What is Encephalitis?

Encephalitis is an acute inflammation of the brain. When I say encephalitis, it doesn’t include meninges affection. When meninges are affected, it’s called meningo-encephalitis.

Incidence of 4-7 per 100,000 persons per year.

The cause of encephalitis is usually infectious in nature. Although bacteria, fungi, protozoa can produce encephalitis, most cases are viral in origin. There is over 100 viruses worldwide that can cause encephalitis, the most important of them are the following:

  1. Herpes Simplex Virus (HSV)
  2. Varicella Zoster Virus (VZV)
  3. Rabies
  4. HIV
  5. H5N1 encephalitis
  6. ArBoVirus encephalitis (Arthropod-Borne viruses) are subdivided into:
  • Flaviviridae (Japanese encephalitis – St. Louis encephalitis – West Nile virus)
  • Togaviridae (Eastern equine encephalitis – Western equine encephalitis)
  • Bunyaviridae (La Crosse encephalitis)

Parasitic infection as toxoplasmosis, malaria, PAM (caused by Nagleria fowleri) or GAE (caused by Acanthamoeba castellanii) can cause encephalitis in immuno-compromised patients.

Bacteria like streptococci, pneumococci, staphylococci can cause ceribritis (inflammation of cerebral cortex). Bartonella henselae (causing cat-scratch disease) or Borrelia burgdorferi (causing Lyme disease) may cause encephalitis too.

Cryptococcus neoformans is a fungus notorious for causing fungal encephalitis in the immuno-compromised.

Pathogenesis

Let’s know how causative organisms (specially viruses) can lead to inflammation of the brain:

  1. The virus replicates outside the CNS.
  2. Enter CNS by hematogenous spread or along neural pathways (eg, rabies virus, HSV, VZV).
  3. Once across BBB (Blood Brain Barrier), the virus enters neural cells, with resultant disruption in cell functioning, perivascular congestion, hemorrhage, and a diffuse inflammatory response.

Regional tropism: It was found that some viruses have more affinity to a particular part of the brain, causing inflammation in that specific part only! That occurs due to neuron cell membrane receptors distribution that are  found only in specific portions of the brain, with more intense focal pathology in these areas. A classic example of regional tropism is the HSV predilection for the inferior and medial temporal lobes.

Clinical Picture

  • Adult patients: acute onset fever, headache, confusion, seizures.
  • In severe cases: nausea, vomiting, sensitivity to bright light and coma.
  • Infants may present irritability, poor appetite, fever, body stiffness and bulging fontanelle.

Diagnosis

  • Neurological examinations: reveals a confused patient with stiff neck, due to the irritation of meninges.
  • Detection of antibodies in the CSF against a specific viral agent or by PCR.
  • Serological tests may show high antibody titre against the causative antigen.
  • Examination of the CSF obtained by lumbar puncture usually reveals increased amounts of protein and WBCs with normal glucose.
  • Bleeding is also uncommon except in patients with herpes simplex type 1 encephalitis.
  • In patients with herpes simplex encephalitis, EEG may show sharp waves in one or both of the temporal lobes.

Treatment

  • Acyclovir (anti-viral) for HSV
  • In advanced cases, supportive treatment, such as mechanical ventilation, is usually needed.
  • Corticosteroids are used to reduce brain swelling and inflammation.
  • Sedatives may be needed for irritability or restlessness.
  • For Mycoplasma infection, parentral tetracycline is given.
  • Encephalitis due to Toxoplasma is treated by giving a combination of pyrimethamine and sulphadimidine.

Vaccination

  • There is no vaccine for most encephalitides until now.
  • A live, attenuated vaccine against Japanese encephalitis virus has been developed and tested in China and appeared to be safe and effective.


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  • Excellent! Clearly written for non-professionals to understand.

    Learn more about encephalitis from the people it has touched. Visit Encephalitis Global Inc. where survivors, caregivers and loved ones share information and support, every day.

  • Your coverage of the acute phase of Encephalitis is excellent. HOWEVER, you have missed the fact that IF the person survives the acute phase, it is the sub-acute phase and the after effects of encephalitis are most challenging. The level of disability related to the ABI caused by Encephalitis is significant and in many cases life long. Receptive and expressive dysphasia, memory issues, sense of time, hearing, disordered thoughts, change of character, disorders of organisational skills, disorders of reality and perception, and many more, impact upon the Encephalitis survivor and need to be understood and managed. Most Encephalitis survivors will need ongoing support and will never re-enter the workforce.

  • Hello Leif!
    I agree that support post-e is of huge importance. The forum at Encephalitis Global receives more than two hundred messages posted every week!
    The article above does focus more on the diagnosis of encephalitis than the issues a survivor copes with post-encephalitis.
    Do you agree, though, that the content makes perfect sense for a biology-themed website?

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