Encephalitis (en-sef-uh-LIE-tis) is inflammation of the brain. There are several causes, but the most common is viral infection.

Encephalitis often causes only mild flu-like signs and symptoms — such as a fever or headache — or no symptoms at all. Sometimes the flu-like symptoms are
more severe. Encephalitis can also cause confused thinking, seizures, or problems with senses or movement.
Rarely, encephalitis can be life-threatening. Timely diagnosis and treatment are important because it's difficult to predict how encephalitis will affect each
individual.
Symptoms
Bulging fontanel
Most people with viral encephalitis have mild flu-like symptoms, such as:
 Headache
 Fever
 Aches in muscles or joints
 Fatigue or weakness
Sometimes the signs and symptoms are more severe, and might include:
 Confusion, agitation or hallucinations
 Seizures
 Loss of sensation or paralysis in certain areas of the face or body
 Muscle weakness
 Problems with speech or hearing
 Loss of consciousness
In infants and young children, signs and symptoms might also include:
 Bulging in the soft spots (fontanels) of an infant's skull
 Nausea and vomiting
 Body stiffness
 Poor feeding or not waking for a feeding
 Irritability
When to see a doctor
Get immediate care if you are experiencing any of the more-severe symptoms associated with encephalitis. Severe headache, fever and altered consciousness
require urgent care.
Infants and young children with any signs or symptoms of encephalitis should receive urgent care.
Causes
The exact cause of encephalitis is often unknown. But when a cause is known, the most common is a viral infection. Bacterial infections and noninfectious
inflammatory conditions also can cause encephalitis.
There are two main types of encephalitis:
 Primary encephalitis. This condition occurs when a virus or other agent directly infects the brain. The infection may be concentrated in one area or
widespread. A primary infection may be a reactivation of a virus that had been inactive after a previous illness.
 Secondary encephalitis. This condition results from a faulty immune system reaction to an infection elsewhere in the body. Instead of attacking only the
cells causing the infection, the immune system also mistakenly attacks healthy cells in the brain. Also known as post-infection encephalitis, secondary
encephalitis often occurs two to three weeks after the initial infection.

Common viral causes

The viruses that can cause encephalitis include:
 Herpes simplex virus (HSV). Both HSV type 1 — associated with cold sores and fever blisters around your mouth — and HSV type 2 — associated with
genital herpes — can cause encephalitis. Encephalitis caused by HSV type 1 is rare but can result in significant brain damage or death.
 Other herpes viruses. These include the Epstein-Barr virus, which commonly causes infectious mononucleosis, and the varicella-zoster virus, which
commonly causes chickenpox and shingles.
 Enteroviruses. These viruses include the poliovirus and the coxsackievirus, which usually cause an illness with flu-like symptoms, eye inflammation and
abdominal pain.
 Mosquito-borne viruses. These viruses can cause infections such as West Nile, La Crosse, St. Louis, western equine and eastern equine encephalitis.
Symptoms of an infection might appear within a few days to a couple of weeks after exposure to a mosquito-borne virus.
 Tick-borne viruses. The Powassan virus is carried by ticks and causes encephalitis in the Midwestern United States. Symptoms usually appear about a
week after a bite from an infected tick.
 Rabies virus. Infection with the rabies virus, which is usually transmitted by a bite from an infected animal, causes a rapid progression to encephalitis
once symptoms begin. Rabies is a rare cause of encephalitis in the United States.
 Childhood infections. Common childhood infections — such as measles (rubeola), mumps and German measles (rubella) — used to be fairly common
causes of secondary encephalitis. These causes are now rare in the United States due to the availability of vaccinations for these diseases.
Risk factors
Anyone can develop encephalitis. Factors that may increase the risk include:
 Age. Some types of encephalitis are more common or more severe in certain age groups. In general, young children and older adults are at greater risk
of most types of viral encephalitis.
 Weakened immune system. People who have HIV/AIDS, take immune-suppressing drugs or have another condition causing a weakened immune
system are at increased risk of encephalitis.
 Geographical regions. Mosquito- or tick-borne viruses are common in particular geographical regions.
 Season of the year. Mosquito- and tick-borne diseases tend to be more common in summer in many areas of the United States.
Complications
The complications of encephalitis vary, depending on factors such as:
 Your age
 The cause of your infection
 The severity of your initial illness
 The time from disease onset to treatment
People with relatively mild illness usually recover within a few weeks with no long-term complications.
Complications of severe illness
Inflammation can injure the brain, possibly resulting in coma or death.
Other complications — varying greatly in severity — may persist for months or be permanent. These complications can include:
 Persistent fatigue
 Weakness or lack of muscle coordination
 Personality changes
 Memory problems
 Paralysis
 Hearing or vision defects
 Speech impairments
Prevention
The best way to prevent viral encephalitis is to take precautions to avoid exposure to viruses that can cause the disease. Try to:
 Practice good hygiene. Wash hands frequently and thoroughly with soap and water, particularly after using the toilet and before and after meals.
 Don't share utensils. Don't share tableware and beverages.
 Teach your children good habits. Make sure they practice good hygiene and avoid sharing utensils at home and school.
 Get vaccinations. Keep your own and your children's vaccinations current. Before traveling, talk to your doctor about recommended vaccinations for
different destinations.
Protection against mosquitoes and ticks
To minimize your exposure to mosquitoes and ticks:
 Dress to protect yourself. Wear long-sleeved shirts and long pants if you're outside between dusk and dawn when mosquitoes are most active, and
when you're in a wooded area with tall grasses and shrubs where ticks are more common.
 Apply mosquito repellent. Chemicals such as DEET can be applied to both the skin and clothes. To apply repellent to your face, spray it on your hands
and then wipe it on your face. If you're using both sunscreen and a repellent, apply sunscreen first.
 Use insecticide. The Environmental Protection Agency recommends the use of products containing permethrin, which repels and kills ticks and
mosquitoes. These products can be sprayed on clothing, tents and other outdoor gear. Permethrin shouldn't be applied to the skin.
 Avoid mosquitoes. Refrain from unnecessary activity in places where mosquitoes are most common. If possible, avoid being outdoors from dusk till
dawn, when mosquitoes are most active. Repair broken windows and screens.
 Get rid of water sources outside your home. Eliminate standing water in your yard, where mosquitoes can lay their eggs. Common problems include
flowerpots or other gardening containers, flat roofs, old tires and clogged gutters.
 Look for outdoor signs of viral disease. If you notice sick or dying birds or animals, report your observations to your local health department.
Protection for young children
Insect repellents aren't recommended for use on infants younger than 2 months of age. Instead, cover an infant carrier or stroller with mosquito netting.
For older infants and children, repellents with 10 to 30 percent DEET are considered safe. Products containing both DEET and sunscreen aren't recommended for
children because reapplication — which might be necessary for the sunscreen component — will expose the child to too much DEET.
Tips for using mosquito repellent with children include:
 Always assist children with the use of mosquito repellent.
 Spray on clothing and exposed skin.
 Apply the repellent when outdoors to lessen the risk of inhaling the repellent.
 Spray repellent on your hands and then apply it to your child's face. Take care around the eyes and ears.
 Don't use repellent on the hands of young children who may put their hands in their mouths.
 Wash treated skin with soap and water when you come indoors.

