What is Encephalitis?

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

Encephalitis literally means brain infection. Strictly speaking, "-itis" means inflammation, which includes redness, swelling, pain, and warmth, and can be due to infection or other types of irritation. The brain can become infected with many different germs, including viruses, bacteria, fungi, and parasites. The symptoms of encephalitis include fever, chills, headache, altered mental status (confusion, delirium, and agitation), stiff neck, nausea, vomiting, seizures, coma (unconsciousness), and death. Viral brain infections are rarely as serious as other kinds of encephalitis.

Rarely, encephalitis can be life-threatening. Timely diagnosis and treatment are important because it's difficult to predict how encephalitis will affect each individual 

What are the Causes of Encephalitis

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.
• 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, mumps and German measles (rubella) — used to be fairly common causes of secondary encephalitis. These causes are now more common in the United States due to routine vaccinations.

What are the Symptoms & Signs of Encephalitis?

When the virus enters the bloodstream, it may cause inflammation of brain tissue and surrounding membranes. White blood cells invade the brain tissue as they try to fight off the infection. The brain tissue swells (cerebral edema), which may destroy nerve cells, cause bleeding in the brain (intracerebral hemorrhage), and brain damage.

• The symptoms of viral encephalitis include fever, chills, headache, altered mental status (confusion, delirium, and agitation), stiff neck, nausea, vomiting, seizures, coma (unconsciousness), and death. Viral brain infections are rarely as serious as other kinds of encephalitis.
• Symptoms of Japanese encephalitis (JE) appear six to eight days after the mosquito bite. JE kills roughly 30% of its victims. Another 30% will have serious and permanent brain damage.
• Symptoms of St. Louis encephalitis (SLE) appear five to 15 days after the mosquito bite. It kills 5% to 30% of its victims.
• Symptoms of tick-borne encephalitis (TBE) appear seven to 14 days after the tick bite. Permanent brain damage occurs in 10% to 20% of patients. Death occurs in only one percent to two percent of victims.

 

Exposure to Viruses

There are many ways a person can get viral encephalitis which include, Breathing in respiratory droplets from an infected person, Contaminated food or drink, Insect Bites, Skin contact, In rural areas, arboviruses -- carried by mosquitoes or ticks, or accidentally ingested -- are the most common ways of exposure.

In urban areas, enteroviruses are most common, which include, Coxsackievirus, Echovirus, and Poliovirus 

Other viruses that can cause encephalitis include, Adenovirus, Cytomegalovirus, Eastern Equine Encephalitis Virus, Epstein-Barr virus, Herpes simplex infection, Measles, Mumps, Rabies, Rubella, Varicella (chickenpox or shingles) and West Nile virus

AIDS patients and others at high-risk can develop encephalitis due to parasites such as certain roundworms, Cysticercosis, and Toxoplasmosis

Although most forms of encephalitis are caused by viruses, the condition may also be caused by bacterial diseases, such as:

Lyme disease, Syphilis, and Tuberculosis

It is also a great possibility that an allergic reaction to vaccinations can cause encephalitis. Which is most common today given the number of vaccinations increase,  Autoimmune disease and the effects of cancer can also cause encephalitis.

Diagnosis For Encephalitis?

• The most definitive method of diagnosis of viral encephalitis is a brain biopsy, in which a small sample of brain tissue is removed and analyzed in a laboratory.
• The typical methods for identifying viruses that may cause encephalitis are products of molecular biology research. Virus detection can be accomplished by fluorescent tagging using antigen-antibody reactions or by polymerase chain reaction (PCR). Their presence can also be detected by isolation of antiviral antibodies in the blood or spinal fluid of patients.
• Fluorescent tagging is done by creating an antibody to the virus, attaching to it a chemical moiety that glows under ultraviolet light, mixing the tag with the sample to be tested, and looking for the fluorescent signature in the mixture.
• PCR (polymerase chain reaction) is a method of multiplying a segment of a gene millions of times so that it can be identified by fluorescence or other similar techniques. Antibodies in infected individuals take time to develop as the disease progresses, but they can also be identified by standard medical laboratory techniques.

Other well-known methods that have been used to diagnose encephalitis are

• Brain MRI
• CT scan of the head
• Culture of cerebrospinal fluid (CSF), blood, or urine (however, this test is rarely useful)
• Electroencephalogram (EEG)
• Lumbar puncture and CSF examination
• Tests that detect antibodies to a virus (serology tests)

                                     

Treatment Options

The goals of treatment are to provide supportive care (rest, nutrition, fluids) to help the body fight the infection and to relieve symptoms. Reorientation and emotional support for confused or delirious people may be helpful.

Specific treatments for Japanese encephalitis, St. Louis encephalitis, or tick-borne encephalitis are currently unknown. Treatment generally focuses on the reduction of symptoms and prevention or management of complications. Therefore, treatment usually does not kill the virus but is directed towards sustaining the patient until the disease runs its course.

Treatment of viral encephalitis should focus on maintaining normal breathing, kidney and bladder function, fluid and electrolyte balance, and proper nutrition. In addition, patients should be monitored for additional infections, fevers, and bedsores.

