User:Den e 2011/Encephalitis 2

Encephalitis
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 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.

Encephalitis is generally a viral illness. Viruses such as those responsible for causing cold sores, mumps, measles, and chickenpox can also cause encephalitis. A certain family of viruses, the Arboviruses are spread by insects such as mosquitoes and ticks. The equine (meaning horse), West Nile, Japanese, La Crosse, and St. Louis encephalitis viruses are all mosquito-borne. Although viruses are the most common source of infection, bacteria, fungi, and parasites can also be responsible.

=Symptoms that relate to other diseases=

Herpes simplex (the virus causing cold sores) remains the most common virus involved in encephalitis in the United States and throughout the world.
 * Age, season, geographic location, regional climate conditions, and strength of the person's immune system play a role in development of the disease and severity of the illness.


 * In the United States, there are 5 main viruses spread by mosquitoes: West Nile, Eastern equine encephalitis (EEE), Western equine encephalitis (WEE), La Crosse, and St. Louis encephalitis.

Venezuelan equine encephalitis is found in South America. It can be a rare cause of encephalitis in Southwestern United States, particularly Texas. The infection is very mild, and nervous system damage is rare.
 * The 1999 New York City outbreak of West Nile virus, spread by the Culex mosquitoes, has caused great concern as the virus continues to spread across the US.


 * Japanese encephalitis virus is the most common arbovirus in the world (virus transmitted by blood-sucking mosquitoes or ticks) and is responsible for 50,000 cases and 15,000 deaths per year. Most of China, Southeast Asia, and the Indian subcontinent are affected.

=Signs and Symptoms=

The illness resembles the flu and usually lasts for 2-3 weeks. It can vary from mild to life-threatening, and even cause death. Most people with a mild case can recover fully. Those with a more severe case can recover although they may have damage to their nervous system. This damage can be permanent.

Symptoms in milder cases of encephalitis usually include:


 * fever
 * headache
 * poor appetite
 * loss of energy
 * 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:


 * 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, but important signs to look for include:


 * vomiting
 * a full or bulging soft spot (fontanel)
 * crying that doesn't stop or that seems worse when an infant is picked up or handled in some way
 * body stiffness

Because encephalitis can follow or accompany common viral illnesses, there sometimes are 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.

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 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.

=Discovery= Cleland, Sir John Burton (1878-1971), pathologist and naturalist. In 1909 Cleland joined the Bureau of Microbiology, Sydney, and he eventually became principal microbiologist. He edited the Australasian Medical Gazette, and made his major contributions to experimental medicine, in collaboration with Burton Bradley and W. McDonald. The first was the proof in 1916, using human volunteers, that the virus disease dengue is transmitted by the culicine mosquito Aedes aegypti. The second was the defining of the newly discovered encephalitis, then called 'Australian X disease', and the proof that it was distinct from poliomyelitis, not only by its microscopic characteristics, but also by the experimental transmission of virus strains to monkeys, sheep and other herbivores.

=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 can be largely prevented through proper immunization. Have your child immunized according to the immunization schedule recommended by your doctor. Kids should also avoid contact with anyone who already has encephalitis.

In areas where encephalitis can be transmitted by insect bites, especially mosquitoes, kids should:


 * Avoid being outside at dawn and dusk (when mosquitoes are most active).
 * Wear protective clothing like long sleeves and long pants.
 * Use insect repellent.
 * Also, all standing water around your home should be drained, including buckets, birdbaths, flowerpots, and tire swings because these are breeding grounds for mosquitoes.

To avoid tick bites:


 * Limit kids' contact with soil, leaves, and vegetation.
 * Have kids wear long-sleeved, light-colored shirts and long pants when outdoors.
 * Check your kids 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:


 * Imaging tests, such as computed tomography (CT) scans or magnetic resonance imaging (MRI), to check the brain for swelling, bleeding, or other abnormalities
 * Electroencephalogram (EEG), which records the electrical signals in the brain, to check for abnormal brain waves.
 * 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
 * Lumbar puncture, or 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 the Doctor Call your 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:


 * severe headache
 * convulsions (seizures)
 * stiff neck
 * inability to look at bright lights
 * double vision
 * difficulty walking
 * problems with speech or hearing
 * difficulty moving an arm or leg
 * loss of sensation anywhere in the body
 * sudden personality changes
 * problems with memory
 * extreme drowsiness or lethargy
 * loss of consciousness

If your infant has any of the following symptoms, seek immediate medical care:

poor appetite or reduced feeding vomiting crying that won't stop
 * high fever or any fever higher than 100.4° Fahrenheit (38° Celsius) in infants younger than 3 *months of age
 * fullness or bulging in the soft spot
 * any stiffness
 * floppiness or decreased tone
 * lethargy

=External Links=


 * http://kidshealth.org/parent/infections/bacterial_viral/encephalitis.html
 * http://www.emedicinehealth.com/encephalitis/article_em.htm
 * http://www.adb.online.anu.edu.au/biogs/A080024b.htm