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Encephalitis literally means an inflammation of the brain, but it usually
refers to brain inflammation caused by a virus. It's a rare disease that
only occurs in approximately 0.5 per 100,000 individuals - most commonly in
children, the elderly, and people with weakened immune systems (i.e., those
with HIV/AIDS or cancer).
Although several thousand cases of encephalitis (also called acute viral
encephalitis or aseptic encephalitis) are reported to the Centers for
Disease Control and Prevention (CDC) every year, experts suspect that many
more may go unreported because the symptoms are so mild.
Signs and Symptoms
Symptoms in milder cases of encephalitis usually include:
a.. fever
b.. headache
c.. poor appetite
d.. loss of energy
e.. just a general sick feeling
In more severe cases of encephalitis, a person is more likely to experience
high fever and any of a number of symptoms that relate to the central
nervous system including:
a.. severe headache
b.. nausea and vomiting
c.. stiff neck
d.. confusion
e.. disorientation
f.. personality changes
g.. convulsions (seizures)
h.. problems with speech or hearing
i.. hallucinations
j.. memory loss
k.. drowsiness
l.. coma
It's harder to detect some of these symptoms in infants, but there are still
some important signs to look for including:
a.. vomiting
b.. a full or bulging soft spot (fontanel)
c.. crying that doesn't stop or that seems worse when an infant is picked
up or handled in some way
d.. body stiffness
Because encephalitis can follow or accompany common viral illnesses, there
are sometimes characteristic signs and symptoms of these illnesses
beforehand. But often, the encephalitis appears without warning.
Causes
Because encephalitis can be caused by many types of germs, the infection can
be spread in several different ways.
Of the many different kinds of viruses that can cause encephalitis, one of
the most dangerous and the most common cause 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 be fatal in as many as half of
newborns who become infected and up to 28% of individuals after the newborn
period. Fortunately, HSV encephalitis is very rare.
Encephalitis can be a complication of Lyme disease transmitted 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.
Prevention
Encephalitis cannot be prevented except to try to prevent the illnesses that
may lead to it. Encephalitis that may be seen with common childhood
illnesses like measles, mumps, and chickenpox can be largely prevented
through proper immunization. Have your child immunized according to the
immunization schedule recommended by your child's doctor. Children should
also avoid contact with anyone who already has encephalitis.
In areas where encephalitis can be transmitted by insect bites, especially
mosquitoes, children should:
a.. Avoid being outside at dawn and dusk (when mosquitoes are most
active).
b.. Wear protective clothing like long sleeves and long pants.
c.. Use insect repellent.
Also, all standing water around your home should be drained, including
buckets, birdbaths, and flowerpots, because these are breeding grounds for
mosquitoes.
Some things you can do to avoid tick bites:
a.. Limit your child's contact with soil, leaves, and vegetation.
b.. Have your child wear long-sleeved, light-colored shirts and long
pants.
c.. Check your child and your pets frequently for ticks.
Duration
For most forms of encephalitis, the acute phase of the illness (when
symptoms are the most severe) usually lasts up to a week. Full recovery can
take much longer, often several weeks or months.
Diagnosis
Doctors use several tests to diagnose encephalitis, including:
a.. imaging tests, such as computed tomography (CT) scans or magnetic
resonance imaging (MRI), to check the brain for swelling, bleeding, or other
abnormalities
b.. electroencephalogram (EEG), which records the electrical signals in
the brain, to check for abnormal brain waves
c.. blood tests to confirm the presence of bacteria or viruses in the
blood, and whether a person is producing antibodies (specific proteins that
fight infection) in response to a germ
d.. lumbar puncture, also known as a spinal tap, in which cerebrospinal
fluid (the fluid that surrounds the brain and spinal cord) is checked for
signs of infection
Treatment
Some children with very mild encephalitis can be monitored at home, but most
will need care in a hospital, usually in an intensive care unit. Doctors
will carefully monitor their blood pressure, heart rate, and breathing, as
well as their body fluids, to prevent further swelling of the brain.
Because antibiotics aren't effective against viruses, they aren't used to
treat encephalitis. However, antiviral drugs can be used to treat some forms
of encephalitis, especially the type caused by the herpes simplex virus.
Corticosteroids may also be used in some cases to reduce brain swelling. If
a child is having seizures, anticonvulsants may also be given.
Over-the-counter (OTC) medications, like acetaminophen, can be used to treat
fever and headaches.
Most people with encephalitis make a full recovery. In a small percentage of
cases, swelling of the brain can lead to permanent brain damage and lasting
complications like learning disabilities, speech problems, memory loss, or
lack of muscle control. Speech, physical, or occupational therapy may be
necessary in these cases.
Rarely, if the brain damage is severe, encephalitis can lead to death.
Infants younger than 1 year and adults older than 55 are at greatest risk of
death from encephalitis.
When to Call Your Child's Doctor
Call your child's doctor if your child has a high fever, especially if he or
she also has a childhood illness (measles, mumps, chickenpox) or is
recovering from one.
Seek immediate medical attention if your child has any of the following
symptoms:
a.. severe headache
b.. convulsions (seizures)
c.. stiff neck
d.. inability to look at bright lights
e.. double vision
f.. difficulty walking
g.. problems with speech or hearing
h.. difficulty moving an arm or leg
i.. loss of sensation anywhere in the body
j.. sudden personality changes
k.. problems with memory
l.. extreme drowsiness or lethargy
m.. loss of consciousness
If your infant has any of the following symptoms, seek immediate medical
care:
a.. high fever or any fever higher than 100.4 degrees Fahrenheit (38
degrees Celsius) in infants younger than 3 months of age
b.. fullness or bulging in the soft spot
c.. any stiffness
d.. floppiness or decreased tone
e.. lethargy
f.. poor appetite or reduced feeding
g.. vomiting
h.. crying that won't stop
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