Encephalitis

ENCEPHALITIS
STUDY UNIT 1.3.2
DR N SCHEEPERS
LEARNING OUTCOMES:SU 1.3.2
• Differentiate between Herpes Simplex Encephalitis, Arthropod-Borne Virus encephalitis and Fungal
Encephalitis in table format under the following headings
 Definition
 Aetiology
 Pathophysiology
 Clinical manifestations
 Assessment and diagnostic findings
 Possible complications
 Preventive measures
 Medical management
 Nursing management
• An acute inflammatory process of brain
tissue.
• Causes: Herpes simplex virus 1 (HSV 1) –
ENCEPHALI most common cause which affects children
TIS and adults. This virus causes cold sores.
- HSV 2 (genital herpes) – affect neonates,
through mother-to-child transmissions.
- Arthropod-borne virus encephalitis –
transmitted through blood feeding
arthropods (mosquitoes and ticks)
- Fungal encephalitis – caused by cryptococcus
neoformans (bird droppings).
RISK
FACTORS • Age: Children < 5 years and young adults or <
55 years
OF HPV • Immunocompromised patients – HIV, cancers
• Geographical regions – mosquitos and ticks
prone
• Seasonal – common in summer
• Pathology involves local
necrotizing haemorrhage that is
PATHOPHYSIO generalized.
LOGY OF HSV
ENCEPHALITIS • Inflammation and cerebral
oedema occur in infected areas
through cerebral hemispheres,
cerebellum, brain stem or spinal
cord
• Direct viral invasion – damages
brain neurons
• Headaches
• Fever
CLINICAL
MANIFESTATI • Personality and behavioural
ONS: HSV changes
• Hallucinations
• Changes in LOC
• seizures
• Severe: memory and speech
problems
• CT Brain and MRI – detect
DIAGNOST inflammation, brain oedema and
IC TESTS brain abscess
• Lumbar puncture – CSF analysis =
viral infection
• EEG – if seizures occur
• Blood test - PCR
• Antiviral agents – Acyclovir (HSV 1) and
MEDICAL ganciclovir (cytomegalovirus) – reduces
MANAGEMENT:H replication of virus
SV
- Administered for 3 weeks
• Corticosteroids – reduce inflammation
(Prednisone)
• Anti-convulsion agents - Phenytoin
Goal: Monitor neurological status and give supportive
care
Relieve symptoms of condition:
- Analgesics – reduce fever and headaches
NURSING
- Antipsychotics – behavioural changes
MANAGEME
- Monitor vital signs and neurological status – LOC
NT changes
- Monitor signs of increased ICP – Bradycardia,
Hypertension, Irregular respiration
- Position of patient – Bed at 30 degrees and neck in
midline
- Preventative measures: risk of injury due to seizures
- Provide non-stimulating environment
- Monitor U&E – renal functioning due to antivirals
- Monitor PCT and CRP – effectiveness of antivirals
COMPLICATI
ONS OF HSV • Seizures
• Increased confusion
• Loss of consciousness
• Brain abscess
ARTHROPOD-BORNE VIRUS
ENCEPHALITIS
PATHOPHYSIOLOGY OF ARBOVIRUS
• Viral replication occurs at site of mosquito bite.
• The host immune response attempts to control viral replication.
• When immune response fails – viremia occurs.
• The virus gains access to CNS via olfactory tract = encephalitis.
• Spreads from neuron to neuron, affecting the cortical grey matter, thalamus and brain
stem.
• Meningeal exudates irritate meninges and increase ICP.

CLINICAL
MANIFESTATIONS:ARBOVIRUS
ONSET:
- Flu-like symptoms: headache , fever , dizziness, nausea and
malaise
SPREAD TO CNS:
- Neck stiffness
- Confusion
- Dizziness
- Tremors
DIAGNOSTIC TESTS: ARBOVIRUS
• TRAVEL HISTORY – Geographical area
• MRI AND CT BRAIN - inflammation of basal ganglia
• LP- CSF analysis
• EEG – abnormal brain waves for viral infections

MEDICAL TREATMENT:ARBOVIRUS
• No specific medication – symptom management

• Control seizures – anti-seizures
• Monitor signs of increased ICP – Bradycardia,
Irregular RR and Hypertension.
• Neuropsychiatric medications – emotional and
behavioural changes.
NURSING MANAGEMENT
• OUT-PATIENT: Fever and headache
• IN-PATIENT: SEVERITY
- Assess neurologic status – identify improvement or deterioration.
- Prevent risk of injury –potential falls or seizures
- Health education
Teach about condition
Prevention of arbovirus – clothing when outside, avoid swimming in lakes, eliminate

standing water
FUNGAL
ENCEPHALITIS
RISK FACTORS: FUNGAL ENCEPHALITIS
COAL MINERS CONSTRUCTION FARMERS

WORKERS
• Fungal spores enters body via
inhalation.
PATHOPHYSIOL • Initially infect lungs, causing vague
OGY: FUNGAL respiratory symptoms or
ENCEPHALITIS pneumonitis
• Fungi may enter bloodstream
causing fungemia
• If fungemia overwhelms the hosts
immune response = spread to CNS
• Fungal invasion can cause -
encephalitis
• Fever
• Headaches
CLINICAL • Malaise
MANIFESTATIO • Meningeal signs- neck stiffness,
NS: FUNGAL photophobia
ENCEPHALITIS • Changes in LOC
• Increased ICP due to hydrocephalus
• Skin lesions – Cryptococcus neoformans
• Seizures – Histoplasma capsulatum
• Ischemic or haemorrhagic stroke –
Aspergillus fumigatus
• History – immunosuppressed
patients
DIAGNOSTIC • Occupational and travel history
TESTS
• LP- CSF analysis (Clear,Increased
WCC and proteins and
decreased glucose)
• MRI Brain – identify areas of
haemorrhage, abscess and
inflamed meninges
• Treat cause of fungus
• Seizures – anticonvulsants
MEDICAL
• Increased ICP – Lumbar puncture or
MANAGEMENT
shunting of CSF
• Antifungals – Amphotericin B
- Fluconazole can be added +

Amphotericin B as maintenance therapy.
• Use of fluconazole – monitor LFTs

• NB: MONITOR SIGNS OF
INCREASED ICP
NURSING • Analgesics – Pain relief
MANAGEMENT
• Limit environmental stimuli
• Administer Benadryl and Tylenol –
before amphotericin B to prevent
flu-like symptoms
• Monitor renal functioning and liver
function

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ENCEPHALITIS

STUDY UNIT 1.3.2

 Assessment and diagnostic findings

• The host immune response attempts to control viral replication.

• When immune response fails – viremia occurs.

• The virus gains access to CNS via olfactory tract = encephalitis.

• Meningeal exudates irritate meninges and increase ICP.

• TRAVEL HISTORY – Geographical area

• MRI AND CT BRAIN - inflammation of basal ganglia

• LP- CSF analysis

• EEG – abnormal brain waves for viral infections

• No specific medication – symptom management

- Assess neurologic status – identify improvement or deterioration.

- Prevent risk of injury –potential falls or seizures

Teach about condition

Prevention of arbovirus – clothing when outside, avoid swimming in lakes, eliminate

COAL MINERS CONSTRUCTION FARMERS

- Fluconazole can be added +

• Use of fluconazole – monitor LFTs

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