Viral encephalitis

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date 19/09/11

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Viral encephalitis

  1. 1. VIRAL ENCEPHALITIS<br />DR.PRAVEEN NAGULA<br />
  2. 2. INTRODUCTION<br />Acute febrile illness plus altered level of consiousness<br />Signs and symtpoms reflect the site of inflammation<br />Impossible to distinguish reliably on the clinical grounds alone one type from other. <br />
  3. 3. Etiology<br />Sporadic cases -- immunocompetent patients <br />HSV,VZV,EBV.<br />Epidemics – arboviruses<br />Alphavriuses – EEE ,western equine virus<br />Flaviviruses – WNV,stlouis encephalitis<br />Bunyaviruses<br />NIPAH virus<br />Toscana virus <br />
  4. 4. Lab investigations<br />CSF examination :<br /><ul><li>To be done in all cases
  5. 5. Same as meninigtis of viral origin
  6. 6. Absent CSF pleocytosis –immunocompromised,glucocorticoid,malignancies
  7. 7. >5 cells/ul -90 % cases
  8. 8. >500 cells/ul – 10 % cases
  9. 9. >1000 cells /ul –mumps ,LCMV.</li></ul>ATYPICAL LYMPHOCYTES – EBV,CMV,HSV<br />Mollaret cells –WNV<br />Neutrophils -40% WNV,echovirus<br />>20% RBC – HSV hemorrhagic encephalitis<br />Decreased CSF glucose – MUMPS,LCMV<br />
  10. 10. CSF PCR –<br />Primary test for CMV,HSV,VZV,EBV<br />Sensitive and specific for HSV<br />Postivity increases with duration of illness<br />Not affected by less than 1 week of therapy<br />Next specific for enteroviruses<br />Not established for EBV<br />Less specific than AbIgM --WNV<br />
  11. 11. MRI <br />Increased signal intensity in frontotemporal,cingulate,linuglar regions on t2 weighted images<br />10 % may have normal MRI<br />EEG – periodic complexes sharp and slow at regular intervals of 2-3 sec.<br />Biopsy not reponding to treatment<br />
  12. 12.
  13. 13. DIFFERENTIAL DIAGNOSIS<br />AMOEBIC ENCEPHALITIS***:<br />Naegleriafowleri – 1 amoebic meningoencephalitis<br />In immuno competent<br />h/o swimming in potentially infected ponds.<br />CSF nuetrophilicpleocytosis<br />Hypoglycorrhachia<br />Motile trophozoites –wet mount of warm fresh CSF.<br />Mortality is 100% <br />Acanthoemba--- chronic granulomatous illness<br />
  14. 14. HSV encephalitis<br />Olfactory ,gustatory hallucinations<br />Anosmia<br />Unusual or bizzarebehaviour<br />Differentiation is important as specific treatment avialable.<br />Temporal lobe intensity<br />
  15. 15. rabies<br />Encephalitis rabies (furious rabies) :<br />Fever,fluctuatingconsciouness<br />Autonomic hyperactivity<br />Hydorphobia<br />Aerophobia<br />Paralytic dumb rabies <br />Acute ascending paralysis<br />Phobic spasms not seen in due to rabies from bat exposure…<br />
  16. 16. Treatment<br />ICU CARE<br />ICP monitoring<br />Fluid restriction<br />Avoid hypotonic fluids<br />Anticonvulsants<br />Prevent apsiration<br />Physiotherapy<br />DVT prophylaxis<br />
  17. 17. treatment<br />Acyclovir <br /> start empirically<br />10 mg/kg IV every 8 hrs for 14 days<br />30 mg/kg/day<br />Additional 7 days in case of positive CSF PCR at 14 days.<br />Ganciclovir 5m g/kg bid<br />foscarnet -CMV virus 60 mg/kg every 8 hrs<br />Cidofovir – nucleotide analogue<br />
  18. 18. THANK YOU <br />
  19. 19. Sagittarian<br />

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