What is encephalitis?
Encephalitis is an acute inflammation (swelling) of the brain usually resulting from either a viral infection or due to the body's own immune system mistakenly
attacking brain tissue.
In medicine, "acute" means it comes on abruptly and develops rapidly; it usually requires urgent care.
The most common cause is a viral infection. The brain becomes inflamed as a result of the body's attempt to fight off the virus.
Encephalitis occurs in 1 in every 1,000 cases of measles.
Encephalitis generally begins with fever and headache. The symptoms rapidly worsen, and there may be seizures (fits), confusion, drowsiness, and loss of
consciousness, and even coma.
Encephalitis can be life-threatening, but this is rare. Mortality depends on a number of factors, including the severity of the disease and age.
Younger patients tend to recover without many ongoing health issues, whereas older patients are at higher risk for complications and mortality.
When there is direct viral infection of the brain or spinal cord, it is called primary encephalitis. Secondary encephalitis refers to an infection which started off
elsewhere in the body and then spread to the brain.
Types
Different types of encephalitis have different causes.
 Japanese encephalitis is spread by mosquitoes
 Tick-borne encephalitis is spread by ticks
 Rabies can be spread through a bite from a mammal
There is also primary or secondary encephalitis.
Primary or infectious encephalitis can result if a fungus, virus, or bacterium infects the brain.
Secondary, or post-infectious, encephalitis is when the immune system responds to a previous infection and mistakenly attacks the brain.
Symptoms
The patient typically has a fever, headache, and photophobia (excessive sensitivity to light). There may also be general weakness and seizures.
Less common symptoms
The individual may also experience nuchal rigidity (neck stiffness), which can lead to a misdiagnosis of meningitis. There may be stiffness of the limbs, slow
movements, and clumsiness. The patient may also be drowsy and have a cough.
More serious cases
In more serious cases, the person may experience very severe headaches, nausea, vomiting, confusion, disorientation, memory loss, speech problems, hearing
problems, hallucinations, as well as seizures and possibly coma. In some cases, the patient can become aggressive.
Signs and symptoms in infants
Initially, encephalitis is harder to detect in young children and babies. Parents or guardians should look out for vomiting, a bulging fontanel (the soft area on the
top center of the head), incessant crying that does not get better when the baby is picked up and comforted, and body stiffness.
Causes
Encephalitis can develop as a result of a direct infection to the brain by a virus, bacterium, or fungus, or when the immune system responds to a previous
infection; the immune system mistakenly attacks brain tissue.
Primary (infectious) encephalitis can be split into three main categories of viruses:
 Common viruses, including HSV (herpes simplex virus) and EBV (Epstein-Barr virus)
 Childhood viruses, including measles and mumps
 Arboviruses (spread by mosquitoes, ticks, and other insects), including Japanese encephalitis, West Nile encephalitis, and tick-borne encephalitis
Secondary encephalitis: could be caused by a complication of a viral infection. Symptoms start to appear days or even weeks after the initial infection. The
patient's immune system treats healthy brain cells as foreign organisms and attacks them. We still do not know why the immune system malfunctions in this way.
In more than 50 percent of encephalitis cases, the exact cause of the illness is not tracked down.
 Encephalitis is more likely to affect children, older adults, individuals with weakened immune systems, and people who live in areas where mosquitoes and ticks
that spread specific viruses are common.
Treatment
Treatment for encephalitis focuses on alleviating symptoms. There are only a limited number of reliably tested specific antiviral agents that can help, one of
which is acyclovir; success is limited for most infections except when the condition is due to herpes simplex.
Corticosteroids may be administered to reduce the brain's inflammation, especially in cases of post-infectious (secondary) encephalitis. If the patient has severe
symptoms, they may need mechanical ventilation to help them breathe and other supportive treatment.
Anticonvulsants are sometimes given to patients who have seizures. Sedatives can be effective for seizures, restlessness, and irritability. For patients with mild
symptoms, the best treatment is rest, plenty of fluids, and Tylenol (paracetamol) for fever and headaches.
Diagnosis

