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Peer-reviewedCC BY-NC-NDJournal of intensive medicine

Meningitis, encephalitis, and beyond: A practical intensive care unit guide to severe central nervous system infections.

  • Katharina M Busl1
  • Nate Ordway2
  • Romain Sonneville3
  1. 1Department of Neurology, College of Medicine, University of Florida, McKnight Brain Institute, Gainesville, Florida, USA.
  2. 2University of Florida Health Shands, Gainesville, Florida, USA.
  3. 3Université Paris Cité, IAME UMR 1137, INSERM, Department of Intensive Care Medicine, DMU INVICTUS, Bichat Claude Bernard Hospital, AP-HP, Paris, France.
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Abstract

Infections of the central nervous system can require immediate admission to an intensive care unit (ICU) because of initial severe neurologic presentation or systemic complications or may be encountered during the course of a hospital stay because of secondary complications. Brain infections include community-acquired or healthcare-associated meningitis, ventriculitis, encephalitis, and brain abscesses, which share specific clinical features but have different pathophysiology, risk factors, and outcomes. In this review, we will provide a practice-based overview of severe presentations of brain infections as encountered by the intensivist, focusing on early decision-making, the sequence of diagnostic and management decisions, and encountered complications. We illustrate the review with case examples to offer real-life illustrations of challenging decision-points. Key take-home points include understanding the first-hour priorities for de novo presentation of meningitis and encephalitis with a focus on early initiation of antimicrobial treatment; awareness of limitations in cerebrospinal fluid (CSF)-based diagnostics for early encephalitis and in healthcare-associated meningitis and ventriculitis, and the importance of an expedited, non-CSF-based diagnostic approach to brain abscesses.

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Cite

BibTeXRIS
BibTeX
@article{busl2026meningitis,
  title = {{Meningitis, encephalitis, and beyond: A practical intensive care unit guide to severe central nervous system infections.}},
  author = {Katharina M Busl and Nate Ordway and Romain Sonneville},
  journal = {Journal of intensive medicine},
  year = {2026},
  month = jul,
  doi = {10.1016/j.jointm.2026.06.005},
  url = {https://europepmc.org/article/MED/42926925},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Meningitis, encephalitis, and beyond: A practical intensive care unit guide to severe central nervous system infections.
AU  - Katharina M Busl
AU  - Nate Ordway
AU  - Romain Sonneville
PY  - 2026
DA  - 2026/07/06
JO  - Journal of intensive medicine
DO  - 10.1016/j.jointm.2026.06.005
UR  - https://europepmc.org/article/MED/42926925
AB  - Infections of the central nervous system can require immediate admission to an intensive care unit (ICU) because of initial severe neurologic presentation or systemic complications or may be encountered during the course of a hospital stay because of secondary complications. Brain infections include community-acquired or healthcare-associated meningitis, ventriculitis, encephalitis, and brain abscesses, which share specific clinical features but have different pathophysiology, risk factors, and outcomes. In this review, we will provide a practice-based overview of severe presentations of brain infections as encountered by the intensivist, focusing on early decision-making, the sequence of diagnostic and management decisions, and encountered complications. We illustrate the review with case examples to offer real-life illustrations of challenging decision-points. Key take-home points include understanding the first-hour priorities for de novo presentation of meningitis and encephalitis with a focus on early initiation of antimicrobial treatment; awareness of limitations in cerebrospinal fluid (CSF)-based diagnostics for early encephalitis and in healthcare-associated meningitis and ventriculitis, and the importance of an expedited, non-CSF-based diagnostic approach to brain abscesses.
SN  - 2097-0250
SN  - 2667-100X
ER  -