXRIS
BibTeX
@article{steinberg2026early,
  title = {{Early differentiation of viral encephalitis and autoimmune encephalitis by clinical and basic laboratory data}},
  author = {Tim Steinberg and Andreas Hierl and David Freudenstein and De-Hyung Lee and Ralf A. Linker and Markus Bauswein and Hendrik Hartmann and Barbara Schmidt and Klemens Angstwurm},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1827372},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1827372/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Early differentiation of viral encephalitis and autoimmune encephalitis by clinical and basic laboratory data
AU  - Tim Steinberg
AU  - Andreas Hierl
AU  - David Freudenstein
AU  - De-Hyung Lee
AU  - Ralf A. Linker
AU  - Markus Bauswein
AU  - Hendrik Hartmann
AU  - Barbara Schmidt
AU  - Klemens Angstwurm
PY  - 2026
DA  - 2026/10/13
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1827372
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1827372/full
AB  - Background and Objectives: Timely differentiation between autoimmune and viral causes of encephalitis is critical for guiding disease-specific treatment. This study aimed to develop a scoring system to facilitate early (< 6 h after presentation) differentiation between viral encephalitis (VE) and autoimmune encephalitis (AE).  Methods: We performed a retrospective, single-center analysis of all patients diagnosed with encephalitis for any etiology at the University Hospital Regensburg between January 1st, 2004 and December 31st, 2020. Based on patient history, clinical findings, and cerebrospinal fluid (CSF) parameters, we developed a scoring system to differentiate between VE and AE.  Results: A total of 434 cases with encephalitis were included, of which 171 had Herpes simplex virus encephalitis, V aricella zoster virus encephalitis, tick-borne encephalitis or autoimmune encephalitis. Based on a homogeneous subgroup of 108 cases of VE and 44 cases of AE, we used a logistic regression model to derive a score including fever, headache, CSF white blood cell count, CSF lactate concentration, and CSF protein concentration for early differentiation. The score showed very good discrimination (AUC 0.94, 95% confidence interval (CI): 0.90–0.99), with a specificity of 87.0% and sensitivity of 88.6% in our cohort.  Discussion and conclusion: Our scoring system might help to identify patients with VE or AE at presentation. Further validation is needed.
SN  - 1664-2295
ER  -