Doctors who identify the classic symptoms in adults - fever, headache, confusion, and occasionally seizures, or irritability, poor appetite, and fever in young
children - may order further diagnostic tests.
A neurological examination generally finds that the patient is confused and drowsy.
If the neck is stiff, caused by irritation of the meninges (membranes that cover the brain and spinal cord), the doctor may consider a diagnosis of meningitis or
meningoencephalitis.
A lumbar puncture, which takes a sample of cerebrospinal fluid from the spine, might reveal higher-than-normal levels of protein and white blood cells.
However, this test is not always conclusive, in some cases, the results may come back normal even though the patient has encephalitis.
A CT scan may be useful in detecting changes in brain structure. It can also rule out other causes, such as stroke, an aneurysm, or a tumor. However, an MRI is
the best imaging option for encephalitis; it can identify the classic brain changes that suggest encephalitis.
An EEG (electroencephalograph) that monitors the electrical activity of the brain may show sharp waves in one or both of the temporal lobes in patients with
encephalitis.
The doctor might order a blood test if a West Nile virus infection is thought to be the cause.

Complications
The majority of patients who have encephalitis go on to have at least one complication, especially elderly patients, those who had symptoms of coma, and
individuals who did not receive treatment at an early stage.
Complications may include:
 Loss of memory - especially among those who had herpes simplex virus encephalitis
 Behavioral or personality changes - such as mood swings, bouts of frustration and anger, and anxiety
 Epilepsy
 Aphasia - language and speech problems
Prevention
Keeping up-to-date with vaccines is the most effective way of reducing the risk of developing encephalitis. These include vaccines for measles, mumps, rubella,
and if the virus exists in those areas, Japanese encephalitis and tick-borne encephalitis.
In areas known to have mosquitoes that carry encephalitis-causing viruses, individuals should take measures to reduce the risk of being bitten. This may include
wearing appropriate clothing, avoiding mosquito-infested areas, avoiding going outside at specific times during the day when there are large numbers of
mosquitoes about, keeping the home mosquito-free, using mosquito repellent, and making sure there is no stagnant water around the home.

