 Encephalitis is an inflammatory disease

involving part or all of the central nervous

system.
 It may be caused by a variety of pathologic
agents, including bacteria, viruses, fungi,
rickettsiae, toxins, chemical substances, or
trauma.
 It may occur as a complication secondary to a
disease, as in measles or as postvaccinal
encephalitis.
 It may occur as a primary infection caused by
viral agents.
 Four types of encephalitis are eastern equine
encephalitis, western equine encephalitis, St.
Louis encephalitis, and Japanese B
encephalitis.
 The virus of arthropod-borne viral
encephalitis belongs to the group of
arboviruses.
 The viruses of eastern and western
encephalitis are classified in group A, whereas
the viruses of St. Louis and Japanese
encephalitis are in group B.
 The natural habitat of the filterable virus
appears to be many species of wild birds and
some domestic birds that live in a symbiotic
relationship with several known species of
mosquitoes, many of which belong to the
Culex group.
 Encephalitis is transmitted to humans by the
bite of an infected mosquito.
 A mosquito becomes infected by biting an
infected bird, and after incubating the virus
in its own body for five to seven days, the
mosquito carries the virus to healthy birds,
horses, and humans.
 Infection is not transmitted from man to
man.
 5 to 15 days, with a range from 4 to 21 days
 Primary encephalitis is an infection caused
by direct invasion of the CNS by the virus,
resulting in an inflammatory reaction. The
arthropod-borne viruses are as follows:
a) Eastern equine encephalitis (EEE)
▪ This is considered as a serious epidemic
disease of horses.
 ▪ It principally affects children under five
years of age.
▪ The virus can multiply in the Aedes
sullicitans mosquito.
 b. Western equine encephalitis (WEE) is
milder and usually affects adults.
 c. St. Louis encephalitis
▪ The virus is transmitted by the bite of an
infected mosquito.
▪ The organism is believed to gain entrance
through the olfactory tract.
 d. Japanese encephalitis
▪ This is a potentially severe viral disease
that is spread by the bite of a infected
mosquito, Culex triteaniorhynchus, which
lives in rural rice-growing and pig-farming
regions. The mosquito breeds in flooded
rice fields and standing water around
planted fields. Once the mosquito is
infected, it carries the virus and is capable
of transmitting the disease for life.
▪ It is a mosquito-borne viral disease that
can affect the central nervous system and
cause several complications and even
death.
▪ JE can be a risk to travelers to rural areas
where the disease is prevalent.
▪ This affects children 5 to 10 years old,
more in males that in females with a ratio
of 3:1.
▪ The case fatality rate is 30 to 35%.
▪ The peak season for JE is March to April
and September to October.
▪ There is no specific treatment for JE.
 Secondary encephalitis
a) Post-infection encephalitis is usually a
complication or sequela to some viral
diseases like measles, chickenpox,and
mumps.
b) Post-vaccinal results after the client
receives a vaccine, most commonly with
the anti-rabies vaccine.
 Fever ( 104° to 105° F)
 Rapid pulse rate
 Headache
 Nausea and vomiting
 Neurologic signs include tremor of the hands,
tongue and lips, speech difficulty, stiff neck,
drowsiness and an altered level of
consciousness
 In severe cases convulsions, coma and death
may occur.
 Leukocytosis
 Continued high fever and convulsions
indicate a poor prognosis
 Motor disturbances
• Persistent convulsions
• Parkinsonian syndrome or paralysis
agitans
• Epilepsy
 Mental disturbances
• Mental dullness
• Mental deterioration
• Lethargy
• Mental depression
• Sleep disturbances

