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Meningoencephalitis
Terms to understand
• Encephalitis
• Encephalopathy
• Meningitis
• Meningism
• Myelitis
• Radiculitis
Meningoencephalitis
• Acute inflammation of meninges & brain
tissue
• CSF – pleocytosis
• Gram stain & culture negative
• ...
Etiology
• Enterovirus; coxsackie, polio, echo
• Arbovirus; JEV, WNV, Dengue
• Herpes virus; HSV1&2, VZ, EBV, CMV.
• Other...
JEV
JEV
JEV
• Flavivirus
• Spread by culex
• Single stranded RNAV
• 1955 in pondicherry
• 2005; 1400 deaths in UP & Bihar
DYNAMICS OF JE TRANSMISSION
Environment
Vector Mosquito
Host - Amplifying Host - Carrier
Victim-Accidental
Full
Recovery
D...
Subcutaneous injection
Regional lymph nodes
Extra neural Tissues
Connective tissue
Striated muscle
Pancreas
Adrenal
Smooth...
Pathogenesis
• Direct invasion & destruction by virus
• Host reaction to viral antigens
• Meningeal congestion
• Mononucle...
Structures affected
• HSV; temporal lobe
• Arbovirus; entire brain
• Rabies; basal parts
• Varicella; cerebellum
Clinical features
• Depends on parenchymal involvement
• Preceding mild febrile illness & exantheme
• Acute onset of high ...
DD
• Meningitis of various organisms
Clues in history
• Travel
• Vaccination
• Rash
• Oral ulcers
• Parotitis, orchitis
• Dogbite
• Pets
Clues in examination
• Cranial N palsy; HSV, EBV, TB.
• Ataxia; VZV,
• AFP; polio, enteroV, tick borne.
• Rash; VZV, typhu...
Diagnosis
• CSF: lymphocytic predominance
 Protein: normal, high in HSV
 Glucose: normal, low in mumps
 Culture of orga...
PLED in HSV
MRI brain (T2W image): right temporal
lobe high signal in a patient with herpes
encephalitis
Bilateral asymmetric
thalamic hyper intensity
Substantia nigra involvement
Management
• Monitor GCS
• ABC
• Restrict IVF
• Anticovulsants, antipyresis ,
• Treat ICT
• Moitor; glucose, BUN, elect, A...
Infant < 1 yr Child 1-4 yrs > 4 years
EYES
4 Open Open Open
3 To voice To voice To voice
2 To pain To pain To pain
1 No re...
Bad Prognosis
• <3 yrs
• GCS <6 for 4days
• Hyponatremia
• 50-60% sequalae
Prevention
• Vaccine for jEV
– Inactivated mouse brain Vaccine
– Live attenuated SA-14-14-2 vaccine
• Mosquito control
• M...
Japanese B encephalitis
Japanese B encephalitis
Japanese B encephalitis
Japanese B encephalitis
Japanese B encephalitis
Japanese B encephalitis
Japanese B encephalitis
Japanese B encephalitis
Japanese B encephalitis
Japanese B encephalitis
Japanese B encephalitis
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Japanese B encephalitis