What Is Encephalitis?
Encephalitis is defined as inflammation of the brain. This definition means encephalitis is different from meningitis, which is defined as inflammation of the layers
of tissue, or membranes, covering the brain. Unfortunately, in some people, both of the diseases may coexist and lead to a more complex diagnosis and
treatment plan; in addition, both conditions share many of the same symptoms so they may be difficult to distinguish. There are many causes of
encephalitis: viruses, bacteria, parasites, chemicals, and even autoimmune reactions. This article is designed to discuss general features of encephalitis; it is not
designed to be all inclusive as book chapters have been written on individual causes. The reader wanting more information than is present in this introduction is
urged to click on the links provided and to check the references provided at the end of this article.
In clinical practice, most doctors consider encephalitis to be a viral illness. Viruses such as those responsible for causing cold sores, mumps, measles,
and chickenpoxcan also cause encephalitis; they will not be further discussed in this article because their major disease manifestations, symptoms, and
complications are detailed in other articles. Major causes of viral encephalitis are herpesviruses and the arboviruses. Arboviruses are spread by insects such as
mosquitoes and ticks. The equine (meaning horse), West Nile, Japanese, La Crosse, and St. Louis encephalitisviruses are all mosquito-borne arboviruses. Although
viruses are the most common source of infection, bacteria, fungi, parasites, chemicals, and autoimmune reactions (limbic encephalitis) can also be responsible
for encephalitis. However, current data suggest that these are far less common than viral infections as causes of encephalitis.
Viral encephalitis resembles the flu in terms of its symptoms and usually lasts for two to three weeks. It can vary from mild to life-threatening and even cause
death. Most people with a mild infection can recover fully. Those with a more severe infection can recover although they may have damage to their nervous
system. This damage can be permanent. Some other general features of viral encephalitis are as follows:
 Age, season, geographic location, regional climate conditions, and the strength of the person's immune system play a role in development of the disease
and severity of the illness.
 Herpes simplex (the virus causing cold sores) remains the most common virus involved in encephalitis in the United States and throughout the world.
These viruses are usually transmitted from person to person.
 In the United States, there are five main encephalitis-causing viruses spread by mosquitoes: West Nile, Eastern equine encephalitis (EEE), Western
equine encephalitis (WEE), La Crosse, and St. Louis encephalitis. Two types of Powassan viruses, an infrequent cause of encephalitis, are transmitted by at least
two types of ticks.
 Venezuelan equine encephalitis is found in South America. It can be a rare cause of encephalitis in the southwestern United States, particularly Texas.
The infection is very mild, and nervous system damage is rare.
 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 worldwide. Most of China, Southeast Asia, and the Indian subcontinent are affected.

