Meningoencephalitis: A Detailed Guide

Last Updated on March 5, 2026 by Nurseslab.in Editorial Team

Overview

Meningoencephalitis is inflammation involving both the meninges—the membranes surrounding the brain and spinal cord—and the brain tissue itself. It combines features of meningitis, such as headache, neck stiffness, and light sensitivity, with evidence of brain dysfunction, such as confusion, personality change, seizures, reduced consciousness, focal weakness, speech disturbance, or abnormal movements. The term describes a clinical syndrome rather than one single infection.

Viruses are important causes, particularly herpes simplex virus, varicella-zoster virus, enteroviruses, and mosquito- or tick-borne viruses. Bacteria, tuberculosis, fungi, parasites, and amoebae can also cause the syndrome. Autoimmune encephalitis, acute disseminated encephalomyelitis, cancer, medication reactions, and inflammatory disorders can closely mimic infection. Because several treatable causes progress quickly, clinicians begin urgent empirical therapy while blood, cerebrospinal fluid, imaging, and electroencephalographic tests are underway.

Anatomy and Disease Mechanisms

The meninges consist of the dura mater, arachnoid mater, and pia mater. Cerebrospinal fluid circulates in the subarachnoid space and cushions the central nervous system. The brain parenchyma contains neurons, supporting glial cells, and intricate vascular networks. In meningoencephalitis, inflammation crosses these compartments. Organisms may enter through the bloodstream, travel along nerves, spread from nearby ear or sinus infection, or reach the nervous system through trauma, surgery, or a cerebrospinal-fluid leak.

Inflammatory mediators disrupt the blood–brain barrier, cause swelling, alter cerebral blood flow, and irritate neurons. Meningeal inflammation produces headache and neck stiffness; parenchymal inflammation produces altered cognition, seizures, focal deficits, or reduced consciousness. Severe disease can cause raised intracranial pressure, stroke, hydrocephalus, brain herniation, respiratory failure, and systemic shock.

Major Causes

• Herpes simplex virus: HSV-1 is a leading cause of severe sporadic encephalitis in many regions and commonly affects the temporal and frontal lobes. HSV-2 more often causes meningitis but can cause meningoencephalitis, particularly in newborns or immunocompromised people.
• Varicella-zoster virus: Can reactivate with or without a visible shingles rash and cause meningitis, encephalitis, vasculopathy, or stroke.
• Enteroviruses: Common causes of viral meningitis; severe brain involvement is more likely in newborns and immunocompromised patients.
• Arboviruses: West Nile, Japanese encephalitis, tick-borne encephalitis, La Crosse, eastern equine encephalitis, and related viruses vary by geography, season, and vector exposure.
• Other viruses: Measles, mumps, influenza, HIV, cytomegalovirus, Epstein–Barr virus, human herpesvirus 6, rabies, and lymphocytic choriomeningitis virus are among recognised causes.
• Bacteria: Pneumococcus, meningococcus, Listeria, group B streptococcus, tuberculosis, rickettsiae, ehrlichiae, Lyme borrelia, syphilis, leptospira, and other organisms may involve both meninges and brain.
• Fungi: Cryptococcus, Coccidioides, Histoplasma, Candida, Aspergillus, and others are especially relevant with immune suppression or endemic exposure.
• Parasites and amoebae: Toxoplasma, free-living amoebae, malaria, and selected helminths cause disease in specific exposure or immune contexts.
• Post-infectious or autoimmune: Acute disseminated encephalomyelitis and antibody-mediated encephalitis can begin after infection and may initially resemble microbial meningoencephalitis.

Transmission and Contagiousness

Meningoencephalitis itself is not spread as a single condition. Contagiousness depends on the cause. Meningococcus and some respiratory viruses spread through respiratory or throat secretions. Enteroviruses can spread by faecal–oral and respiratory routes. Tuberculosis spreads through airborne particles. Arboviruses spread through mosquitoes or ticks and usually do not pass directly between people. Herpes viruses are common, but brain infection is not usually acquired from casual contact with a patient who has encephalitis. Fungal disease is generally acquired from the environment or reactivation rather than another person.

Hospitals apply precautions according to the suspected organism. Public-health teams determine whether household or other close contacts need antibiotics, vaccination, testing, or monitoring. Casual contact rarely justifies self-treatment.