Increased pressure in the brain should be monitored. Diuretics, mannitol, and hyperventilation may reduce this pressure. If seizures result from viral encephalitis, anti-seizure drugs such as phenytoin, valproic acid, and carbamazepine may be used.

For tick-borne encephalitis, the specific immunoglobulin is available. An immunoglobulin is an antibody that is prepared in an animal and then purified and injected into a patient. Snake venom antitoxin is an example. These antibodies perform the same function as antibodies produced by the patient, but there is no wait time for the patient to produce them, which may take so long that the disease does its damage before they become effective.

1. Conventional Treatment

Viral

• Antiviral drugs

These are used by injection if the encephalitis has been caused by a virus such as herpes simplex or chickenpox.

• Steroid Injections

These are used if encephalitis is caused by a problem with the immune system and sometimes in cases linked to the chickenpox virus.

• Immunoglobulin therapy

These drugs help "control the immune system" and are required if the steroids do not work

• Plasmapheresis

This procedure removes the substances in the blood that are attacking the brain and is used when immunoglobulin therapy does not work.

• Surgery

Surgery is used to remove abnormal growths (tumors) and is carried out if encephalitis was triggered by a tumor somewhere in the body.

Bacterial

• Antibiotics or antifungal drugs

These drugs are used if encephalitis is caused by a bacterial or antifungal infection.

2. Homeopathy

Encephalitis an acute inflammatory disease of the brain due to direct viral invasion or to hypersensitivity initiated by a virus or other foreign protein with dysfunction of the brain. Allopathic medications only work on a limited number of viruses, whereas Homoeopathy is effective both in the prevention and treatment of Encephalitis safely and gently.

Homeopathy is a medical treatment that will avoid some of the side-effects and adverse reactions of conventional medical treatment. Homeopathy is the second most popular medical treatment in the world and the most popular holistic system of medicine. Homeopathy is based on remedies made from a variety of different substances, and the basis is that substances that cause symptoms of illness can also cure those same symptoms of illness.

This is the principle of “Like cures Like” on which all homeopathy is based.

Usually, the task of the homeopath is to find a remedy whose symptom picture matches the symptoms of a person’s illness. These remedy symptom pictures have been developed over the last 220 years. Yet there is one main remedy that has been found useful in the treatment of encephalitis, and the earlier it can be used the better the outcome.

Belladonna

Belladonna is a remedy made from deadly nightshade and is routinely used to treat complaints where there is a sudden infection with high fever. Other symptoms dealt with by Belladonna include migraines and throbbing headaches, and most of the other early symptoms of Encephalitis.

Therefore the advantage is that Belladonna, whether viral or bacterial, can be used at the very earliest stage of encephalitis, without ever knowing that the condition is leading to the encephalitis.

Yet if the condition does move rapidly into encephalitis, there should be no delay in getting the patient to the hospital and giving this remedy while getting the proper care will still be extremely useful.

There are numerous other homeopathic remedies such as Gelsemium (droopy eyelids, weak, head feels heavy), Opium (spaced out, drowsy, sleepy), Nux Moschata (sleepy, forgetful, confused), and Helleborus (mental dullness, weak memory, poor concentration, apathy) for treatment of encephalitis. However, when we treat our patients with homeopathy we treat the person, not the disease. In other words, we hunt for strong and unique characteristic symptoms of the individual to find the correct homeopathic medicine (similimum).

3. Other Complementary Treatments

Note: There is a currently a lack of scientific data on the use of integrative therapies for the treatment or prevention of viral encephalitis. The therapies listed below have been studied for viral infections in general and should be used only under the supervision of a qualified healthcare provider

• Astragalus: Astragalus products are derived from the roots of Astragalus Membranaceus or related species, which are native to China. In traditional Chinese medicine, astragalus is commonly found in mixtures with other herb and is used in the treatment of numerous ailments, including heart, liver, and kidney diseases, as well as cancer, viral infections, and immune system disorders. Anti-viral activity has been reported with the use of astragalus in laboratory and animal studies. Limited human research has examined the use of astragalus for viral infections in the lung, heart (pericarditis, myocarditis, endocarditis), liver (hepatitis B and C), cervix (papilloma virus), and in HIV disease. Studies have included combinations of astragalus with the drug interferon, or as a part of herbal mixtures. However, most studies have been small and poorly designed. Due to a lack of well-designed research, firm conclusions cannot be drawn.

Note-Avoid if allergic to astragalus, peas, or any related plants, or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplant or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.

• Blessed thistle: Blessed thistle leaves, stems, and flowers have traditionally been used in "bitter" tonic drinks and in other preparations taken by mouth to enhance appetite and digestion. Evidence of activity of blessed thistle against herpes viruses, influenza, or poliovirus is currently lacking in available preliminary research. Effects of blessed thistle (or chemicals in blessed thistle called lignans) against HIV are not clear. Human research of blessed thistle as a treatment for viral infections is lacking.