 Endocrine disturbances
• Patient may grow either fat or thin.
• Sexual interest or activity is lost.
 Treatment must be symptomatic and
supportive.
 Convulsions must be controlled.
 Nose and throat secretions should be
sanitarily disposed of.
 TSB or alcohol sponges may be given if the
temperature is excessively high.
 Unless patient is comatose, oral fluid should
be encouraged.
 Oral care should be done strictly.
 A mouth gag and protective devices, such as
bedrails, should be available in case
convulsions occur.
 Intake and output records should be closely
monitored.
 Patients should be observed for neurologic
signs involving speech, swallowing difficulty,
twitching, eye movements, and indications of
paralysis.
 The beginning, duration, and frequency of all
convulsions should be carefully observed and
recorded.
 CSF analysis
 Serologic test- 90% confirmatory, done on
the 7th day of illness
 Complement-fixation test
 Hemagglutination-inhibition antibody test
 ELISA (IgM)
 Polymerase chain reaction.
 Keep the patient in a quiet, well- ventilated
room.
 Stretch linens.
 Encourage or perform oral hygiene on the
patient.
 Do bed baths if not contraindicated.
 Sanitary disposal of nose and throat
secretions.
 Oral fluids should be encouraged.
 If stupor or coma is present, intravenous
fluids and gavage feeding may be ordered.
 Bedrails should be available.
 Intake and output records are maintained,
and temperature, pulse, and respiration rates
are taken at four-hour intervals or oftener if
indicated.
 Observed for neurologic signs involving
speech, swallowing difficulty, twitching, eye
movements, and indication of paralysis,
 Turn the patient to sides at least every 3-4
hours.
 Encourage increased oral fluid intake.
 Encourage high caloric intake.
 Moisten lips with mineral oil.
 Render TSB if febrile.
 Sleep pattern disturbances
 Altered cerebral perfusion
 Altered nutrition: Less than body
requirement
 Impaired physical mobility
 Impaired swallowing
 Ineffective airway clearance
 Impaired communication
 Preventive measures are directed toward the
identification of mosquito vectors.
 Prevention and control must be geared
toward the elimination of breeding places,
destruction of larvae, screening of homes,
and use of repellents.
 A broad public education program about all
phases of preventive programs is important.
 At least four forms of acute encephalitis have
occurred epidemically and sporadically in the
United States: the von Economo, the St.
Louis type, the eastern and western equine
types.
DEFINITION:
 Von Economo’s encephalitis is a disease
affecting the central nervous system,
characterized by a variety of symptoms in
different eases, depending upon the site of the
lesions.
 “Sleeping sickness “ sometimes applied to this
disease. Synonyms: encephalitis lethargica; the
Vienna type of infectious encephalitis; Type A
encephalitis; epidemic encephalitis
ETIOLOGY:
 Neurotropic form of herpes virus.

SOURCES OF INFECTION:
 Nasal and oral discharges of infected
individuals or carriers.
PATHOLOGY
 The spinal fluid may show a variably
increased cell count, chiefly of the
mononuclear variety; the globulin usually is
increased, and the sugar content may be
increased, and then may be some reduction
of colloidal gold.
 The blood shows a leukocytosis.
MODE OF TRANSMISSION:
 Direct contact with an infected individual or
carrier, or indirectly by articles freshly soiled
with the discharges from the nose and throat
of infected persons.

SUSCEPTIBILITY
 Children and young adults
INCUBATION PERIOD:
 Four to twenty –one days

COURSE OF THE DISEASE:

 Headache
 Malaise
 Fever
 Drowsiness
 Gastrointestinal disturbances
 Sometimes convulsions
 Lethargy
 Weakness
 Involvement of the central nervous system
 Nystagmus
 Diplopia
 Unequal pupils
 Ptosis
 Paralysis of the eye muscles
 Stiff neck
 Kernig’s sign
 Motor disturbances
 Tremors
 Diplopia

Ptosis Unequal Pupils

PERIOD OF CONVALESCENCE:
 Convalescence is very slow.
 10% of the cases some progressive disease of
the central nervous system occurs.
COMPLICATIONS AND SEQUELAE:
 Mental or psychic impairment
 Insomnia
 Changes in personality
 Inversion of the sleep curve
 Ptosis and squint
 Facial asymmetry
 Difficulty in speech
 Deglutition
 Tremors
 Ties
 Parkinson’s syndrome (paralysis agitans)
characterized by a masklike facial expression,
spasticity of the voluntary muscles, and
marked tremors

PERIOD OF COMMUNICABILITY:
 Probably transmissible during the acute
febrile stage
TREATMENT:
 Lumbar puncture is done as a diagnostic and
therapeutic measure.
 Treatment is symptomatic.

