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What is encephalitis?
Click Image to Enlarge Encephalitis is a term used to describe inflammation of the membranes that surround the brain and spinal cord. This condition causes problems with the brain and spinal cord function. The inflammation causes the brain to swell, which leads to changes in the child's neurological condition, including mental confusion and seizures.
Fever Headache (or bulging of the fontanelles, the soft spots on a baby's head)
Sensitivity to light Neck stiffness Sleepiness or lethargy Increased irritability Seizures Skin rashes Difficulty talking and speech changes Changes in alertness, confusion, or hallucinations Loss of energy Loss of appetite Unsteady gait Nausea and vomiting
The symptoms of encephalitis may resemble other problems or medical conditions. Always consult your child's doctor for a diagnosis.
X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
Blood tests Urine and stool tests Sputum culture. A diagnostic test performed on the material that is coughed up from the lungs and into the mouth. A sputum culture is often performed to determine if an infection is present.
Electroencephalogram (EEG). A procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp.
Lumbar puncture (spinal tap). A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord.
Brain biopsy. In rare cases, a biopsy of affected brain tissue may be removed for diagnosis.
Your child's age, overall health, and medical history The extent of the condition Your child's tolerance for specific medications, procedures, or therapies Expectations for the course of the condition Your opinion or preference
The key to treating encephalitis is early detection and treatment. A child with encephalitis requires immediate hospitalization and close monitoring. Sometimes, depending on what doctors think the
specific cause of the encephalitis is, certain medications can be used to fight infections that may cause it. The goal of treatment is to reduce the swelling in the head and to prevent other related complications. Medications to control the infection, seizures, fever, or other conditions may be used. The extent of the problem is dependent on the severity of the encephalitis and the presence of other organ system problems that could affect the child. In severe cases, a breathing machine may be required to help the child breathe easier. As the child recovers, physical, occupational, or speech therapy may be necessary to help the child regain muscle strength and/or speech skills. The health care team educates the family after hospitalization on how to best care for their child at home and outlines specific clinical problems that require immediate medical attention by his or her doctor. A child with encephalitis requires frequent medical evaluations following hospitalization.
----http://www.yalemedicalgroup.org/stw/Page.asp?PageID=STW026957
Encephalitis literally means an inflammationof the brain, but it usually refers to braininflam mation caused by a virus. It's a raredisease that occurs in approximately 0.5 per 100,000 in dividuals most commonly in children, the elderly, and people withweakened immune systems (e.g., t hose with HIV/AIDS or cancer). Although several thousand cases of encephalitis (also calledacute viral encephalitis or asepti c encephalitis) are reported tothe Centers for Disease Control and Prevention (CDC) every y ear,experts suspect that many more may go unreported because thesymptoms are so mild.
In more severe cases of encephalitis, a person is more likely toexperience high fever and an y of a number of symptoms thatrelate to the central nervous system, including: severe headache nausea and vomiting stiff neck confusion disorientation personality changes convulsions (seizures) problems with speech or hearing hallucinations memory loss drowsiness coma
It's harder to detect some of these symptoms in infants, butimportant signs to look for inclu de: vomiting a full or bulging soft spot (fontanel) crying that doesn't stop or that seems worse when an infant ispicked up or handled in so me way body stiffness
Because encephalitis can follow or accompany common viralillnesses, there sometimes are s igns and symptoms of theseillnesses beforehand. But often, the encephalitis appears withou twarning.
Causes
Because encephalitis can be caused by many types of germs, the infection can be spread in several different ways. One of the most dangerous and most common causes of encephalitis is the herpes simplex virus (HSV). HSV is the same virus that causes cold sores around the mouth, but when it attacks the brain it may occasionally be fatal. Fortunately, HSV encephalitis is very rare.
Encephalitis can be a very rare complication of Lyme diseasetransmitted by ticks or of rabies spread by rabid animals. Mosquitoes can also transmit the viruses for several types of encephalitis, including West Nile encephalitis, St. Louis encephalitis, and Western Equine encephalitis. Over the last several years in the United States, there's been concern about the spread of West Nile virus, which is transmitted to humans by mosquitoes that pick up the virus by biting infected birds. Milder forms of encephalitis can follow or accompany common childhood illnesses, including measles, mumps, chickenpox, rubella (German measles), and mononucleosis. Viruses like chickenpox spread mostly via the fluids of the nose and throat, usually during a cough or sneeze. Less commonly, encephalitis can result from a bacterial infection, such as bacterial meningitis, or it may be a complication of other infectious diseases like syphilis. Certain parasites, like toxoplasmosis, can also cause encephalitis in people with weakened immune systems.