Note: Avoid if allergic to blessed thistle, mugwort, bitter weed, blanket flower, chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed, Echinacea or any plants of the Asteraceae or Compositae families. Use cautiously with peptic ulcer disease. Avoid with a history of bleeding diseases or gastroesophageal reflux disease (GERD), or if taking drugs for blood thinning, stroke, stomach diseases, or to control stomach acid. Avoid if pregnant or breastfeeding. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures.

• Cranberry: Cranberry is popular as a food, and is often consumed as relish, sauce, jam, juice, or dried berries. Limited laboratory research has examined the antiviral activity of cranberry. Reliable human studies supporting the use of cranberry in this area are currently lacking. Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium genus. Sweetened cranberry juice can affect blood sugar levels. Use cautiously with a history of kidney stones. Avoid more than the amount usually found in foods if pregnant or breastfeeding.
• Focusing: Early research showed that increased experiential involvement (an indication of focusing taking place) did not have an effect on antibody titers to Epstein-Barr virus. More studies in the area of immune function and antibody production are required before a recommendation can be made in this area.
• Green tea: Preliminary research suggests that green tea decreases viral load in carriers of the HTLV-1 virus. Additional well-designed controlled research is needed before a recommendation can be made for or against the use of green tea in the treatment of HTLV-1 carriers. Avoid if allergic or hypersensitive to caffeine or tannin. Use cautiously with diabetes or liver disease.
• Sorrel: Historically, sorrel has been used as a salad green, spring tonic, diarrhea remedy, weak diuretic, and soothing agent for irritated nasal passages. Sorrel has been used with other herbs to treat bronchitis, viral infections, bacterial infections and sinus conditions in Germany since the 1930s. 

Note- Avoid with a known allergy to sorrel. Avoid large doses of sorrel because there have been reports of toxicity and death, possibly due to oxalates found in sorrel. Tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. High alcohol sorrel formulations may also cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding.

• Turmeric: The rhizome (root) of turmeric (Curcuma longa Linn.) has long been used in traditional Asian medicine to treat gastrointestinal upset, arthritic pain, and "low energy." Evidence suggests that turmeric may help treat viral infections. However, there is currently not enough human evidence in this area. Well-designed trials are needed to determine if these claims are true.

Note- Avoid if allergic or hypersensitive to turmeric, curcumin, yellow food colorings, or plants belonging to the Zingiberaceae (ginger) family. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, diabetes, hypoglycemia, or gallstones. Use cautiously with blood-thinners, such as warfarin (like Coumadin®), and blood sugar-altering medications. Avoid in medicinal amounts if pregnant or breastfeeding. Turmeric should be stopped prior to scheduled surgery.

• Vitamin A: The role of vitamin A in the prevention, transmission, or treatment of HIV is controversial and not well established. A clear conclusion cannot be formed based on the available scientific research. Vitamin A supplementation has also been suggested to help prevent infections. Additional research is needed in this area.

4. Additional Supporting Treatments

• Physical therapy to improve strength, flexibility, balance, motor coordination and mobility
• Occupational therapy to develop everyday skills and to use adaptive products that help with everyday activities

• Speech therapy to relearn muscle control and coordination to produce speech
• Psychotherapy to learn coping strategies and new behavioral skills to improve mood disorders or address personality changes

 

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.

Final Words

Get immediate care if you are experiencing any of the more severe symptoms associated with encephalitis. A severe headache, fever and altered consciousness require urgent care. 

Prognosis and outcome of Encephalitis vary. Some cases are mild and short, and the person fully recovers. Other cases are severe, and permanent impairment or death is possible.

The acute phase normally lasts for 1 - 2 weeks. Fever and symptoms gradually or suddenly disappear and some people may take several months to fully recover.

Complications may occur depending on the severity of the infection and the health status of the infected individual, viral encephalitis may cause seizures, coma, or death.

The elderly and infants are more vulnerable and may have a more severe case of the disease.

References

1. Centers for Disease Control. .
2. Diagana M, Preux PM, Dumas M. Japanese encephalitis revisited. J Neurol Sci. 2007 Nov 15;262(1-2):165-70
3. Dumpis U, Crook D, Oksi J. Tick-borne encephalitis. Clinical Infectious Diseases. 1999;2882-890
4. Gould EA, Solomon T. Pathogenic flaviviruses. Lancet. 2008 Feb 9;371(9611):500-9
5. Haglund M, Forsgren M, Lindh G, et al. A 10-year follow-up study of tick-borne encephalitis in the Stockholm area and a review of the literature - Need for a vaccination strategy. Scand J Infect Dis. 1996; 28(3)217-224
6. Hoenninger VM, Rocha H, Orlinger KK, et al. Analysis of the effects of alterations in the tick-borne encephalitis virus 3'- a noncoding region on translation and RNA replication using reporter replicons. Virology. 2008;377(2):419-30
7. Japanese Encephalitis. U.S. Army Center for Health Promotion and Preventive Medicine, Entomological Sciences program 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland
8. Natural Standard: The Authority on Integrative Medicine