METHODS OF CONTROL:
 Recognition and reporting
 Isolation
 Quarantine
 Immunization
DEFINITION:
 St. Louis encephalitis is a
meningoencephalitis caused by a specific
virus and characterized by a varied
symptomatology.

ETIOLOGY
 A specific virus has been proved to be the
cause of the St. Louis type.
SOURCES OF INFECTION:
 Birds and chickens are a probable source of
infection.

PATHOLOGY:
 Vascular congestion of the brain as well as the
spinal cord, engorgement of the blood vessels of
the meninges with diffuse infiltration of
lymphocytes.
 Degeneration and necrosis of the gray and white
matter.
MODE OF TRANSMISSION:
 Transmitted by the bite of Culex mosquitoes
which have fed on infected fowls and other
birds; mites may serve as vectors.

SUSCEPTIBILITY:
 Infants and older age group
INCUBATION PERIOD:
 4 to 21 days

CLINICAL MANIFESTATION
 Fever
 Headache
 Drowsiness
 Disorientation
 Motor disturbances
 Meningeal irritation with increase of cells in the
spinal fluid
PERIOD OF CONVALESCENCE:
 The course of the disease may be stormy but
recovery usually is rapid.
 The temperature returns to normal within 7
to 10 days.
 In severe cases, convalescence is prolonged.
COMPLICATIONS AND SEQUELAE:
 Sequelae are not common, and when they
do occur, they are less severe than those of
the von Economo type.
 Parkinsonism is rare.
DIFFERENTIAL DIAGNOSIS
 Complement fixation and neutralization tests
aid in confirming the diagnosis

TREATMENT
 The treatment is symptomatic.
METHODS OF CONTROL
 Recognition and reporting
 Isolation
 Immunization
DEFINITION:
 Equine encephalomyelitis occurs in the
western and eastern forms.
 Both are viral infectious capable of being
transmitted to man.
 The western type is a disease primarily of
horses and mules; the eastern type is a
disease primarily of horses, mules and birds.
ETIOLOGY
 The virus causing eastern equine
encephalomyelitis is more virulent than the
virus causing the western type of the disease.

SOURCES OF INFECTION
 Transmitted by insects, especially several
species of mosquito.
PATHOLOGY
 In the western type of the disease the most
marked pathologic changes occur in the brain
and meninges, the spinal cord rarely being
involved.
 Foci of degeneration and necrosis are
widespread in the gray matter, and
infiltration of white blood cells is diffuse
 In the eastern type, the lesions most
frequently involve the brain stem and basal
ganglia.
 Destruction of nerve cells, inflammatory
changes in the small blood vessels and
thrombosis.
INCUBATION PERIOD
 The incubation period has not been determined
for eastern encephalomyelitis.
 4 to 21 days for the western type of the disease.

CLINICAL MANIFESTATIONS
 The western equine type resembles the St. Louis
type clinically.
 Eastern type is abrupt onset and more severe
with high fever, vomiting, drowsiness, and
convulsions.
PERIOD OF CONVALESCENCE
 Recovery is slow.
 The eastern type of the disease is more
severe than the western.
COMPLICATIONS AND SEQUELAE
 In the western type sequelae are rare, but
nervous and mental sequelae usually follow
the eastern type.

DIFFERENTIAL DIAGNOSIS
 The diagnosis is made by laboratory tests.
TREATMENT
 No specific treatment for equine
encephalomyelitis

METHODS OF CONTROL
 Recognition and reporting
 Isolation
 Immunization
 Isolation
 Comfort of the patient
 Care of the mouth
 Care of the eyes
 Diet
 Clinical recording
 Disinfection