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Japanese B encephalitis

  1. 1. Meningoencephalitis
  2. 2. Terms to understand • Encephalitis • Encephalopathy • Meningitis • Meningism • Myelitis • Radiculitis
  3. 3. Meningoencephalitis • Acute inflammation of meninges & brain tissue • CSF – pleocytosis • Gram stain & culture negative • Changes in MRI brain • Mostly self limiting
  4. 4. Etiology • Enterovirus; coxsackie, polio, echo • Arbovirus; JEV, WNV, Dengue • Herpes virus; HSV1&2, VZ, EBV, CMV. • Others; mumps, measles, rabies, adenoV. • Bacteria; TB, mycoplasma, rickettsiae • Protozoa; acanthameba, toxoplasma
  5. 5. JEV
  6. 6. JEV
  7. 7. JEV • Flavivirus • Spread by culex • Single stranded RNAV • 1955 in pondicherry • 2005; 1400 deaths in UP & Bihar
  8. 8. DYNAMICS OF JE TRANSMISSION Environment Vector Mosquito Host - Amplifying Host - Carrier Victim-Accidental Full Recovery DeathRecovery with residual complications
  9. 9. Subcutaneous injection Regional lymph nodes Extra neural Tissues Connective tissue Striated muscle Pancreas Adrenal Smooth muscle Efferent lymphatics Thoracic duct Plasma ViremiaReticuloendothelial cell clearance Humoral antibody Olfactory epithelium Vascular endothelium Neural Parenchyma Neurons, Glia(?) CNS antibody lymphocytes, macrophage Cellular dysfunction Cellular lysis Inflammation ? ?
  10. 10. Pathogenesis • Direct invasion & destruction by virus • Host reaction to viral antigens • Meningeal congestion • Mononuclear infiltration • Neuronal disruption • Neuronophagia, vasculitis • Demyelination [ADEM]
  11. 11. Structures affected • HSV; temporal lobe • Arbovirus; entire brain • Rabies; basal parts • Varicella; cerebellum
  12. 12. Clinical features • Depends on parenchymal involvement • Preceding mild febrile illness & exantheme • Acute onset of high fever, headache, irritability,lethargy,nausea,myalgia • Convulsions, stupor, coma • Fluctuating FND, emotional outburst • Ant.horn cell injuryflaccid paralysis [west nile,entero virus]
  13. 13. DD • Meningitis of various organisms
  14. 14. Clues in history • Travel • Vaccination • Rash • Oral ulcers • Parotitis, orchitis • Dogbite • Pets
  15. 15. Clues in examination • Cranial N palsy; HSV, EBV, TB. • Ataxia; VZV, • AFP; polio, enteroV, tick borne. • Rash; VZV, typhus, mycoplasma • Parotitis; mumps, • LN; HIV, EBV, CMV, Rubella. • Dementia; HIV • Hydrophobia; rabies.
  16. 16. Diagnosis • CSF: lymphocytic predominance  Protein: normal, high in HSV  Glucose: normal, low in mumps  Culture of organism [entero V]  Viral antigen by PCR  Culture from NPswab, vesicle, feces, urine  IgM, IgG titre
  17. 17. PLED in HSV
  18. 18. MRI brain (T2W image): right temporal lobe high signal in a patient with herpes encephalitis
  19. 19. Bilateral asymmetric thalamic hyper intensity
  20. 20. Substantia nigra involvement
  21. 21. Management • Monitor GCS • ABC • Restrict IVF • Anticovulsants, antipyresis , • Treat ICT • Moitor; glucose, BUN, elect, ABG, LFT, • Acyclovir
  22. 22. Infant < 1 yr Child 1-4 yrs > 4 years EYES 4 Open Open Open 3 To voice To voice To voice 2 To pain To pain To pain 1 No response No response No response VERBAL 5 Coos, babbles Oriented, speaks, interacts, social Oriented and Alert 4 Irritable cry, consolable Confused speech, disoriented, consolable Disoriented 3 Cries persistently to pain Inappropriate words, inconsolable Nonsensical speech 2 Moans to pain Incomprehensible, agitated Moans, unintelligible 1 No response No response No response MOTOR 6 Normal spontaneous movement Normal spontaneous movement Follows commands 5 Withdraws to touch Localizes pain Localizes pain 4 Withdraws to pain Withdraws to pain Withdraws to pain 3 Decorticate flexion Decorticate flexion Decorticate flexion 2 Decerebrate extension Decerebrate extension Decerebrate extension 1 No response No response No response
  23. 23. Bad Prognosis • <3 yrs • GCS <6 for 4days • Hyponatremia • 50-60% sequalae
  24. 24. Prevention • Vaccine for jEV – Inactivated mouse brain Vaccine – Live attenuated SA-14-14-2 vaccine • Mosquito control • Management of pigs

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