What Causes Viral Encephalitis?
 Herpes simplex (HSV): This type of virus causes cold sores of the mouth and lesions of the genitals. HSV is transmitted directly through human contact.
Newborns can also get the virus by passing through an infected birth canal. Once inside the body, the virus travels through nerve fibers and can cause an
infection of the brain. The virus may also undergo a period of latency in which it is inactive. At a later time, emotional or physical stress can reactivate the virus to
cause an infection of the brain. It causes the most subacute (between acute and chronic) and chronic (lasting three or more months) encephalitis infections in
humans.
 Arbovirus: Hosts are animals such as birds, pigs, chipmunks, and squirrels that carry the virus. Mosquitoes (known as vectors, or ways of transmitting the
virus) feed on these animals and become infected. The virus grows and cycles between the hosts and the vectors. Humans become infected through mosquito
 bites. Once inside the body, the virus replicates and travels in the bloodstream. If there is a large enough amount of the virus, the brain can become infected. The
majority of cases occur between June and September when the mosquitoes are most active. In warmer climates, the disease can occur year-round.
o West Nile virus (WNV): This virus was first isolated from an adult woman with a fever in the West Nile District of Uganda in 1937. The nature of
the virus was studied in Egypt in the 1950s. In 1957, as a result of an outbreak in Israel in the elderly, the WNV became recognized as a cause for severe
inflammation of the spinal cord and brain in humans. In the early 1960s, it was first noted that horses were becoming ill in Egypt and France. This virus then
emerged in North America in 1999, with encephalitis reported in humans and horses.
 The virus cycles between the Culex mosquito and hosts such as birds, horses, cats, bats, chipmunks, skunks, squirrels, and domestic
rabbits. The mosquito feeds on the infected hosts, carries the virus in its salivary glands, and then passes it on to humans or other animals during a blood meal. It
usually takes three to 15 days from the time of infection to the onset of disease symptoms. In the U.S., crows became a major host, but the disease would kill the
crows; as a result, the number of infections dropped dramatically as the crow population died off.
 West Nile encephalitis is not transmitted from person to person (such as through touching or kissing or from a health-care worker
caring for a sick person) nor can it be passed from animal to human. Blood transfusions are the exception; the virus may be passed among people by blood
transfusions if the donor is infected.
 The chance that people will become severely ill from a mosquito bite is extremely small. According to the Centers for Disease Control
and Prevention (CDC), even in areas where mosquitoes are reported to carry the virus, much fewer than 1% of them are infected. Furthermore, less than 1% of
the people who get bitten and become infected will become severely ill. Therefore, the majority of cases are mild, and people can fully recover. For example, the
CDC reported 690 people infected in 2011, with a total of 43 deaths.
 Prognosis is usually guarded in the extremes of age (infants, young children, and the elderly). Death rates as a result of West Nile
encephalitis range from 3%-15% and are highest among the elderly. At the present time, there is no documented evidence to suggest that a pregnancy is at risk
due to WNV infection. It is assumed that if a person contracts WNV, he or she will develop a natural immunity that is lifelong. However, it may wane in later
years. Currently, there is no commercially available vaccine for humans.
 A relative of West Nile virus, Powassan virus, was discovered in 1958, but its vector is the blacklegged (deer) tick. It is very rare; only
about 60 individuals have been diagnosed since 1958. There is no vaccine available. It has a 10% death rate.
 La Crosse encephalitis: The first case occurred in La Crosse, Wisconsin, in 1963. Since then, the largest number of cases has been identified in woodland
areas of the midwestern and mid-Atlantic United States. This virus is the most common cause of mosquito-borne encephalitis in children younger than 16 years
of age. Each year, about 75 cases are reported to the Centers for Disease Control and Prevention (CDC). The virus cycles between the daytime-biting treehole
mosquito (Aedes triseriatus) and hosts such as chipmunks and squirrels. Some investigators consider the cause of California encephalitis to be the La Crosse virus.
The La Crosse encephalitis virus can cause adverse effects on IQ and school performance. About 80-100 people are diagnosed each year in the U.S., and 1% of
people with this infection may die.
 St. Louis encephalitis: Since 1964, an average of about 102 people is reported infected per year. Outbreaks can occur throughout most of the United
States, although large urban epidemics have occurred in the midwestern and southeastern regions. The last major epidemic of St. Louis encephalitis occurred in
the Midwest from 1974-1977. There were 2,500 cases in 35 states reported to the CDC. Additionally, there were 20 reported cases in New Orleans in 1999. The
virus cycles between birds and the Culex mosquitoes breeding in stagnant water. It grows in both the mosquito and the bird but does not make either one sick.
Only the infected mosquito can transmit the disease to humans during the blood meal. The virus cannot be transmitted from person to person through kissing or
touching nor can it be transmitted from the infected bird. The disease tends to affect mostly adults and is generally milder in children.
What Are Other Less Frequent Causes of Encephalitis?
 Eastern equine encephalitis (EEE): According to the CDC, there have been confirmed cases in the United States of EEE since 1964 with a rate of about 0-
21 diagnosed infections per year (average about six per year). This virus is found along the East and Gulf Coasts. The virus causes severe disease in
horses, puppies, and birds such as pheasants, quails, and ostriches. In humans, flu-like symptoms develop four to 10 days after the bite of an infected mosquito.
Usually, human illnesses are preceded by those in horses. EEE can cause death in 50%-75% of human infections; 90% of infected people have mild to severe
impairments. Those who recover may suffer severe permanent brain damage such as mental retardation, seizures, paralysis, and behavior abnormalities.
 Western equine encephalitis (WEE): This virus was isolated from the brain of a horse with encephalitis in California in 1930. The worst epidemic was in
Canada and the western U.S. when over 300,000 horses and mules were diagnosed, along with over 3,300 humans in 1941. Since 1964, there have been at least
639 confirmed cases, but currently only a few per year are reported. However, it remains a cause of encephalitis in the western part of the United States and
Canada. In 1994, there were two confirmed and several suspected cases of WEE reported in Wyoming. In 1997, 35 strains of WEE virus were isolated from
mosquitoes collected in Scotts Bluff County, Nebraska. The WEE virus cycles between certain types of birds (small, mostly songbirds) and Culex
tarsalismosquitoes, a species associated with irrigated agriculture and stream drainage. The virus has also been found in several other mammals. Horses and
humans become sick through bites by infected mosquitoes. Infants are particularly affected and can have permanent problems such as seizure disorders and
developmental delay as a result of the infection. A vaccine is not available for humans. WEE is becoming more frequently encountered in the U.S.
 Venezuelan equine encephalitis (VEE): This virus is found in Central and South America and is a rare cause of encephalitis in the southwestern part of
the United States. It is an important cause of encephalitis in horses and humans in South America. From 1969-1971, an outbreak from South America to Texas
killed over 200,000 horses. In 1995, there were an estimated 90,000 human infections with VEE in Columbia and Venezuela. The virus cycles between forest-
dwelling rodents and mosquito vectors, especially the species Culex. VEE infection in humans is much less severe than that of WEE and EEE. While adults tend to
develop a flu-like illness, children tend to develop overt encephalitis. Deaths are rare in humans but are common in horses. There is an effective vaccine for
horses but none for humans.
 Japanese encephalitis: This virus is responsible for 50,000 cases and 15,000 deaths per year. Most of China, Southeast Asia, and the Indian subcontinent
are affected. The geographic distribution is expanding. Rarely, cases may appear in United States civilians and military personnel traveling to and living in Asia.
Children and young adults are mostly affected. Older adults are affected when there are epidemics in new locations. The virus cycles between domestic pigs, wild
birds, and Culex tritaeniorhynchus mosquitoes, which breed in rice fields. The disease is not transmitted through human contact, pigs, or birds. Only the
mosquitoes can transmit the disease during feedings.
 Zika virus: This virus is spread by the bite of an infected Aedes species mosquito; the virus can be passed from a pregnant woman to her fetus, and this
has been associated with certain birth defects, including microcephaly, Guillain-Barré disease, and disseminated encephalomyelitis. A major outbreak of this
disease began in 2015 and is ongoing in Brazil and has spread to other countries. Zika typically is spread via the mosquito vector, but transmission through sexual
intercourse has also been documented.
 The following is a short summary of the viruses that cause the majority of encephalitis infections, although they may also cause other diseases.