Contagiousness
Brain inflammation itself is not contagious, but any of the various viruses that cause encephalitis can be. Of course, just because a child gets a certain virus does not mean that he or she will develop encephalitis. Still, to be safe, children should avoid contact with anyone who has encephalitis.
http://kidshealth.org/parent/infections/bacterial_viral/encephalitis.html#
Causes
What causes encephalitis? Encephalitis means that the brain tissue has become inflamed, and this can be caused by different things. 1. 2. 3. It can be the normal (and healthy) reaction of the body to a viral or bacterial infection. It can be the immune system over-reacting to an infection that might not even be still present in the body. It can have an auto-immune cause (the bodys immune cells become confused and start to attack healthy tissue), and occur without an infection of any kind. Where you live might also play a role. For example, in New England, the West Nile virus is the most common mosquito-born viral cause of encephalitis.
1. Viruses and other infectious agents There are some viruses that we know can cause encephalitis: herpes simplex virus This is a common cause of encephalitis. Most children have been exposed to this virus, and your child may be infected with it even if she does not have a cold sore or blister around her mouth, or other sign of the virus. enteroviruses These viruses enter the body through the gastrointestinal tract, and can also cause hand-foot-mouth disease measles, mumps, rubella and chickenpox viruses Keeping your child up-to-date with her vaccinations greatly lowers the rate of encephalitis from these viruses. Other times, we may find signs in your childs blood or spinal fluid (such as an increased white blood c ell count) that her body is battling a virus or other infection that may be causing the encephalitis, even if we dont know which particular one it is. Encephalitis can also occur following infection by agents carrying diseases, including ticks ( Lyme disease), mosquitos (West Nile virus), and cats (Bartonella, otherwise known as cat-scratch disease) or other animal exposures, environmental exposure such as swimming in fresh-water bodies, or travel to certain regions. 2. Non-infectious causes In the past, physicians assumed that if we couldnt identify the cause of a case of encephalitis, the cause must be a virus that we werent able to detect. But now we recognize that encephalitis can also be caused by over-activity of your childs immune system in a way that may not have been triggered by a virus. Its important to remember that the severity of symptoms has nothing to do with the cause, and two people might have equally severe cases of encephalitis caused by different factors.
http://www.childrenshospital.org/az/Site832/mainpageS832P1.html
Viral encephalitis
Introduction:
Encephalitis is an inflammation of the brain. Most often, it is caused by a viral infection. Several different viruses can cause encephalitis. The most common are the herpes viruses, childhood viruses such as measles, and viruses transmitted by mosquito bite. There are two types of encephalitis -- primary and secondary. In primary encephalitis, a virus attacks the brain and spinal cord directly. In secondary or postinfectious encephalitis, the virus invades another part of your body and travels to your brain. The virus causes inflammation of the nerve cells (encephalitis) or the surrounding membranes (meningitis). Encephalitis is different from meningitis, but these two brain infections often occur together.
Most cases of encephalitis are mild and don't last long. However, in some cases encephalitis can be life threatening. About 10,000 - 20,000 cases of encephalitis are reported each year in the United States.
Signs and Symptoms:
Ninety percent of people with encephalitis have flu-like symptoms, such as fever, sore throat, cough, and malaise. If meningitis accompanies encephalitis, the person may experience headache, stiff neck, intolerance to light, and vomiting. People with severe encephalitis usually have some change in consciousness, ranging from mild confusion to coma, often including disorientation and delusion with possible hallucinations, agitation, and personality changes. Up to 50% of people with encephalitis may have seizures. Other signs and symptoms of encephalitis depend on which area of the brain is most affected. These may include trouble using or understanding words or coordinating voluntary muscle movements, muscle weakness or partial paralysis on one side of the body, uncontrollable tremors or involuntary movements, and not being able to regulate body temperature. Infants may have bulging in the fontanels or soft spots on the skull.