Risk Factors

• Newborn, very young, or advanced age.
• Immune suppression from HIV, cancer, transplantation, steroids, biological medicines, or congenital immune disorders.
• Pregnancy, which increases susceptibility to invasive Listeria infection.
• Missing vaccination against preventable causes.
• Recent ear infection, sinusitis, pneumonia, skull fracture, neurosurgery, cerebrospinal-fluid leak, or implanted nervous-system device.
• Travel to or residence in regions with mosquito-, tick-, tuberculosis-, rabies-, or fungal exposure.
• Outdoor work, camping, animal exposure, rodent contact, freshwater exposure, or unpasteurised and high-risk foods according to the pathogen.
• Asplenia, complement deficiency, or complement-inhibitor therapy.
• Newborn exposure to maternal genital herpes or infection around delivery.

Symptoms in Older Children and Adults

• Fever, severe headache, neck stiffness, nausea, vomiting, or light sensitivity.
• Confusion, disorientation, reduced attention, unusual behaviour, hallucinations, agitation, or personality change.
• Marked drowsiness, difficulty waking, or coma.
• New seizures, including subtle staring, lip smacking, or unexplained episodic unresponsiveness.
• Speech or language difficulty, memory loss, facial weakness, one-sided limb weakness, altered sensation, or poor coordination.
• Abnormal movements, tremor, rigidity, or involuntary jerks.
• Hearing change, double vision, cranial nerve symptoms, or loss of balance.
• Rash, shock, cold extremities, rapid breathing, or reduced urine in invasive bacterial disease.

Symptoms in Babies and Young Children

• Fever or an abnormally low temperature.
• Poor feeding, weak suck, vomiting, or reduced wet nappies.
• Unusual irritability, a high-pitched cry, or distress when held.
• Floppiness, stiffness, reduced movement, or abnormal posturing.
• Sleepiness, poor interaction, or difficulty waking.
• Seizures, staring episodes, twitching, or pauses in breathing.
• A tense or bulging fontanelle, though this may be absent.
• Pale, mottled, or blotchy skin; cold hands and feet; or a non-blanching rash.

Emergency Recognition

• Call emergency services for fever with altered mental state, seizure, focal neurological deficit, severe drowsiness, rapidly worsening headache, or a seriously ill infant.
• Do not wait for a rash, neck stiffness, or loss of consciousness.
• Place an unconscious breathing person safely on their side if trained and monitor breathing.
• Do not give food or drink to someone with reduced consciousness or repeated vomiting.
• Record seizure duration and protect the person from injury; do not restrain movements or place anything in the mouth.
• Tell clinicians about recent antibiotics, vaccination, immune suppression, travel, insect or animal exposure, pregnancy, new medicines, and unusual behaviour.

Diagnostic Evaluation

1. Immediate stabilisation assessment: Airway, breathing, circulation, oxygenation, blood pressure, perfusion, glucose, temperature, consciousness, seizure activity, and signs of raised intracranial pressure are assessed first.
2. Detailed history: Onset, fever, headache, neck symptoms, behavioural change, seizures, rash, recent infection, antibiotics, vaccination, travel, vector exposure, animal bite, foods, medicines, immune status, pregnancy, and substance exposure are reviewed.
3. Neurological examination: Mental status, speech, memory, cranial nerves, strength, sensation, reflexes, coordination, gait, abnormal movements, and meningeal signs are documented.
4. Blood tests: Full blood count, inflammatory markers, glucose, electrolytes, liver and kidney function, coagulation, blood gas, and lactate assess severity and treatment safety.
5. Blood cultures: Collected promptly before antibiotics when this does not delay treatment.
6. Lumbar puncture: Cerebrospinal fluid is obtained as soon as safely possible. Treatment must not wait when the procedure is delayed or contraindicated.
7. Core cerebrospinal fluid studies: Opening pressure, appearance, white and red cell counts, differential, protein, glucose with paired blood glucose, Gram stain, culture, and PCR are interpreted together.
8. Viral testing: Cerebrospinal fluid PCR commonly includes HSV-1, HSV-2, varicella-zoster virus, and enteroviruses. Timing matters; early HSV PCR can occasionally be negative and may need repetition when suspicion remains high.
9. Targeted infectious studies: Tests for tuberculosis, Cryptococcus, fungi, arboviruses, HIV, syphilis, Lyme disease, rickettsial infection, parasites, or amoebae are selected from epidemiology and host risk.
10. Brain MRI: Preferred imaging for encephalitis. Temporal-lobe abnormalities support HSV; other patterns may suggest autoimmune, post-infectious, vascular, or pathogen-specific disease.
11. Computed tomography: Useful when MRI is unavailable, for rapid assessment of haemorrhage or mass effect, or before lumbar puncture when specific warning signs are present.
12. Electroencephalography: Detects seizures and non-convulsive status epilepticus. Periodic temporal discharges can support HSV encephalitis but are not specific.
13. Autoimmune testing: Serum and cerebrospinal fluid antibody panels are considered with psychiatric symptoms, movement disorder, autonomic instability, unexplained seizures, or negative infectious studies.
14. Tumour screening: Age- and syndrome-directed pelvic, testicular, chest, abdominal, or whole-body imaging may be needed in suspected paraneoplastic autoimmune encephalitis.
15. Advanced tests: Metagenomic sequencing or, rarely, brain biopsy may be considered when disease progresses despite broad evaluation and treatment.

