encephalitis


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Encephalitis

 

Definition

Encephalitis is an inflammation of the brain, usually caused by a direct viral infection or a hyper-sensitivity reaction to a virus or foreign protein. Brain inflammation caused by a bacterial infection is sometimes called cerebritis. When both the brain and spinal cord are involved, the disorder is called encephalomyelitis. An inflammation of the brain's covering, or meninges, is called meningitis.

Description

Encephalitis is an inflammation of the brain. The inflammation is a reaction of the body's immune system to infection or invasion. During the inflammation, the brain's tissues become swollen. The combination of the infection and the immune reaction to it can cause headache and a fever, as well as more severe symptoms in some cases.
Approximately 2,000 cases of encephalitis are reported to the Centers for Disease Control in Atlanta, GA each year. The viruses causing primary encephalitis can be epidemic or sporadic. The polio virus is an epidemic cause. Arthropod-borne viral encephalitis is responsible for most epidemic viral encephalitis. The viruses live in animal hosts and mosquitos that transmit the disease. The most common form of non-epidemic or sporadic encephalitis is caused by the herpes simplex virus, type 1 (HSV-1) and has a high rate of death. Mumps is another example of a sporadic cause.

Causes and symptoms

Causes

There are more than a dozen viruses that can cause encephalitis, spread by either human-to human contact or by animal bites. Encephalitis may occur with several common viral infections of childhood. Viruses and viral diseases that may cause encephalitis include:
  • chickenpox
  • measles
  • mumps
  • Epstein-Barr virus (EBV)
  • cytomegalovirus infection
  • HIV
  • herpes simplex
  • herpes zoster (shingles)
  • herpes B
  • polio
  • rabies
  • mosquito-borne viruses (arboviruses)
Primary encephalitis is caused by direct infection by the virus, while secondary encephalitis is due to a post-infectious immune reaction to viral infection elsewhere in the body. Secondary encephalitis may occur with measles, chickenpox, mumps, rubella, and EBV. In secondary encephalitis, symptoms usually begin five to 10 days after the onset of the disease itself and are related to the breakdown of the myelin sheath that covers nerve fibers.
In rare cases, encephalitis may follow vaccination against some of the viral diseases listed above. Creutzfeldt-Jakob disease, a very rare brain disorder caused by an infectious particle called a prion, may also cause encephalitis.
Mosquitoes spread viruses responsible for equine encephalitis (eastern and western types), St. Louis encephalitis, California encephalitis, and Japanese encephalitis. Lyme disease, spread by ticks, can cause encephalitis, as can Colorado tick fever. Rabies is most often spread by animal bites from dogs, cats, mice, raccoons, squirrels, and bats and may cause encephalitis.
Equine encephalitis is carried by mosquitoes that do not normally bite humans but do bite horses and birds. It is occasionally picked up from these animals by mosquitoes that do bite humans. Japanese encephalitis and St. Louis encephalitis are also carried by mosquitoes. The risk of contracting a mosquito-borne virus is greatest in mid- to late summer, when mosquitoes are most active, in those rural areas where these viruses are known to exist. Eastern equine encephalitis occurs in eastern and southeastern United States; western equine and California encephalitis occur throughout the West; and St. Louis encephalitis occurs throughout the country. Japanese encephalitis does not occur in the United States, but is found throughout much of Asia. The viruses responsible for these diseases are classified as arbovirus and these diseases are collectively called arbovirus encephalitis.
Herpes simplex encephalitis, the most common form of sporadic encephalitis in western countries, is a disease with significantly high mortality. It occurs in children and adults and both sides of the brain are affected. It is theorized that brain infection is caused by the virus moving from a peripheral location to the brain via two nerves, the olfactory and the trigeminal (largest nerves in the skull).
Herpes simplex encephalitis is responsible for 10% of all encephalitis cases and is the main cause of sporadic, fatal encephalitis. In untreated patients, the rate of death is 70% while the mortality is 15-20% in patients who have been treated with acyclovir. The symptoms of herpes simplex encephalitis are fever, rapidly disintegrating mental state, headache, and behavioral changes.

Symptoms

The symptoms of encephalitis range from very mild to very severe and may include:
  • headache
  • fever
  • lethargy (sleepiness, decreased alertness, and fatigue)
  • malaise
  • nausea and vomiting
  • visual disturbances
  • tremor
  • decreased consciousness (drowsiness, confusion, delirium, and unconsciousness)
  • stiff neck
  • seizures
Symptoms may progress rapidly, changing from mild to severe within several days or even several hours.

