Encephalitis

Several factors increase the risk of developing encephalitis:

Age

• Infants, young children, and the elderly are more vulnerable to viral encephalitis.

Compromised Immunity

• Individuals with weakened immune systems, such as those with HIV, cancer, or those undergoing chemotherapy or taking immune-suppressing drugs, are at higher risk.

Geographical Location

• Areas with high rates of mosquito or tick-borne diseases tend to see more cases of encephalitis.

Seasonal Factors

• Encephalitis caused by mosquito and tick-borne viruses is more common during the summer and rainy seasons when these insects are most active.

Acute encephalitis is a medical emergency. When a patient presents with fever and altered consciousness, encephalitis is suspected. To confirm the diagnosis, a healthcare provider will perform a physical examination, review the patient's medical history, and order various tests.

A. Clinical History

Before diagnosing encephalitis, it's crucial to rule out conditions that may present with similar symptoms. The physician will conduct a thorough examination, review the patient’s symptoms, and assess the onset to exclude other potential causes.

B. Lab Tests and Imaging Studies

Imaging Tests:

• Imaging methods such as magnetic resonance imaging (MRI) or computed tomography (CT) scans can provide detailed views of the brain. In some cases, a single photon emission computed tomography (SPECT) scan may also be used. These tests help detect abnormalities, lesions, tumors, and other causes of cerebral dysfunction, and may identify any issues that could make performing a lumbar puncture risky.

Lumbar Puncture (Spinal Tap):

• This procedure involves collecting cerebrospinal fluid (CSF) to examine the protective fluid surrounding the brain and spinal cord. In cases of inflammation, the number of white blood cells in the CSF typically rises. Testing the CSF can sometimes identify the virus or infectious agent responsible for the encephalitis.

Cerebrospinal Fluid (CSF) Polymerase Chain Reaction (PCR):

• PCR amplifies specific genetic material to identify viral DNA in CSF samples. It is a crucial test for detecting viruses that affect the central nervous system (CNS), such as cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), and enteroviruses.

Electroencephalogram (EEG):

• EEG records the brain's electrical activity. While it does not directly detect the virus causing encephalitis, abnormal EEG patterns can suggest encephalitis as a possible diagnosis.

Other Lab Tests:

• Blood tests, such as a complete blood count (CBC), along with urine or serum toxicology screening, may help identify viruses or other infectious agents.

Intracranial Pressure Monitoring (ICP):

• This test measures the pressure within the skull, which may rise if the brain swells.

Brain Biopsy:

• In rare cases, a sample of brain tissue may be taken for testing. This procedure carries significant risk and is usually reserved for situations where other tests are inconclusive or if the patient's condition worsens despite treatment.

Detection of Intrathecal Synthesis of Antibodies:

• This test helps detect specific antibodies in CSF that can point to infections like herpes simplex virus (HSV), West Nile virus, and varicella-zoster virus (VZV).

Since encephalitis can spread from one person to another, certain measures can reduce the risk of infection.

Avoid Sharing Items with Infected Individuals:

• Refrain from sharing personal items such as food, utensils, and glasses with anyone who may be infected or exposed to the disease.

Practice Hand Hygiene:

• Regular handwashing with soap and water, especially after using the bathroom and before meals, can help prevent the spread of infection.

Prevent Mosquito Bites:

• To reduce the risk of mosquito-borne encephalitis, take the following steps:
• Wear long-sleeved clothing, pants, and shoes to cover exposed skin.
• Avoid staying outdoors in areas where mosquitoes are active.
• Use mosquito repellents on the skin and clothing.
• Install mosquito screens on windows and doors to keep insects out.
• Sleep under bed nets to prevent mosquito bites at night.
• Use electric mosquito zappers or similar devices.
• Consider growing mosquito-repelling plants such as tulsi or lemongrass.

Vaccination:

• Vaccines are a highly effective way to prevent encephalitis. The MMR vaccine (measles, mumps, rubella) is essential, and for those living in areas with a high risk of Japanese encephalitis or tick-borne encephalitis, these vaccines are recommended. Travelers to high-risk areas should also get vaccinated.

Avoid Self-Medicating:

• Consult a doctor before taking any antibiotics if you live, work, or study with someone diagnosed with bacterial encephalitis.

Specialists to Visit

If encephalitis is suspected, it's important for caregivers or family members to seek emergency medical care, as patients may not be able to make decisions on their own. The following specialists should be consulted:

• Neurologist
• Internal Medicine Specialist
• Infectious Disease Specialist
• Pediatrician

The key to surviving encephalitis lies in early detection and treating the underlying cause effectively. Treatment depends on the cause and severity of the symptoms, and may involve the following:

Antiviral Medications

Antiviral drugs are prescribed for viral encephalitis:

• Acyclovir: Commonly used for suspected viral encephalitis, particularly in cases of herpes simplex virus (HSV) encephalitis.
• Ganciclovir and Foscarnet: These medications may be used separately or together for treating cytomegalovirus (CMV) encephalitis.
• Ribavirin: This may be helpful in treating children with severe adenovirus or rotavirus encephalitis.

Antibiotics

Antibiotics are used to treat bacterial infections that may be causing encephalitis. Some common examples include:

• Ceftriaxone
• Penicillin G
• Vancomycin

Immunotherapy

Immunotherapy is used to treat certain types of autoimmune encephalitis:

• Steroids: Often used as adjunct therapy in tuberculosis (TB) encephalitis, bacterial encephalitis, and autoimmune encephalitis. They help reduce brain inflammation and intracranial pressure (ICP).
• IV Antibodies (IVIG): These have shown benefits for viral and autoimmune encephalitis. However, the evidence supporting their use is limited, so they are not part of standard treatment.
• Plasma Exchange: This therapy can be beneficial, particularly in severe cases of autoimmune encephalitis that don’t respond to steroids or IVIG.

Supportive Care

Supportive care includes monitoring intracranial pressure, restricting fluids, managing fever, and tracking blood pressure. In some cases, patients may need a feeding tube, catheter, or a breathing tube.

Timely treatment typically leads to a better outcome, but untreated or delayed treatment can cause irreversible brain damage or even death. Common complications include:

• Chronic fatigue
• Persistent headaches
• Muscle weakness or coordination problems
• Movement disorders like tremors or involuntary jerks
• Post-encephalitis seizure disorder
• Paralysis
• Hearing or vision issues
• Speech problems
• Difficulty concentrating
• Personality changes
• Memory impairment
• Depression

Effective self-management can help in recovery:

• Educate yourself about the condition.
• Follow the prescribed medication regimen.
• Consult a doctor if you have concerns.
• Ensure proper nutrition.
• Manage stress levels.
• Get adequate rest.

Encephalitis is a severe condition, and both the acute phase and long-term effects can be challenging for patients and families. Recovery can take time, but the following therapies can greatly aid in the healing process:

• Occupational Therapy: An occupational therapist helps patients adjust to sensory changes and aids in daily activities like eating, dressing, and bathing.
• Physical Therapy: The goal of physical therapy is to enhance mobility, restore function, relieve pain, and prevent injuries. It includes exercises and coordination training to regain strength and movement.
• Speech Therapy: This therapy improves communication skills, aiding patients with speech production issues. If speaking becomes difficult, alternative communication strategies are explored.
• Cognitive Therapy: Many patients experience cognitive and behavioral changes after encephalitis. Cognitive therapy helps restore thinking and reasoning abilities and manage emotional responses.