Causes:
Arboviruses, or viruses carried by insects, are among the most common causes of viral encephalitis. Some of the major arboviruses that are transmitted by mosquito include:
Eastern equine encephalitis -- This infection is relatively rare, with only a few cases reported each year. However, about half the people who develop severe symptoms die or suffer permanent brain damage. La Crosse encephalitis -- usually affects children under 16 years of age in the upper Midwestern United States. It is rarely fatal. St. Louis encephalitis -- People in rural Midwestern and southern United States are primarily affected. Many people have mild symptoms, although symptoms can be severe in people over age 60. Up to 30% of infected seniors die of the condition. West Nile encephalitis -- Primarily affects people in Africa and the Middle East, but outbreaks have spread across the United States. Most cases are mild. Symptoms are most severe in older adults and people with weakened immune systems, and it can be fatal among those populations. Western equine encephalitis -- People in the western United States and Canada are most at risk. It usually causes a mild infection, except in children under 1 year of age, who can suffer permanent brain damage.
Herpes simplex virus type 1 (HSV-1), which is responsible for cold sores
HSV-2, which is responsible for genital herpes Varicella zoster virus, which causes chicken pox and shingles Epstein-Barr virus, which causes mononucleosis Childhood viruses that can cause encephalitis include: Measles (rubeola) German measles (rubella) Mumps
Not all cases of encephalitis are caused by viruses. Some other causes of encephalitis include:
Bacterial infection Fungal infection Parasitic infection Noninfectious causes, such as allergic reactions or toxins
Risk Factors:
The following factors may increase your risk of becoming infected with viral encephalitis:
Being very young or an older adult Being exposed to mosquitoes or ticks Having a weakened immune system Not being vaccinated against measles, mumps, and rubella Traveling to areas where viral encephalitis is common
Diagnosis:
Encephalitis is a serious condition, so you should see a doctor if you or your child start having symptoms of encephalitis. Diagnosis and initial treatment usually happens in a hospital. After doing a physical exam, a doctor may take the following steps to diagnose the condition:
Blood test -- finds viruses in the blood Spinal tap (lumbar puncture) -- finds viruses in the fluid that surrounds the brain and spinal cord Brain imaging -- magnetic resonance imaging (MRI) and computerized tomography (CT) scan see whether swelling is present in the brain Electroencephalogram (EEG) -- finds abnormal brain waves
Preventive Care:
The best way to prevent encephalitis is to avoid getting viruses that lead to encephalitis:
Protect yourself from mosquitoes. Use insect repellent and wear long pants and long sleeves. The most effective bug sprays use DEET, picaridin, or oil of lemon eucalyptus. Do not apply insect repellent to children under 2 years of age. Make sure your child is vaccinated against childhood diseases such as the measles, mumps, and rubella (MMR). Eat a healthy diet to keep your immune system healthy.
Treatment Approach:
Viral encephalitis is a serious medical condition. Although there are no specific medications to treat encephalitis, often people with symptoms are given the antiviral medication acyclovir (Zovirax). It works against herpes simplex and varicella-zoster viruses. Complementary and alternative therapies have not been studied very much for the treatment of encephalitis. But some studies indicate that scalp acupuncture, combined with proper medication, may help the healing process. Treatment includes careful observation and supportive care, including rest, proper nutrition, and fluids, to allow the body to fight the infection. You should always see your doctor if you have symptoms of encephalitis; don't try to treat yourself. Always tell your health care provider about the herbs and supplements you are using or considering using, as some supplements may interfere with conventional treatments.
Medications
Acyclovir (Zovirax) -- treats encephalitis caused by HSV, VZV, and EBV Ganciclovir (Cytovene) -- treats encephalitis caused by cytomegalovirus and HSV1 Anticonvulsant medications -- prevent and treat seizures associated with encephalitis
No specific vitamins or supplements have been shown to reduce symptoms of encephalitis. However, following these tips may help your overall health as you recover:
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers). Avoid refined foods, such as white breads, pastas, and especially sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein. Use healthy oils in foods, such as olive oil or vegetable oil. Avoid caffeine, alcohol, and tobacco. Drink 6 - 8 glasses of filtered water daily.
Omega-3 fatty acids, such as fish oil, one to three times daily, to help decrease inflammation and help with immunity. Fish oil may increase the risk of bleeding, so ask your doctor before taking it. Vitamin C, 500 - 1,000 mg one to three times daily, as an antioxidant and for immune system support. Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for digestive and immune system health. If you are taking antibiotics, taking probiotics as well may help you avoid some side effects such as diarrhea. You should refrigerate your probiotic supplements for best results.
Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. No herbs have been shown to help treat encephalitis. These herbs may help strengthen the immune system:
Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory, and immune effects. Use caffeine-free products. You may also make teas from the leaf of this herb. Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation and antiviral activity. Cat' s claw can interfere with some medications, so ask your doctor before taking it. People with leukemia should not take cat' s claw. Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for immune system support. Garlic can increase the risk of bleeding and interfere with certain medications, so ask your doctor before taking it. Astragalus (Astragalus membranaceus) standardized extract, 250 - 500 mg four times daily for immune system support and antiviral activity. Astragalus interacts with lithium and maybe with some other medications, so ask your doctor before taking it.
Elderberry (Sambucus nigra), one to two teaspoonfuls of standardized liquid extract two to four times daily, for immune system support and antiviral activity.
Acupuncture
A study of a small number of people with complications from encephalitis suggests that acupuncture delivered to the scalp may reduce severe complications and symptoms. Some practitioners believe that scalp acupuncture works for people with encephalitis because all meridians converge at the head, and the method can stimulate and regulate qi (energy) throughout the entire body. More research is needed.
Other Considerations: Pregnancy
The most common cause of encephalitis in newborns is vaginal delivery by a mother who is infected with herpes simplex virus 2 (HSV-2). This infection in newborns is often severe and fatal. For this reason, pregnant women with a history of HSV-2 infection may be advised to have a cesarean section, even if there is no sign of an active infection.
Prognosis and Complications
Full recovery from encephalitis can take weeks or months. People recovering from serious cases may have complications ranging from fatigue and difficulty concentrating to tremors and personality changes. The most severe problems associated with encephalitis come from the destruction of nerve cells in the brain. How severe the complications are depends on the person's immune system -- whether it is healthy or weak -and what infection caused the encephalitis. For example, many of those infected with Eastern equine encephalitis and St. Louis encephalitis have permanent brain damage, such as problems with memory, speech, vision, hearing, muscle control, and sensation, and a low survival rate. Those infected with Epstein-Barr or varicella zoster rarely have any serious complications. Most cases of encephalitis are mild and people make a full recovery.
Alternative Names:
Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
encephalitis can take 1-6 days to show and there is no treatment per se, though treatments used normally include breathing aides, seizure control and temperature management.6 This review provides an overview of recent research and developments in the diagnosis, treatment and impact of treatment on childrens wellbeing. Encephalitis is still evolving, this is because of an increase in migration patterns, leading to arboviruses spreading to new areas; the number of immunocompromised patients have increased due to HIV infection, cancer treatments and transplant surgery.7 These patients have been placed at risk due to a lower immune system. Since encephalitis was first documented there have been sudden epidemics.8 On the positive side, vaccination has helped to reduce encephalitis, where the cause was due to measles and mumps viruses.9 Presentation of encephalitis may begin with brief flu-like symptoms, followed by severe headaches, nausea and altered consciousness.4 There may be seizures, swelling of the meninges and other neurological signs. It is essential that a comprehensive history of the patient be obtained in order to make the best and most effective diagnosis. If encephalitis is caught in the early stages, prognosis is excellent as swift treatment can be given, however, if there are delays, it can be fatal.
Encephalitis: Outcomes
In most forms, the acute phase of encephalitis (when symptoms are the most severe) usually lasts up to a week. Full recovery can take much longer, often several weeks or months. Children may need rehabilitation, this should be fully assessed and a package of treatment and therapies offered. Difficulties during recovery and afterwards may include post-encephalitic seizures (this could remain as epilepsy) and severe disturbance of conscious. The flow chart through the illness helps explain the process from the first symptoms developing, through to discharge, and support from professionals. This flow chart illustrates the possibilities of what may happen next in order to aid access to support at the level that may be needed, and to gain quicker access to the professionals who can help.
Cerebra 2010 It is important to note here that although the flow chart does show progress through the system and addresses full recovery and the possibility of longer term implications, it does not cover the possibility of bereavement. It is anticipated that this project will aid understanding of the illness, encephalitis, and its shortand long-term implications for the child, family and the systems that the child is included in, thereby raising awareness of the need for early diagnosis for swift recovery and reducing the possibility of long-term implications.