Diagnosis

Diagnosis of encephalitis includes careful questioning to determine possible exposure to viral sources. Tests that can help confirm the diagnosis and rule out other disorders include:
  • Blood tests. These are to detect antibodies to viral antigens, and foreign proteins.
  • Cerebrospinal fluid analysis (spinal tap). This detects viral antigens, and provides culture specimens for the virus or bacteria that may be present in the cerebrospinal fluid.
  • Electroencephalogram (EEG).
  • CT and MRI scans.
A brain biopsy (surgical gathering of a small tissue sample) may be recommended in some cases where treatment to date has been ineffective and the cause of the encephalitis is unclear. Definite diagnosis by biopsy may allow specific treatment that would otherwise be too risky.

Treatment

Choice of treatment for encephalitis will depend on the cause. Bacterial encephalitis is treated with antibiotics. Viral encephalitis is usually treated with antiviral drugs including acyclovir, ganciclovir, foscarnet, ribovarin, and AZT. Viruses that respond to acyclovir include herpes simplex, the most common cause of sporadic (non-epidemic) encephalitis in the United States.
The symptoms of encephalitis may be treated with a number of different drugs. Corticosteroids, including prednisone and dexamethasone, are sometimes prescribed to reduce inflammation and brain swelling. Anticonvulsant drugs, including dilantin and phenytoin, are used to control seizures. Fever may be reduced with acetaminophen or other fever-reducing drugs.
A person with encephalitis must be monitored carefully, since symptoms may change rapidly. Blood tests may be required regularly to track levels of fluids and salts in the blood.

Prognosis

Encephalitis symptoms may last several weeks. Most cases of encephalitis are mild, and recovery is usually quick. Mild encephalitis usually leaves no residual neurological problems. Overall, approximately 10% of those with encephalitis die from their infections or complications such as secondary infection. Some forms of encephalitis have more severe courses, including herpes encephalitis, in which mortality is 15-20% with treatment, and 70-80% without. Antiviral treatment is ineffective for eastern equine encephalitis, and mortality is approximately 30%.
Permanent neurological consequences may follow recovery in some cases. Consequences may include personality changes, memory loss, language difficulties, seizures, and partial paralysis.

Prevention

Because encephalitis is due to infection, it may be prevented by avoiding the infection. Minimizing contact with others who have any of the viral illness listed above may reduce the chances of becoming infected. Most infections are spread by hand-to-hand or hand-to-mouth contact; frequent hand washing may reduce the likelihood of infection if contact cannot be avoided.
Mosquito-borne viruses may be avoided by preventing mosquito bites. Mosquitoes are most active at dawn and dusk, and are most common in moist areas with standing water. Minimizing exposed skin and use of mosquito repellents on other areas can reduce the chances of being bitten.
Vaccines are available against some viruses, including polio, herpes B, Japanese encephalitis, and equine encephalitis. Rabies vaccine is available for animals; it is also given to people after exposure. Japanese encephalitis vaccine is recommended for those traveling to Asia and staying in affected rural areas during transmission season.

Resources

Organizations

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

Key terms

Cerebrospinal fluid analysis — A analysis that is important in diagnosing diseases of the central nervous system. The fluid within the spine will indicate the presence of viruses, bacteria, and blood. Infections such as encephalitis will be indicated by an increase of cell count and total protein in the fluid.
Computerized tomography (CT) Scan — A test to examine organs within the body and detect evidence of tumors, blood clots, and accumulation of fluids.
Electroencephalagram (EEG) — A chart of the brain waves picked up by the electrodes placed on the scalp. Changes in brain wave activity can be an indication of nervous system disorders.
Inflammation — A response from the immune system to an injury. The signs are redness, heat, swelling, and pain.
Magnetic Resonance Imaging (MRI) — MRI is diagnostic radiography using electromagnetic energy to create an image of the central nervous system (CNS), blood system, and musculoskeletal system.
Vaccine — A prepartation containing killed or weakened microorganisms used to build immunity against infection from that microorganism.
Virus — A very small organism that can only live within a cell. They are unable to reproduce outside that cell.

en·ceph·a·li·tis

, pl.

en·ceph·a·lit·i·des

(en-sef'ă-lī'tis, en-sef-ă-lit'i-dēz), Avoid the nonword en-sef-a-lit'i-dē, an inappropriate back-formation from the plural.
Inflammation of the brain.
[G. enkephalos, brain, + -itis, inflammation]

encephalitis

(ĕn-sĕf′ə-lī′tĭs)
n.
Inflammation of the brain.

en·ceph′a·lit′ic (-lĭt′ĭk) adj.

encephalitis

Inflammation of the brain, usually caused by a virus.
 
Clinical findings
Headache, stiff neck and back, nausea, vomiting.

Diagnosis
CT with and without contrast; MRI after initial evaluation.