When Lumbar Puncture Is Deferred

• Unstable airway, breathing, or circulation requiring immediate resuscitation.
• Known or suspected severe bleeding disorder, very low platelets, or unsafe anticoagulation.
• Signs suggesting dangerous intracranial pressure or mass effect.
• Markedly reduced consciousness, focal neurological deficit, papilloedema, or selected new adult seizures requiring imaging first.
• Skin infection or suspected epidural infection at the puncture site.

Deferral must not delay empirical antibiotics or intravenous aciclovir when indicated. Blood cultures and molecular samples are collected, imaging is obtained promptly, and lumbar puncture is reconsidered after stabilisation.

Differential Diagnosis

• Sepsis-associated encephalopathy without direct brain infection.
• Autoimmune encephalitis, including anti-NMDA receptor disease.
• Acute disseminated encephalomyelitis and other demyelinating disease.
• Stroke, cerebral venous sinus thrombosis, subarachnoid haemorrhage, or vasculitis.
• Brain abscess, subdural empyema, tumour, or hydrocephalus.
• Status epilepticus with prolonged post-ictal confusion.
• Toxic or metabolic encephalopathy from hypoglycaemia, sodium disturbance, liver or kidney failure, medication, alcohol, or recreational substances.
• Heatstroke, thyroid crisis, porphyria, mitochondrial disease, or another metabolic disorder.
• Primary psychiatric illness; new psychosis with fever, seizures, movement disorder, catatonia, or autonomic instability needs neurological assessment.

Immediate Treatment Principles

• Stabilise airway, breathing, circulation, oxygenation, blood glucose, temperature, and seizures.
• Collect blood cultures promptly if this does not delay therapy.
• Start age- and risk-appropriate intravenous empirical antibiotics immediately when bacterial meningitis or meningoencephalitis is possible.
• Add Listeria coverage for relevant age groups, pregnancy, or immune compromise according to local guidance.
• Start intravenous aciclovir promptly when encephalitis is suspected because delayed treatment of HSV encephalitis worsens outcome.
• Use dexamethasone with or just before the first antibiotic dose when bacterial meningitis is suspected and local guidance recommends it.
• Apply infection-control precautions appropriate to the suspected organism.
• Transfer severe cases to intensive care for shock, respiratory failure, uncontrolled seizures, raised intracranial pressure, or rapid neurological decline.

Cause-Specific Treatment

• HSV meningoencephalitis: Intravenous aciclovir is continued for a guideline-directed course, with dose adjusted for age, weight, kidney function, and immune status. Adequate hydration and renal monitoring reduce crystal nephropathy risk.
• Varicella-zoster disease: Intravenous aciclovir is generally used; vasculopathy, immune suppression, and eye involvement may alter duration and adjunctive care.
• Acute bacterial disease: Broad intravenous antibiotics are narrowed to culture and susceptibility results. Treatment duration depends on pathogen, source, complications, and response.
• Tuberculous disease: Prolonged multidrug anti-tuberculosis therapy plus corticosteroids is commonly required, with management of hydrocephalus, stroke, and electrolyte abnormalities.
• Fungal disease: Organism-specific induction, consolidation, and maintenance therapy may be prolonged. Cryptococcal disease requires active control of raised intracranial pressure.
• Arboviral disease: Most forms have no proven specific antiviral; intensive supportive care, seizure control, and public-health reporting are central.
• Rickettsial or ehrlichial disease: Doxycycline is started promptly when epidemiology and presentation support it, without waiting for confirmatory serology.
• Autoimmune encephalitis: After reasonable exclusion and treatment of infection, specialists may use high-dose corticosteroids, intravenous immunoglobulin, plasma exchange, rituximab, or another immune therapy and treat an associated tumour.
• ADEM: High-dose corticosteroids are typical first-line therapy after infection has been assessed; intravenous immunoglobulin or plasma exchange may be used for severe refractory disease.

