{"id":393,"date":"2023-05-08T16:55:56","date_gmt":"2023-05-08T16:55:56","guid":{"rendered":"https:\/\/mayhospitalshendam.com\/?p=393"},"modified":"2023-05-08T19:16:51","modified_gmt":"2023-05-08T19:16:51","slug":"viral-encephalitis","status":"publish","type":"post","link":"https:\/\/mayhospitalshendam.com\/?p=393","title":{"rendered":"VIRAL ENCEPHALITIS"},"content":{"rendered":"<p><i>BY<\/i><br \/>\nDr Nansel, Charles<\/p>\n<p>&nbsp;<\/p>\n<p>OUTLINES<\/p>\n<ul>\n<li>Definition<\/li>\n<li>Epidemiology<\/li>\n<li>Etiology<\/li>\n<li>Pathology<\/li>\n<li>Clinical features &amp; Diagnosis<\/li>\n<li>Treatment<\/li>\n<li>Prognosis<\/li>\n<li>Complications<\/li>\n<li>Differentials<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>DEFINITION<\/b><\/p>\n<ul>\n<li><b>Encephalitis<\/b> is an acute inflammatory process affecting the brain parenchyma tissue clinically expressed by fever, impaired consciousness, seizures, focal neurologic deficits.<\/li>\n<\/ul>\n<p>Variants<\/p>\n<ul>\n<li><b>Encephalomyelitis<\/b> &#8212; affecting the spinal cords<\/li>\n<li><b>Encephalomyeloradiculitis<\/b> &#8212;- affecting the nerve roots<\/li>\n<li><b>Meningoencephalitis<\/b> &#8212;&#8211; affecting both the meninges and brain parenchyma<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>EPIDEMIOLOGY<\/b><\/p>\n<ul>\n<li>In the united states, &lt;20,000 cases reported annually<\/li>\n<li>Incidence of 3.5-7.4 per 100,000 persons per year<\/li>\n<\/ul>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-394\" src=\"https:\/\/i0.wp.com\/mayhospitalshendam.com\/wp-content\/uploads\/2023\/05\/download-1.jpg?resize=300%2C158&#038;ssl=1\" alt=\"\" width=\"300\" height=\"158\" srcset=\"https:\/\/i0.wp.com\/mayhospitalshendam.com\/wp-content\/uploads\/2023\/05\/download-1.jpg?resize=300%2C158&amp;ssl=1 300w, https:\/\/i0.wp.com\/mayhospitalshendam.com\/wp-content\/uploads\/2023\/05\/download-1.jpg?w=310&amp;ssl=1 310w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<p><b>RISK FACTORS<\/b><\/p>\n<ul>\n<li>Age \u2013young and older adults are at greater risk<\/li>\n<li>Weakened immune system\u2013 HIV\/AIDS patients on immune suppressing drugs<\/li>\n<li>Geographical regions&#8212;mosquito or tick borne viruses are common in particular geographical regions<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>AETIOLOGY (Causes) <\/b><\/p>\n<ul>\n<li>Viral infection is the most common and important cause, with over 100 viruses implicated worldwide<\/li>\n<li>Herpes viruses \u2013HSV-1, HSV-2, Varicella zoster virus (VZV), Cytomegalovirus (CMV), Epstein-Barr virus (EBV), Human herpes virus 6<\/li>\n<li>Adenoviruses<\/li>\n<li>Enteroviruses, e.g. Poliovirus, Coxsackie virus<\/li>\n<li>Measles, Mumps and Rubella viruses<\/li>\n<li>Arboviruses \u2013 examples; Japanese encephalitis, St loius encephalitis virus; West Nile encephalitis virus;Eastern, Western and Venezulean equine encephalitis; tick borne encephalitis virus<\/li>\n<li>Bunyaviruses&#8212;examples; La Crosse strain of californis virus<\/li>\n<li>Renoviruses&#8212;example; Colorado tick fever virus<\/li>\n<li>Arenaviruses&#8212;-example; lymphocytic choriomeningitis virus<\/li>\n<li><\/li>\n<\/ul>\n<p>NON-VIRAL CAUSES<\/p>\n<p>Not all cases of encephalitis are caused by viruses<\/p>\n<p>Some other causes include:<\/p>\n<ul>\n<li>BACTERIA<\/li>\n<li>FUNGI<\/li>\n<li>PARASITES<\/li>\n<li>NON INFECTIOUS CAUSES e.g. allergic reaction, toxins.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>PATHOLOGY<\/b><\/p>\n<p>Viral encephalitis is characterised by the following<\/p>\n<ul>\n<li>Diffuse damage to the cell in the cortex, basal ganglia and brain stem<\/li>\n<li>Inclusion bodies are present in the neurons and the glial cells<\/li>\n<li>Infiltration of the brain substance by inflammatory cells (polymorphs initially, followed later by lymphocytes and monocytes)<\/li>\n<li>These cells are found between the neurons and in the perivascular spaces<\/li>\n<li>Neuroglia proliferation is also seen<\/li>\n<li>The herpes simplex virus often infects the temporal lobes while the substantia nigra, mid brain and basal ganglia are usually involved in encephalitis lethargica<\/li>\n<li><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>HERPES SIMPLEX VIRUS (HSV)<\/b><\/p>\n<ul>\n<li>Two types have been identified (HSV-1&amp;2)<\/li>\n<li>HSV-1 major cause of herpetic stomatitis, herpes labialis, keratoconjuctivitis and encephalitis<\/li>\n<li>HSV-2 -causes genital herpes<\/li>\n<\/ul>\n<p><b>HSV-1<\/b><\/p>\n<ul>\n<li>Portal of entry is usually through the mouth, occasionally skin.