Measles (Rubella) Mumps German Measles (Rubella) Chickenpox (Varicilla) Polio viruses Influenza
Fever
Neurological examination
Nausea
Herpes Simplex Virus (Cold Sore virus) Herpes B Shingles (Herpes zoster) Tummy bugs (Entero viruses) Glandular Fever (Epstein-Barr Virus) Cytomegalovirus
Vomiting
Neurological examination: sensory system Neurological examination: deep tendon reflexes Neurological examination: coordination and the cerebellum Neurological examination:gait
Loss of memory
Can be treated at home in mild cases. In more complex cases, patient will need to be treated in hospital, usually in the intensive care unit. Corticosteroids may be used in some cases to reduce brain swelling. If a child is having seizures, anti-convulsants may be given. Over the counter medications can be used to treat fever and headaches(such as paracetamol).
Memory loss
Sleep problems
HIV
Unable to speak
Causes Rabies
Treatment
Secondary encephalitis:
Enzyme-linked immunosorbent assays (ELISA) are carried out. Imaging tests such as CT, and MRI scans and EEGs are carried out. Spinal Tap collecting cerebrospinal fluid for analysis of white blood cells.
problems
Speech, physical, or occupational therapy may be necessary in these cases Changes in social relationships
Behaviour management Rarely, if brain damage is severe, encephalitis can lead to death. Infants younger than 1 and adults over 55 years are at greatest risk.
West Nile Encephalitis Bacterial cases include: Bartonella henselae (cat scratch) Mycobacterium tuberculosis (TB) Brain injury and/or brain tumor Drug reactions; lead poisoning or vaccine reaction
Stiff neck and back Seizures (fits) Sleepiness that may lead to coma
adults. People suffering from AIDS/HIV and undergoing cancer therapies or organ transplantation are susceptible to encephalitis. People visiting or living in areas prevalent with mosquito-borne viruses are at increased risk being infected with encephalitis. People with hobbies of gardening, jogging, playing golf or bird-watching need to exercise extra care during an encephalitis outbreak. Mosquito-borne diseases are more prevalent during summer months in the UK since it is the prime mating time for birds and mosquitoes, thus the risk of getting infected is greater during this season.
Prevention Methods Seek early treatment for any high fevers. Wear long trousers and long sleeves to avoid ticks and mosquitoes when in wooded areas or in grassy areas. Use insect repellent on any exposed areas of skin. Avoid spending a long time outdoors during dusk, which is when insects tend to bite. A Caesarian section (C-section) should be preformed if the mother has active herpes lesions, in order to protect the newborn. Vaccinate children against viruses that can cause encephalitis (measles, mumps). Japanese encephalitis can be prevented with three doses of vaccine. If travelling in Asia, opt for a vaccine if the area (or surrounding areas) you are visiting is experiencing an epidemic. Elderly, very young children and pregnant woman are at higher risk of developing symptoms of infection, extra care should be taken for these groups when travelling abroad.
Conclusions
Encephalitis, when caught early, has a good prognosis and excellent recovery rates; however, if diagnosis and treatment are delayed it can often be catastrophic, and even fatal. The studies reviewed were specific to encephalitis, its causes and its implications. Things have changed dramatically since the condition was first identified and there have been many discoveries to help manage the illness, in the forms of anti-viral medication andantibiotics, alongside many of the treatments for other symptoms such as seizures (anti-convulsants). Corticosteroids may be used in some cases to reduce brain swelling. This, alongside developments in MRI and CT scans, and the continued pursuit of other ways of treating this illness, gives much hope for the future. The studies looked at children who had been admitted into hospitals with symptoms of encephalitis and how each case was managed, as well as the outcomes.9 It was shown that older children were able to maintain some of their executive skills functions and younger children appear to sustain less impact in this area, as they are yet to gain these skills.1Where there were ongoing implications, these were recorded as physical changes such asweakness in one side of the body and co-ordination problems, or behavioural changes such as a very placid child becoming more demanding. Enabling the child to meet their own needs through practice and learning new skills will help, and will boost confidence in the child. Parents of these children had many coping strategies to improve their childs everyday life. Many children found comfort and support within an environment where their needs could be met, such as where patience was
shown and time was set aside forrecovery and rest, along with a nutritional balanced diet to support and help recovery. There is still much to be learned about encephalitis, but the research papers have shown many developments to help improve our understanding of this illness, its causes and its treatment. More importantly, for those involved in the care of a child with encephalitis, it enables them to access information to help, support and to provide guidance for their child.7 http://www.cerebra.org.uk/English/getinformation/conditions/Pages/Encephalitisinchildrenandyoungp eople.aspx