Disease Geographic Location Vector/ Hosts Comment

Herpes Human-to-human
United States/the world Prompt treatment with acyclovir increases survival to 90%
encephalitis contact

Majority are mild cases. Less than 1% of those infected will become
West Nile Africa, West Asia, Middle East, United Mosquito/mostly
severely ill. Full recovery is expected. A vaccine for humans is not
encephalitis States birds
commercially available.

East Coast (from

Eastern equine Often occurs in horses. High mortality rate (50%-75%); frequent outcomes
Massachusetts to Florida), Mosquito/birds
encephalitis (seizures, slight paralysis), especially in children
Gulf Coast

Western
Western United States and Often occurs in horses.
equine Mosquito/birds
Canada Particularly affects infants
encephalitis

Venezuelan
equine Western Hemisphere Mosquito/rodents Rare in United States; low mortality rate, rare after-effects
encephalitis

Throughout the United States, Mosquito/

La Crosse Most common cause of
especially in midwestern & chipmunks,
encephalitis encephalitis in children younger than 16 years of age
southeastern regions squirrels

St. Louis Midwestern & mid-Atlantic

Mosquito/birds Mostly affects adults
encephalitis United States

Vaccine available for ages 17 and older. See

Japanese Temperate Asia, southern and Mosquito/birds and
Prevention section.
encephalitis southeastern Asia pigs
High morbidity/mortality rates

South America, Asia, Pacific Islands,

Zika virus Mosquitoes Birth defects including microcephaly, neurologic damage
Central America

A special cause of viral encephalitis is HIV. This virus is mainly known for its damage to the human immune system. However, as HIV disease progresses, some
individuals develop encephalitis symptoms termed AIDS dementia complex. It results in cognitive disorders (There is memory loss, abstract thinking and verbal
fluency decline, and motor control may be markedly decreased.). Other causes of encephalitis are as follows but will not be further discussed in detail in this
article; the reader is referred to the links provided:
 Bacteria, such as N. meningitidis, and those that cause Lyme disease, syphilis, tuberculosis, and occasionally other bacteria such as Mycoplasma spp.
have been implicated in a few individuals.
 Fungi such as Candida, Mucormycosis, Cryptococcus, and others
 Rabies virus
 Parasites such as Toxoplasma (often seen in HIV-infected patients) or the parasite Naegleria
 Allergies to vaccinations
 Autoimmune disease such as Rasmussen's encephalitis
 Cancers involving the brain tissue
 Prion caused encephalitis (rare) such as bovine spongiform encephalitis or mad cow disease
 Myalgic encephalitis or chronic fatigue syndrome (no defined cause)
 Chemical encephalitis such as that seen with alcohol (Wernicke-Korsakoff syndrome) due to a decline in liver functions and ultimately, affecting the
brain tissue, or by drug use
In recent years, researchers have begun more intensive studies of some types of encephalitis. In 2012, the CDC began a multicenter study of epidemic myalgic
encephalomyelitis (or chronic fatigue syndrome or CFS) that is ongoing to better understand this problem.
Another cause of encephalitis under study is encephalitis believed to be caused by an autoantibody attack on subunits of brain N-methyl-d-aspartate (NMDA)
glutamate receptors. The autoantibodies are termed anti-NMDA receptor antibodies, and the disease is termed NMDA receptor encephalitis, first identified in
2007. The disease is found mainly in young women (over 80%) and has been associated with ovarian teratomas (germ cell tumors). Some investigators think it
may have been seen previously as an outbreak of encephalitis of unknown cause termed (epidemic) encephalitis lethargica that occurred worldwide between
1918 and 1928. Recent research suggests that the anti-NMDA receptor symptoms (seizures, unresponsiveness, motor-control problems, and others) caused by
this autoimmune disease can be treated with immunotherapy to reduce or halt symptoms in some patients. Some individuals believe this disease is related
to autism but currently no convincing evidence has shown such a relationship.