<\/li>\n<li>Primary infection may go unnoticed or may produce a severe inflammatory reaction with vesicle formation leading to painful ulcers<\/li>\n<li>Virus remain latent in trigeminal ganglia but may be reactivated by stress, trauma, febrile illness producing cold sore.<\/li>\n<\/ul>\n<p><b>HSV-2<\/b><\/p>\n<ul>\n<li>Affects the genitals<\/li>\n<li>Remains latent in the sacral ganglia<\/li>\n<li>Gives pain in the groin, buttock and upper thigh (radiculomyelopathy)<\/li>\n<li>Neonates may develop primary HSV infection following vagina delivery in the presence of active genital HSV infection in the mother.<\/li>\n<li>Immunocompromised patients e.g. those receiving intensive cancer chemotherapy may develop disseminated HSV infection involving the viscera.<\/li>\n<li><\/li>\n<\/ul>\n<p><b>CLINICAL MANIFESTATION<\/b><\/p>\n<ul>\n<li>Flu-like symptoms (fever, sore throat, cough and malaise)<\/li>\n<li>If meningitis and encephalitis, (headache, stiff neck, vomiting)<\/li>\n<li>Infants may have bulging in the fontanelles or soft spot on the skull<\/li>\n<li>Altered level of consciousness (confusion, behavioural abnormalities)<\/li>\n<li>Mild lethargy to coma, focal neurological deficit<\/li>\n<li>Focal or generalized seizure<\/li>\n<li>Hallucination<\/li>\n<li>Agitation<\/li>\n<li>Personality change<\/li>\n<li>Behavioural disorders<\/li>\n<li>Tremors<\/li>\n<li>CN deficits e.g. ocular palsies, facial weakness<\/li>\n<li>Temperature dysregulation<\/li>\n<li><\/li>\n<\/ul>\n<p><b>DIAGNOSIS<\/b><\/p>\n<ul>\n<li>Blood culture<\/li>\n<li>Lumbar puncture \u2013 (lymphocytic pleocytosis &gt;5cells<\/li>\n<li>Normal glucose concentration<\/li>\n<li>CSF culture<\/li>\n<li>CSF PCR<\/li>\n<li>Brain imaging&#8212; (MRI or CT) shows edema<\/li>\n<li>EEG shows slow wave change<\/li>\n<\/ul>\n<p><b>DIFFERENTIALS<\/b><\/p>\n<ul>\n<li>Bacterial meningitis with cerebral edema<\/li>\n<li>Brain abscess<\/li>\n<li>Cerebral malaria<\/li>\n<li>Cerebral venous thrombosis<\/li>\n<\/ul>\n<p><b>TREATMENT<\/b><\/p>\n<ul>\n<li>No specific medications to treat it<\/li>\n<li>Acyclovir (Zovirax)\u2014 (10mg\/kg) 3times daily for 2-3weeks<\/li>\n<li>Ganciclovir (caused by cmv n hsv1)<\/li>\n<li>Anti-convulsant to prevent and treat seizures<\/li>\n<li>Corticosteroids may be given to reduce brain inflammation<\/li>\n<li>Sedatives can be effective for seizures, restlessness<\/li>\n<li>analgesics<\/li>\n<li>Nutritional and dietary supplements<\/li>\n<li>Eat antioxidant foods including fruits e.g. Cherries, tomatoes, vegetables<\/li>\n<li>Avoid caffeine, alcohol and tobacco<\/li>\n<li><\/li>\n<\/ul>\n<p>Supplements<\/p>\n<ul>\n<li>Vitamin C (500-1,000mg 1-3daily) as an anti-oxidant, and to boost immune system<\/li>\n<li>Probiotic supplement for digestive and immune system health.<\/li>\n<li>Omega-3-fatty acids such as fish oil (1-3times daily) to help decrease inflammation and boost immune system.<\/li>\n<\/ul>\n<p>PROGNOSIS:<\/p>\n<ul>\n<li>The prognosis is dependent on the virulence of the virus and the patient\u2019s health status.<\/li>\n<li>Extremes of age(&lt;1y or &gt;55y), immune-compromised status, and preexisting neurologic conditions are associated with poorer outcomes.<\/li>\n<\/ul>\n<p><b>COMPLICATIONS<\/b><\/p>\n<ul>\n<li>Keratitis<\/li>\n<li>Skin infections such as herpetic whitlow and erythema multiforme<\/li>\n<li>Dendritic ulceration<\/li>\n<li>Epilepsy<\/li>\n<li>Memory loss<\/li>\n<li>Aphasia<\/li>\n<\/ul>\n<p><b>PREVENTION\u00a0\u00a0\u00a0 <\/b><\/p>\n<ul>\n<li>Vaccination\u2013 vaccines which include measles, mumps, rubella.<\/li>\n<li>Avoid mosquito infested areas<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><b>REFERENCES<\/b><\/p>\n<ul>\n<li>Kumar &amp; Clark: Clinical medicine, 17th edition<\/li>\n<li>Harrison\u2019s Textbook of Medicine, 11th edition<\/li>\n<li>A compendium of Clinical Medicine, by O.O Akinkugbe.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>BY Dr Nansel, Charles &nbsp; OUTLINES Definition Epidemiology Etiology Pathology Clinical features &amp; Diagnosis Treatment Prognosis&#8230;<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[63,62],"class_list":["post-393","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-brain-risk","tag-viral"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>VIRAL ENCEPHALITIS - May Hospital, Shendam<\/title>\n<meta name=\"description\" content=\"Encephalitis is an acute inflammatory process affecting the brain parenchyma tissue clinically expressed by fever, impaired consciousness, seizures, focal neurologic deficits.\" 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