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Viral encephalitis - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of viral encephalitis.

Alternative Names

West Nile virus

Highlights:

Causes

Encephalitis, an inflammation of the brain, is rare but can be caused by many different viruses. They include:

  • Arboviruses, which are transmitted by blood-sucking insects such as mosquitoes. In the U.S., mosquito-borne encephalitis types include West Nile encephalitis, Eastern equine encephalitis, Western equine encephalitis, St. Louis encephalitis, La Crosse encephalitis.
  • Herpes viruses, which include herpes simplex virus, Epstein-Barr virus, and varicella-zoster virus.
  • Enteroviruses, which are various viruses that enter the body through the gastrointestinal tract.
  • Rabies virus, which is transmitted from the saliva of an infected animal.
  • Viruses that cause childhood infections, such as rubella, measles, and mumps.

Symptoms

Encephalitis symptoms can appear within 2 days to 2 weeks of exposure to the virus. In milder cases, symptoms resemble the flu. In severe cases of encephalitis, symptoms may include:

  • Fever
  • Headache
  • Vomiting
  • Lethargy and reduced consciousness
  • Seizures
  • Memory loss
  • Stiff neck and back
  • Confusion
  • Speech, hearing, and vision problems
  • Muscle weakness
  • Partial paralysis
  • Loss of consciousness
  • Coma

Treatment

Because encephalitis can be dangerous, it needs to be diagnosed promptly. Patients are treated immediately, even before diagnostic tests identify the specific virus that caused the illness. If herpes is a possible cause, the standard treatment is the antiviral drug acyclovir. Once the cause has been determined, other drugs may be administered. Many types of encephalitis, such as the ones caused by West Nile virus and other arboviruses, do not respond to antiviral drugs.

Prevention

The best way to prevent becoming infected with a mosquito-borne virus is to avoid being bitten by a mosquito. Use insect repellant when you go outside, especially during the peak mosquito hours of dusk and dawn. Remove mosquito-breeding environments (such as standing water in flower pots) from your property.

Resources

References

Bleck TP. Arthropod-borne viruses affecting the central nervous system. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 406.

Bleck TP. Cytomegalovirus, Epstein-Barr virus, and slow virus infections of the central nervous system. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 393.

Katz TM, Miller JH, Hebert AA. Insect repellents: historical perspectives and new developments. J Am Acad Dermatol. 2008 May;58(5):865-71. Epub 2008 Feb 13.

Lindquist L, Vapalahti O. Tick-borne encephalitis. Lancet. 2008 May 31;371(9627):1861-71.

Loeb M, Hanna S, Nicolle L, Eyles J, Elliott S, Rathbone M, et al. Prognosis after West Nile virus infection. Ann Intern Med. 2008 Aug 19;149(4):232-41.

Modlin JF. Enterovirus infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 402.

Nath A, Berger JR. Acute viral encephalitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 439.

Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008 Aug 1;47(3):303-27.

Voelker R. Effects of West nile virus may persist. JAMA. 2008 May 14;299(18):2135-6.

Whitley RJ. Herpes simplex virus infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 397.

  • Reviewed last on: 2/11/2009
  • Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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