Is Encephalitis Contagious?
The answer to this question depends upon the underlying cause of encephalitis. For example, some herpes viruses are contagious from person to person and can
cause encephalitis. In this case, encephalitis is considered to be contagious. Viruses that are transmitted through the bite of infected insects are not considered
contagious from person to person. Other causes of encephalitis such as autoimmune problems or chemical encephalitis are not contagious.
What Is the Incubation Period and Contagious Period for Encephalitis?
The contagious period and incubation period for encephalitis depends on the underlying cause of encephalitis. For example, some herpesviruses have an
incubation period of about three to seven days on average but may range from about one to three weeks. The contagious period for some viruses may include
the incubation period and the time it takes for the lesions (blisters, for example, in shingles) to crust over. Consequently, the contagious period and incubation
period for encephalitis depends upon the cause of encephalitis being contagious; noncontagious encephalitis has no contagious or incubation period.
What Are Encephalitis Symptoms and Signs?
he signs and symptoms of encephalitis are the same for adults and children. Infants may have poor feeding, irritability, vomiting, bulging fontanel, and body
stiffness; such symptoms in an infant always constitute a medical emergency.
 Signs and symptoms may last for two to three weeks, are flu-like, and can include one or more of the following which in some individuals may become
progressively worse and continue over time:
o Fever
o Fatigue, muscle weakness, rhythmic muscle contractions, muscle pain
o Sore throat
o Stiff neck and back
o Loss of appetite
o Vomiting and nausea
o Headache
o Confusion
o Irritability
o Unsteady gait, weakness
o Problems with coordination
o Drowsiness
o Visual sensitivity to light
 More severe cases may involve these signs and symptoms:
o Seizures
o Muscle weakness
o Paralysis
o Memory loss
o Sudden impaired judgment
o Delirium and/or hallucinations
o Disorientation
o Poor responsiveness or altered level of consciousness

What Specialists Treat Encephalitis?

There are many causes (see causes section) of encephalitis. What type of specialists may be consulted depends upon the underlying cause of the disease. In
general, primary-care physicians, pediatricians, emergency-medicine specialists, infectious-disease specialists, toxicologists, critical-care specialists, neurologists,
and possibly others may be consulted to help diagnose and treat encephalitis.
When Should Someone Seek Medical Care for Encephalitis?
Call the doctor for immediate advice if an infant, child, or adult develops acute signs and symptoms of encephalitis if they have any of these associated
conditions:
 Sores around the lips or genitals through contact with another person
 Having been in wooded or forest areas and suspect mosquito bites
 Visiting an area where these viral (or other) diseases are common, especially outside the United States
 Having been bitten by a tick
If signs and symptoms of encephalitis develop and the doctor is not available, go immediately to a hospital's emergency department for further evaluation. Do
not hesitate or decide on your own that you or your child simply have the flu. Symptoms indicating severe illness require emergency treatment.

How Do Doctors Diagnose Encephalitis?

