Encephalitis - Causes, symptoms and treatment. MF.
Encephalitis is an inflammatory disease of the brain. There are primary encephalitis - epidemic encephalitis( Economo disease), tick - borne( spring - summer) encephalitis, two - wave viral meningoencephalitis, leukoencephalitis( demyelinating childhood encephalitis) and secondary - influenza, malarial, measles.
Epidemic encephalitis( lethargic, encephalitis, Encephalitis A).
First observed in 1915 - 1916 in France and Austria in the form of epidemic outbreaks among soldiers. Described for the first time by Ekonomo in 1917, by Geimanovic and Raimist in 1920.After the first imperialist war in 1920 - 1926 there was a pandemic of the "classical form" of epidemic encephalitis.
The causative agent of this disease is a filtering virus that has not been isolated to date. The path of transmission of the virus is airborne. In the acute stage in the substance of the brain, it causes an inflammatory process, affecting the hypothalamus, basal nuclei, nuclei of the oculomotor nerves. In the chronic stage, the toxic-degenerative process develops most pronounced in the black substance and pale sphere.
For the clinic of epidemic encephalitis is characterized by a triad of symptoms:
• common symptoms - headache, fever to 38 degrees, malaise;
• marked sleep disorder - from drowsiness to co-morbidity from 7 to 8 days to a month or more;
• oculomotor disorders: ptosis( descending of the upper eyelid), diplopia( doubling), ophthalmoplegia( absence of eyeball movements).It is rarely possible to damage the facial nerve with the development of paresis of facial musculature, trigeminal nerve with pain in the face, single convulsions are possible.
At present, the acute stage - lethargic or oculocephalic - has changed somewhat. Periods of sleepiness are replaced by insomnia, drowsiness during the day and sleeplessness at night. There was a vestibular form - attacks with dizziness, nausea, vomiting, headache, photophobia.
Another modern option is the pseudo-gastritis form - irritability and weakness after a short abortion with temperature and slight oculomotor disorders. Hyperkinetic form - short acute period( headache, fever, drowsiness) and after 1 -3 months there are convulsions, violent movements - twitching, hiccups, wormlike movements with fingers, twists - twitching of the head. This form is distinguished by a particularly heavy current. Grippoid form - erased acute period - 1-2 days influenza-like condition and then gradually develops parkinsonism.
The chronic stage of epidemic encephalitis is the development of parkinsonism( from several weeks from the disease to 1 - 2 years).Gradually, the change in muscle tone increases, which leads to a slowing and impoverishment of movements( brady and oligokinesia).Later, a trembling, trembling - rigid or akinetic - rigid form of parkinsonism develops or their combination with various sleep disorders. The patient's movements are shackled, his head and hands are shaking, his facial expression is absent, salivation is increased, slow monotonous quiet speech, greasiness of the face, mental disorders are possible.
Currently, the disease is rare, occurs atypically. They are sick at any age, but more often young - 20-30 years.
Treatment of epidemic encephalitis
Patients are subject to mandatory hospitalization. The incubation period is not set accurately, therefore, persons who have been in contact with the patient are observed for 3 months. Specific treatment does not exist until now. Symptomatically prescribed antiviral agents, hormone therapy, dehydration, B vitamins, antiallergic drugs, atropine-like drugs, antispasmodics.
Prevention of epidemic encephalitis
For the purpose of prevention, the diseased person should be isolated before the end of the acute stage, the room where he was, his articles and clothing disinfected.
Tick-borne encephalitis
Tick-borne encephalitis( spring-summer, taiga) - acute neuroviral infection, which is transmitted by ticks, characterized by acute onset, fever and marked damage to the nervous system.
Described this disease in 1934 - 1939 years A. G. Panov, MB Krol. The causative agent - a filtering virus was discovered in 1937 by LA Zilber. EN Levkovich.there is a disease in the Far East, Siberia, the Urals, the Volga region, Belarus and a number of European countries.
Tick-borne encephalitis belongs to the group of natural-focal diseases of man. The main storage and carrier of the virus are ixodid mites.
Ixodes tick and sucked ixodid tick.
Additional reservoir can be rodents - hare, hedgehog, chipmunk, field mouse, birds - thrush, dandy, finch, predators - wolf. A person gets sick through a tick bite, possibly also by ingesting raw milk of goats and cows.
Symptoms of tick-borne encephalitis
The incubation period is 10 to 31 days. The virus enters the blood, the nervous system and develops encephalitis. High temperature - up to 40 degrees, severe headache, pain in the muscles, possibly a violation of consciousness, chills, nausea and vomiting, sleep disturbances. The acute period is 6 to 14 days. There is reddening of the skin of the face and breast of the patient, the vessels of the eyes. Possible development of bronchitis, pneumonia, disorders of the cardiovascular system and gastrointestinal tract. There are five clinical forms of the disease:
• febrile,
• meningeal,
• meningoencephalic
• poliomyelitis
• polyradiculoneurotic.
