When should I consider referring a patient with suspected encephalitis to a specialist, and what information should I provide in the referral?

When to refer a patient with suspected encephalitis to a specialist:

• Arrange emergency ambulance transfer to Accident and Emergency immediately if encephalitis is suspected, as it is a serious neurological condition requiring urgent hospital assessment.
• Urgent hospital assessment by a specialist (such as a neurologist or infectious disease specialist) is indicated if there are signs of central nervous system infection, altered consciousness, focal neurological deficits, or diagnostic uncertainty.
• In children, immediate hospital assessment is recommended if encephalitis is suspected, especially if there are complex neurological features or if the child is very young (under 18 months), as clinical signs may be subtle.

Information to include in the referral:

• Patient demographics and presenting symptoms, including onset and progression of neurological signs.
• Details of any fever, seizures, altered level of consciousness, or focal neurological deficits.
• Relevant medical history, including recent infections, immunisation status, and any immunocompromising conditions.
• Results of any initial investigations performed (e.g., blood tests, imaging, lumbar puncture if done).
• Current treatment and response, including any antibiotics or antivirals started.
• Any social or safeguarding concerns if relevant.

Referral should be made urgently to secondary care for specialist assessment and management, as encephalitis can rapidly progress and requires multidisciplinary care including possible intensive care support ⁴,⁵.