The doctor will often question a patient about their travel history. Geographic location and seasonal occurrence can help identify the specific cause of
encephalitis. The doctor will often do a physical exam that includes looking for insect bites and will probably complete a neurologic evaluation. The physician
often will order some blood tests, including a complete blood count (CBC). Depending on the patient's unique situation, the doctor may perform one or more of
the following tests:
 An imaging study of the brain such as a CT scan or magnetic resonance imagining (MRI) is often done. MRI is the procedure of choice if herpes
encephalitis is suspected.
 A study called polymerase chain reaction (PCR) to detect genetic material of the virus has greatly improved the diagnosis of herpes encephalitis.
Variations of this test are used by the CDC and some state agencies to identify the various other virus types that may cause encephalitis.
 A reading of the electrical activity of the brain with an EEG can detect irregularities. Herpes encephalitis produces a characteristic EEG pattern.
 A lumbar puncture, also known as a spinal tap, may be necessary to isolate and identify the virus. During this procedure, the doctor applies local
numbing medication and then inserts a needle into the lower back to collect fluid from the space around the spinal column for analysis.
 The virus may also be isolated from tissue or blood.
 Urine or serum toxicology screening tests may also be done.
 Brain biopsy is an option although it is rarely done and usually only if the other tests do not give an answer.
Self-Care at Home for Encephalitis
Because encephalitis can cause death, seek treatment from a primary-care doctor or a hospital's emergency department if the patient seems very ill. Any home
treatment or remedy to relieve the flu-like symptoms should be carried out according to the doctor's advice and recommendation after diagnosis. If the
symptoms become more severe, transport the person to an appropriate emergency facility (for example, an infant or child should go to an emergency center
that has a pediatric facility as part of the hospital).
What Is the Medical Treatment for Encephalitis?
Encephalitis is usually a viral illness, which means that antibiotics are not used to treat viral infections. However, some antiviral drugs have been used to treat
HSV infections, and some doctors may attempt to use antiviral drugs on other acute viral infections. No antiviral drugs to date are used to treat arboviral
infections.
As mentioned previously, there are other nonviral causes (see above) of encephalitis, so the treatment for a given case depends on the doctor's working
diagnosis. If the encephalitis is due to non-viral causes, then other treatments, specific to the cause, are warranted. Many clinicians consult an infectious-disease,
immunology, or cancerexpert to help manage the various types of treatments. With the exception of herpes encephalitis, the mainstay of treatment is symptom
relief. People with viral encephalitis are kept hydrated with IV fluids while monitoring for brain swelling. Anticonvulsants like lorazepam (Ativan) can be given
for seizure control. Steroids have not been established as being effective although they may still be used in some cases. Diuretics may be used to lower
intracranial pressure in individuals who have encephalitis and increased intracranial pressure.
 Herpes encephalitis can cause rapid death if not diagnosed and treated promptly. Therefore, medication is usually started when the doctor suspects
herpes to be the diagnosis without waiting for the confirmatory results. The recommended treatment is acyclovir (Zovirax) given by IV for two to three weeks.
Acyclovir-resistant herpes encephalitis can be treated with foscarnet(Foscavir). Liver and kidney functions are monitored through the course of medication.
 Currently, the use of antiviral drugs in the treatment of other types of viral encephalitis is being studied.
Follow-up for Encephalitis
It is important to follow up with the doctor after the initial treatment because certain nervous system problems (complications) can develop after what appears
to be a successful initial treatment. Relapse can occur with herpes encephalitis.
Complications of encephalitis may include the following:
 Seizures
 Coma
 Increased intracranial pressure
Is It Possible to Prevent Encephalitis?
There are no commercially available human vaccines for most arboviral diseases in the U.S. There is a Japanese encephalitis vaccine available in the U.S., but it is
for ages 17 and above and not widely available. Equine (horse) vaccines are available for EEE, WEE, and Venezuelan equine encephalitis (VEE), but none of these
are available for humans. A vaccine against human encephalitis is available in Europe against viruses that are transmitted by tick vectors (tick-borne encephalitis
or TBE or TBEV), but this vaccine is not available in the U.S. currently (2016). Some of the causes of encephalitis are contagious (for example, herpes, HIV, and
most bacterial causes) while others require vectors like mosquitoes or ticks (West Nile virus, WEE, VEE, Zika, and others) and are not spread from person to
person.
The following measures are suggestions for prevention of encephalitis that is transmitted by vectors (mosquitoes, ticks):
 Wear long pants and long-sleeved shirts to avoid ticks and mosquitoes when in forests or grassy areas.
 Use insect repellant in exposed areas of the body.
 Avoid spending a long time outdoors during dusk when insects tend to bite.
 A Caesarian section (C-section) can be performed if the mother has active herpes lesions of the genital tract to protect the newborn.
 Vaccinate children against viruses that can cause encephalitis (measles, mumps).
 Japanese encephalitis can be prevented with three doses of the vaccine. Take precautions when traveling to areas where this strain is common
(available mainly for ages 17 and older).
o According to the U.S. Centers for Disease Control and Prevention, the vaccine is not recommended for all travelers to Asia. It should be offered
to people spending a month or longer in areas where the disease-causing mosquitoes are known to be present and during the transmission season. However,
travelers spending fewer than 30 days should receive the vaccine if the area is experiencing an epidemic outbreak.
o The benefit of the vaccine should be weighed against the side effects and the risk of developing the disease by getting the shot. The risk of
developing a serious allergic reaction such as hives is low.
o Special consideration should be given to the elderly and pregnant women. The elderly have a higher chance of developing symptoms with
infection. The Japanese encephalitis virus can infect the fetus and cause death. Therefore, these two groups should be cautious when traveling abroad.
Prevention methods of human-to-human transfer of specific viral, bacterial, and other rare causes of encephalitis are detailed in individual articles available in
links to the specific diseases (for example, herpes, HIV, and specific bacterial types).
What Is the Prognosis of Encephalitis?
The outcome of the disease varies and depends on factors such as initial cause, age, severity of the case, and strength of the immune system. For example,
people who are HIV positive, have cancer, or who have other illnesses have a weaker immune system and are less able to withstand another disease. These
patients have a wide range of outcomes that range from good to poor. In general, those people with mild cases and otherwise relatively good health usually will
recover without any problems. Poorer outcomes can be summarized as follows:
 The death rate for certain patients with viral encephalitis can be high.
 The St. Louis encephalitis virus can cause death in up to 30% of the cases.
 Japanese encephalitis can cause death rates that range from 0.3% to 60% of the people infected, usually within the first week of illness.
 In untreated cases of herpes encephalitis, 50%-75% of people die within 18 months. Treatment with acyclovir (Zovirax) can increase survival up to 90%.
 Patients with AIDS or chemical (alcohol) encephalitis often have only a fair to poor outcome.
The cause of the encephalitis has an important bearing on outcomes; as medicine advances, the prognosis may improve for some causes. Readers are
encouraged to research other specific articles and links to get more information and details about potential treatments that improve outcome for each cause of
encephalitis.
Reviewed on 11/20/2017
REFERENCES:

Ayoade, Folusakin O. "California Encephalitis." Medscape.com. July 1, 2016. <http://emedicine.medscape.com/article/234159-overview>.

Howes, David S. "Encephalitis Clinical Presentation." Medscape.com. Apr. 3, 2016. <http://emedicine.medscape.com/article/791896-clinical#b3>.

United States. National Institute of Neurological Disorders and Stroke. "NINDS Rasmussen's Encephalitis Information Page." Dec. 19, 2011.
<http://www.ninds.nih.gov/disorders/rasmussen/rasmussen.htm>.