Supportive and Intensive Care

• Seizures: Treat promptly with emergency antiseizure medicines, continuous infusions when necessary, and electroencephalographic monitoring for non-convulsive seizures.
• Intracranial pressure: Elevate the head when appropriate, optimise oxygenation and ventilation, and use osmotic therapy, cerebrospinal-fluid drainage, or neurosurgery in selected patients.
• Fluids and circulation: Treat shock while avoiding harmful under-resuscitation or excess. Monitor sodium carefully because inappropriate antidiuretic hormone secretion or cerebral salt wasting can occur.
• Respiratory support: Intubation and ventilation may be needed for coma, recurrent seizures, weak airway reflexes, or hypoventilation.
• Temperature and metabolism: Treat fever, hypoglycaemia, electrolyte abnormalities, kidney injury, and liver dysfunction.
• Nutrition and swallowing: Assess aspiration risk and start safe enteral nutrition when possible.
• Pressure, eye, and clot prevention: Immobility requires skin care, eye protection, physiotherapy, and thrombosis prevention appropriate to bleeding risk.
• Behavioural and autonomic symptoms: Severe agitation, catatonia, dysautonomia, or movement disorder may require coordinated neurological, psychiatric, and intensive-care management.

Complications

• Brain swelling, raised intracranial pressure, herniation, or hydrocephalus.
• Status epilepticus and later epilepsy.
• Stroke, cerebral venous thrombosis, vasculitis, or intracranial haemorrhage.
• Memory loss, language impairment, reduced attention, executive dysfunction, personality change, or intellectual disability.
• Weakness, spasticity, movement disorder, poor coordination, chronic dizziness, or fatigue.
• Hearing or visual impairment and cranial nerve dysfunction.
• Aspiration pneumonia, respiratory failure, shock, kidney injury, or disseminated coagulation in severe infection.
• Sleep disturbance, depression, anxiety, post-traumatic symptoms, irritability, or social withdrawal.
• Death despite appropriate treatment, particularly with delayed therapy or highly virulent organisms.

Recovery and Rehabilitation

Recovery can take weeks, months, or years. Improvement may be uneven, and difficulties become more obvious when the person returns to complex study, employment, parenting, or social demands. A normal-looking scan does not exclude cognitive fatigue or behavioural change. Families often need education because the survivor may have limited awareness of deficits.

• Physiotherapy for strength, balance, endurance, tone, and mobility.
• Occupational therapy for self-care, sensory regulation, fatigue, home adaptation, and return to work or school.
• Speech and language therapy for communication, cognition, and swallowing.
• Neuropsychological assessment for memory, attention, executive skills, behaviour, and learning.
• Audiology and ophthalmology when hearing or vision is affected.
• Neurology follow-up for seizures, headaches, movement disorder, and medication review.
• Psychological or psychiatric support for mood, trauma, personality change, and family adjustment.
• Graded return to driving, employment, education, and sport according to local regulations and functional assessment.

Prognosis

Outcome depends on the cause, age, immune status, level of consciousness, seizure burden, brain regions affected, systemic shock, and speed of effective treatment. Herpes simplex encephalitis was frequently fatal before aciclovir; early antiviral treatment markedly improves survival but many survivors still have memory, language, behavioural, or seizure disorders. Some viral meningitis-predominant illnesses resolve completely, while rabies, primary amoebic disease, severe bacterial infection, and some fungal or tuberculous cases have high mortality.

An unidentified cause does not mean that the illness was mild or imaginary. Extensive testing fails to find an organism or antibody in a substantial proportion of encephalitis cases. Follow-up should be based on actual neurological and functional needs rather than the certainty of the laboratory label.

Prevention

• Follow national vaccination schedules for meningococcal, pneumococcal, Haemophilus influenzae type b, measles, mumps, rubella, varicella, influenza, and other preventable infections.
• Use destination-specific vaccines such as Japanese encephalitis, tick-borne encephalitis, or rabies vaccination when recommended.
• Practise hand and respiratory hygiene and avoid sharing items contaminated with saliva.
• Use mosquito repellent, protective clothing, bed nets, and environmental vector control; check promptly for ticks after exposure.
• Avoid animal bites and obtain urgent rabies post-exposure care after a potentially risky exposure.
• Use safer food practices to reduce Listeria risk during pregnancy and immune suppression.
• Diagnose and treat tuberculosis, HIV, and immune disorders promptly.
• Repair persistent cerebrospinal-fluid leaks and manage recurrent ear or sinus infection appropriately.
• Follow public-health advice regarding prophylaxis or vaccination for qualifying close contacts.