Pronunciation
Medspeak-UK: pronounced, enn KEFF uh lie tuss
Medspeak-US: pronounced, enn SEFF uh lie tuss

Encephalitis aetiology
Bacterial
• Tuberculosis
• Syphilis
• Lyme disease

Viral
• Arboviruses (arthropod-borne, e.g., West Nile virus)
• HSV-1 and 2
• Herpes zoster
• CMV
• Poliomyelitis
• Rabies
• HIV
• JC polyomavirus—progressive multifocal leukoencephalopathy
• Measles—subacute sclerosing panencephalitis

Fungal/parasitic (usually immunocompromised patients)
• Candida
• Mucor
• Aspergillus
• Cryptococcus
• Toxoplasma

encephalitis

Meningoencephalitis Neurology Inflammation of the brain, usually caused by a virus Clinical Findings of aseptic meningitis–headache, stiff neck and back, fever, N&V Imaging CT without and with contrast; MRI after initial evaluation. See Acute disseminated encephalitis, California encephalitis, Eastern equine encephalitis, Flea bite encephalitis, Granulomatous amebic encephalitis, Herpes simplex encephalitis, Japanese encephalitis, La Crosse encephalitis, Lyme meningoencephalitis, Murray Valley encephalitis, Primary amebic meningoencephalitis, Rasmussen's encephalitis, St. Louis encephalitis, Venezuelan equine encephalitis, Viral encephalitis, Von Economo's encephalitis, Western equine encephalitis. Cf Encephalopathy.

en·ceph·a·li·tis

, pl. encephalitides (en-sefă-lītis, -liti-dēz)
Inflammation of the brain parenchyma.
Compare: meningoencephalitis
Synonym(s): cephalitis.
[G. enkephalos, brain, + -itis, inflammation]

encephalitis

Inflammation of the brain, most commonly from infection, usually by viruses. These include herpes simplex, herpes zoster, ARBOVIRUSES, polioviruses, echoviruses or Coxsackie viruses. Secondary encephalitis may follow mumps, measles, rubella, and chickenpox. Encephalitis causes severe headache, fever, vomiting, sickness, stiff neck and seizures, and may progress to mental confusion, coma and death.

encephalitis

or

sleeping sickness

an inflammatory viral disease of the human CENTRAL NERVOUS SYSTEM that is ENDEMIC in parts of North America. Encephalitis is not to be confused with AFRICAN SLEEPING SICKNESS, which is caused by a trypanosome protozoan.

en·ceph·a·li·tis

, pl. encephalitides (en-sefă-lītis, -liti-dēz)
Inflammation of the brain.
[G. enkephalos, brain, + -itis, inflammation]
References in periodicals archive ?
Encephalitis is a viral disease that causes mild flu-like symptoms such as high fever, convulsions, and headache and has been reported from many parts of India.
Dr Ava Easton, of the Encephalitis Society, said: "If fans are just flying in to watch matches in the cities, they probably don't need vaccines.
More than 90 percent of people infected with the disease suffer from mild fever or show no apparent symptoms, but some infections result in high fever, vomiting and seizures, and could develop into acute encephalitis which can even cause swelling around the brain and a coma.
During 2013 and 2017, the number of Japanese encephalitis cases confirmed respectively was 16, 18, 30, 23 and 25, according to the agency.
Conclusion: In this study we were able to determine that patients with anti-N-Methyl-D-Aspartate Receptor encephalitis have a favorable outcome if diagnosed and treated aggressively early in the course of disease.
on the territory of Seversk ZATO, up to 20 cases of tick-borne viral encephalitis and ixodial borreliosis are registered annually, which confirms the presence of a permanently functioning natural foci.
- Abnormality of brain parenchyma on neuroimaging suggestive of encephalitis that is either new from prior studies or appears acute in onset.
In many cases, the presentation of encephalitis is monolateral in the beginning, but the lesions gradually become widespread and bilateral, and they affect the contralateral temporal lobe asymmetrically.
The anti-GAD antibodies typically cause a form of autoimmune encephalitis with classic temporal lobe lesions on MR imaging with the expected clinical findings of limbic encephalitis, and/or additional features of stiff person syndrome with early and prominent development of seizures [6].
During this 1-year period, 104 children admitted who were fulfilling clinical criteria of AES according to WHO case definition (Acute-onset of fever with change in mental status including symptoms such as confusion, disorientation, coma or inability to talk and/or often with new onset of seizures excluding simple febrile convulsion in a person of any age at any time of the [year.sup.1]) were enrolled in the study, excluding patients presenting with encephalitis but with clinico-investigational diagnosis confirmative of cerebral malaria, non-infectious encephalopathy (Hypoxic, ischaemic, vascular, toxic and metabolic) and patients with history of CNS disorder.
Benjamin Yson said that no case of Japanese encephalitis had been reported in Manila or the National Capital Region.
Methods: The demographic, clinical, laboratory, imaging, electrophysiology, and polymerase chain reaction (PCR) DNA results of patients examined with a pre-diagnosis of encephalitis were retrospectively examined.