The most febrile form is 3-5 days of fever and mild neurological symptoms.
The most common form - meningeal - a strong headache with meningeal signs( stiff neck, Kernig symptom - unable to unbend legs in the supine position on the back, bent at the knee and hip joints).Lasts 7 to 14 days. The outcome is favorable.
The most severe form - meningoencephalic - gives a high mortality rate - up to 20%.Expressed the symptoms of fever, meningeal symptoms, often there is delirium, hallucinations, psychomotor agitation, epileptic seizures, hemiparesis, twitching.
In poliomyelitic form, paresis and paralysis of the arms and muscles of the neck develop in patients with a fever background - the hand falls, the head hangs on the chest, the affected muscles are atrophied.
Poliradiculoneurotic form is characterized by the defeat of peripheral nerves - pain along the nerves, tingling, numbness. It occurs less frequently than all other forms.
Inspection after a bite of a tick
For the diagnosis, a blood test, a CSF, is taken. The main method - serological - diagnostic is the growth of antibody titer in 4 times.
Treatment of tick-borne encephalitis
Patients are hospitalized in infectious hospitals.
Serum, immunoglobulin, antibiotics, dehydration, B vitamins, anticholinesterase preparations, biostimulants are used for treatment. In the recovery period - in addition use neuroprotectors, massage, physiotherapy exercises.
The recovery period lasts a long time. Possible residual effects in the form of muscle atrophy of the shoulder girdle, kozhevnikovskaya epilepsy - twitching a certain group of muscles and periodic deployed epiprustupy.
Prevention of tick-borne encephalitis
Prevention of tick-borne encephalitis is the protection of humans against tick bites. This is the right clothing( anti-encephalitic costumes) in the forest, the use of tick-repellent, self and mutual examination after leaving the taiga. The mites crawl up the grass in search of food - the place of the bite.
So it looks like a tick on the grass in full size.
Therefore, you can not walk barefoot, lying in the woods in the grass. The detected tick must be removed immediately. You can not crush it. It is better to immediately go to the emergency department of the nearest hospital or Sanitary and Epidemiological Station. If this is not possible - remove the mite yourself - by grasping it( with tweezers, a special device, thread) as close to the proboscis and rotating it along the axis.
Do not jerk violently - you can break it and get infected. You'll need to apply iodine on the wound.
The tick is examined in special laboratories for infection. It must be brought alive in a glass jar with a lid closed. Only 10 days after the bite, you can check the blood for tick-borne encephalitis. Persons who have been bitten by a tick must be given anti-malignant immunoglobulin or antiviral drugs - anaferon, iodantipyrine, cycloferon, arbidol, remantadine. Active population immunization is carried out in Primorsky Krai, Urals, Altai, Latvia, Estonia. .. - endemic foci. First of all, schoolchildren, pensioners - amateurs of hikers, mushroom pickers and summer residents, persons whose work is associated with leaving the green zone are vaccinated. Between vaccinations should be 2 months, and before going into the forest - 3 weeks, so that immunity could develop. The educational work with the population is carried out.
Two-wave viral meningoencephalitis
Two-wave viral meningoencephalitis is a peculiar clinical variant of tick-borne encephalitis. Infection occurs with the use of goat's milk. The name is known as goat encephalitis. But the infection is also possible through the tick bite. It is characterized by a short febrile period - 2 - 4 days, then the temperature decreases and after a few days it rises again. The second wave is usually heavier than the first.
Seasonality July - September. The incubation period for infection with milk is 4 - 7 days, with a sting - 20 days. Encephalitis flows milder, easier, does not go into a chronic stage. The flow is favorable.
Influenza encephalitis - meningoencephalitis
The background of the flu develops a sharp headache, dizziness, nausea, vomiting, meningeal signs, double vision, eyelid droop. With severe form - hemorrhagic it is possible to develop seizures, hemiplegia, speech disorders, movement coordination disorders.
Treatment of influenza encephalitis
Treatment - antibiotics, dehydration, desensitization, vitamins. Medicines are prescribed by a doctor.
Prevention of influenza encephalitis
Prevention of the disease - is the prevention of influenza - vaccination against the flu, timely treatment to the doctor, enhancing the body's defenses - immunostimulants, vitamins, nutrition, natural phytoncides - onions, garlic, lemons, limiting contacts and mass activities in the periodepidemics of influenza, use of gauze dressings, preventive use of oxolin ointment.
Malaria encephalitis
Malarial encephalitis( Japanese, autumnal, encephalitis B) is an acute neuroviral infection that causes meningoencephalitis.
Its first epidemics with high mortality were recorded in 1871 in the Japanese cities of Kyoto and Osaka. For 100 years in Japan there have been several major epidemics of mosquito encephalitis. Only in 1934 there was established an agent - a filtering virus and its carrier - a mosquito.
Malaria mosquito .