Nursing Care of a Patient with Meningoencephalitis

Overview

Meningoencephalitis is inflammation of both the meninges and the brain tissue. It may be caused by viruses, bacteria, fungi, parasites, autoimmune conditions, or post-infectious inflammation. It is a neurological emergency because patients can deteriorate quickly with seizures, altered mental status, raised intracranial pressure, respiratory compromise, sepsis, or long-term neurological disability. Nursing care focuses on early recognition, airway and breathing support, infection control, prompt treatment support, seizure precautions, neurological monitoring, fluid and temperature management, family education, and prevention of complications.

Nursing Assessment

• Assess airway, breathing, circulation, oxygen saturation, respiratory pattern, blood pressure, heart rate, temperature, hydration status, and signs of shock or sepsis.
• Assess neurological status frequently, including level of consciousness, orientation, Glasgow Coma Scale, pupils, motor response, speech, behaviour, neck stiffness, photophobia, headache, vomiting, focal deficits, abnormal movements, and seizure activity.
• Assess for symptoms of raised intracranial pressure such as worsening headache, repeated vomiting, decreasing consciousness, unequal pupils, bradycardia with hypertension, abnormal posturing, or papilloedema if assessed by the provider.
• Review exposure and risk history, including recent respiratory or gastrointestinal illness, insect or tick bites, travel, animal exposure, immunosuppression, HIV risk, vaccination status, recent neurosurgery, head trauma, sinus or ear infection, and sick contacts.
• Review diagnostic results such as blood cultures, complete blood count, inflammatory markers, glucose, electrolytes, renal and liver function, blood gas, lumbar puncture results, cerebrospinal fluid studies, CT or MRI findings, EEG, and pathogen testing when ordered.
• Assess pain, fever, nausea, vomiting, swallowing safety, nutrition, elimination, skin integrity, mobility, fall risk, aspiration risk, and ability to communicate needs.
• Assess family understanding, anxiety, baseline cognition and function, advance directives when relevant, caregiver support, and discharge or rehabilitation needs.

Priority Nursing Diagnoses

• Risk for ineffective cerebral tissue perfusion related to inflammation, cerebral oedema, increased intracranial pressure, seizures, or sepsis.
• Risk for ineffective airway clearance related to reduced level of consciousness, secretions, vomiting, weak cough, or seizures.
• Hyperthermia related to infectious or inflammatory process.
• Acute pain related to headache, meningeal irritation, photophobia, fever, or increased intracranial pressure.
• Risk for injury related to seizures, confusion, agitation, weakness, altered consciousness, or impaired mobility.
• Risk for deficient fluid volume related to fever, vomiting, poor intake, diaphoresis, or increased metabolic demand.
• Deficient knowledge related to disease process, medications, infection control, warning signs, follow-up, and possible rehabilitation needs.

Nursing Interventions

• Activate urgent medical review for suspected meningoencephalitis, especially with fever, headache, neck stiffness, altered mental status, seizures, focal neurological signs, or rapid deterioration.
• Maintain airway safety, position the patient to promote ventilation, provide oxygen as prescribed, keep suction available, and prepare for advanced airway or intensive care support if consciousness or breathing worsens.
• Perform frequent neurological observations and report decreasing level of consciousness, new focal deficits, seizures, unequal pupils, persistent vomiting, abnormal posturing, or signs of raised intracranial pressure immediately.
• Support prompt diagnostic and treatment actions, including blood cultures, lumbar puncture preparation when safe, imaging when ordered, and early administration of prescribed antimicrobials, antivirals, corticosteroids, or other cause-specific medicines.
• Implement seizure precautions, maintain a safe environment, administer anti-seizure medicines as prescribed, document seizure features and duration, and protect the patient from injury during events.
• Use infection prevention measures according to the suspected organism and facility policy, including appropriate isolation precautions, hand hygiene, respiratory etiquette, and prophylaxis guidance for close contacts when ordered.
• Manage fever and pain with prescribed antipyretics, analgesics, cooling measures as appropriate, low-stimulation environment, dim lighting for photophobia, and reduced noise.
• Maintain fluid and electrolyte balance by monitoring intake and output, urine output, daily weight when ordered, laboratory trends, vomiting, diarrhoea, and signs of dehydration or fluid overload.
• Use aspiration, fall, pressure-injury, and delirium precautions for patients with altered consciousness, weakness, poor mobility, or swallowing difficulty.
• Coordinate multidisciplinary care with infectious diseases, neurology, critical care, pharmacy, rehabilitation, speech therapy, physiotherapy, occupational therapy, dietetics, social work, and community nursing.

Patient and Family Education

• Explain that meningoencephalitis means inflammation affecting both the brain coverings and brain tissue, and that urgent treatment is needed to prevent serious complications.
• Teach the family to seek emergency care for fever with severe headache, neck stiffness, confusion, unusual behaviour, seizure, repeated vomiting, severe drowsiness, weakness, rash, breathing difficulty, or rapid worsening.
• Review the purpose and schedule of prescribed medicines, including antibiotics, antivirals, anti-seizure medicines, corticosteroids, pain medicines, or fever medicines, and stress completing the prescribed course.
• Teach infection-control measures such as hand hygiene, respiratory etiquette, avoiding sharing utensils when contagious illness is suspected, and following isolation or contact-prophylaxis instructions.
• Encourage vaccination review according to local recommendations, especially for preventable causes such as meningococcal, pneumococcal, Haemophilus influenzae type b, influenza, measles, mumps, varicella, and other relevant vaccines.
• Explain that recovery may require follow-up for hearing, vision, memory, speech, mobility, seizures, mood, school or work performance, and rehabilitation needs.
• Encourage caregivers to monitor fatigue, headaches, behaviour changes, sleep problems, weakness, seizures, medication side effects, and difficulty returning to normal activities after discharge.

Expected Outcomes

• The patient maintains a patent airway, adequate oxygenation, stable circulation, and stable temperature.
• The patient shows stable or improving neurological status with reduced confusion, headache, photophobia, vomiting, or seizure activity.
• Antimicrobial, antiviral, anti-seizure, and supportive therapies are administered promptly as prescribed.
• The patient remains free from preventable aspiration, falls, pressure injury, uncontrolled seizures, severe dehydration, septic shock, and avoidable neurological deterioration.
• The patient and family explain warning signs, medication use, infection-control measures, follow-up needs, and possible rehabilitation requirements.
• The patient receives coordinated care and appropriate referral for neurological, cognitive, hearing, vision, mobility, speech, psychosocial, or school/work support.

Evaluation

Evaluate nursing care by reviewing airway and respiratory stability, temperature, pain, hydration, neurological observations, seizure frequency, signs of raised intracranial pressure, laboratory and cerebrospinal fluid results, medication response, side effects, infection-control needs, mobility, swallowing, cognition, family understanding, and follow-up attendance. Revise the care plan if consciousness decreases, seizures persist, respiratory status worsens, intracranial pressure signs appear, sepsis develops, complications occur, or the patient requires intensive care, rehabilitation, or additional specialist support.

REFERENCES

1. Dash SK. Herpes meningoencephalitis: Causes, diagnosis, and treatment. in: Meningoencephalitis – disease which requires optimal approach in emergency manner. doi:10.5772/intechopen.68553
2. Centers for Disease Control and Prevention (U.S.). Naegleria fowleri — Primary Amebic Meningoencephalitis (PAM) — Amebic Encephalitis (https://www.cdc.gov/parasites/naegleria/index.html). Last reviewed 5/3/2023.
3. Dash SK. Herpes Meningoencephalitis: Causes, Diagnosis, and Treatment. In: Pana M, ed. Meningoencephalitis. 2017.
4. Rasul CH, Muhammad F, Hossain MJ, Ahmed KU, Rahman M. Acute meningoencephalitis in hospitalised children in southern Bangladesh (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431749/). Malays J Med Sci. 2012;19(2):67-73.
5. Rasul CH, Muhammad F, Hossain MJ, Ahmed KU, Rahman M. Acute meningoencephalitis in hospitalised children in southern Bangladesh. Malays J Med Sci. 2012;19(2):67-73.
6. Stott KE, Loyse A, Jarvis JN, et al. Cryptococcal meningoencephalitis: time for action (https://pubmed.ncbi.nlm.nih.gov/33872594/). Lancet Infect Dis. 2021;21(9):e259-e271.

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