Natural foci of distribution - Japan, China, India, Korea, Vietnam, Africa, Java, the Philippines, the Far East and the Primorsky Territory.
The incidence among people depends on the activity of mosquitoes. The reservoir of the virus in nature is wild birds. Whitened at any age. After the transferred disease, there is persistent immunity, that is, you can not twice recover.
The virus when bitten by a mosquito enters the blood and spreads to all internal organs. Thus, mosquito encephalitis is a generalized hemorrhagic capillarotoxicosis.
The incubation period is 5 to 14 days, possibly up to 21 days.
Symptoms of malarial encephalitis
The onset of the disease is acute - high fever( up to 40), headache, pain throughout the body, chills, nausea, vomiting, drowsiness, redness of face, injection of eye vessels. After 3 to 4 days, the condition worsens - the meningeal syndrome is growing. Pupils react weakly to light, they can be of different sizes. There may be nonsense, aggressiveness, which are replaced by drowsiness and coma. There may be seizures, muscle tone rises, lips may appear herpetic rashes, breathing is impaired, and the pulse becomes faster.
A severe complication of this period may be cerebral edema with a wrenching into the large occipital foramen, a drop in cardiac activity and death.
The blood count increased the white blood cell count, lymphocytes and eosinophils decreased, ESR increased.with a favorable course of the disease all symptoms regress, but the healing process is long and difficult - 4-6 weeks. Neurological defects are possible - paresis, coordination disorders, mental disorders that lead to disability. Mortality rate is 40 - 70%.
For the diagnosis is taken into account the stay in the endemic area in the summer - autumn period, the clinic of the disease, serological tests of blood and liquor.
Treatment of malarial encephalitis
Serum, specific immunoglobulin, resuscitation, detoxification, hormone therapy, neuroprotectants, anticholinesterase drugs, vitamins are used for treatment.
Naturally, such a disease is treated only in a hospital with the presence of intensive care unit and all appointments are made by a doctor.
Prevention of malarial encephalitis
Prophylaxis - anti-mosquito measures in mosquito encephalitis-endemic areas, individual mosquito protection, vaccination, the introduction of a bitten immunoglobulin.
Encephalitis in infections of
Encephalitis can develop with various infections, as their complication - simple herpes, measles, chickenpox, rubella.
Rubella encephalitis occurs on the 3rd - 4th day of rash with rubella.
The source of rubella is a sick child.
Transmission path - airborne.
The causative agent is a virus.
Sick children of early age. Can be congenital and acquired. Rubella is dangerous for pregnant women - the risk of congenital malformations of the plague - the triad of Greg - the defeat of the cardiovascular system, eyes and hearing aids. The course is heavy, the lethality is high. High fever, upsets of consciousness up to coma, generalized seizures, epileptic seizures, hemiparesis.
No specific treatment. Symptomatically used corticosteroids, lasix, nootropic drugs - encephabol, nootropil, cerebrolysin.
Caries encephalitis develops towards the end of the rash stage with a new wave of fever and coma, gross cerebral symptoms - headache, vomiting and focal lesions - paralysis, hyperkinesis( twitching), ataxia, loss of vision.
The measles causative agent is a virus.
Transmission path - airborne.
Mostly children aged 2-5 years are ill. Mortality is high. After the disease, the immunity is stable. On recovery, residual defects are possible - paresis, convulsive seizures, decreased intelligence. Specific treatment is not. Apply antibiotics, anticonvulsants, nootropics, vitamins. Prevention - double vaccination of children aged 1 to 6.
All encephalitis in infectious hospitals are treated. After the encephalitis is transferred, in the chronic stage of encephalitis it is necessary to observe with the neurologist, to take course medication, aimed at improving brain activity, restoring the motor, atactic defect. In case of development of parkinsonism - permanent treatment - pramipexole( mirapex), leftist, nakom, yumeks.
Consultation of a doctor on the topic of encephalitis
Question: if I'm vaccinated against tick-borne encephalitis and I was bitten by a tick, what should I do?
Answer: extract the tick, take no medication is not necessary.
Question: Is sanatorium treatment after the encephalitis transferred?
Answer: during the first year is not shown. In the future, depending on the neurological deficit in the not hot season.
Question: Is it possible to distinguish excephalitic mite from non-contagious?
Answer: you can not. Ticks infected and not infected with encephalitis virus are absolutely identical in appearance.
Question: When traveling to which regions do I need to get vaccinated against encephalitis?
Answer: Inoculation against Japanese encephalitis when traveling to the countries of South Asia and the Far East in late summer and early autumn, from tick-borne encephalitis when traveling to Austria, the Czech Republic, Karelia, the Urals, the Krasnoyarsk and Khabarovsk Territories, the Novosibirsk Region, the Volga Region.
Each country has its own requirements for vaccination arriving or departing. The World Health Organization annually publishes relevant requirements for all countries.
If you are going on a foreign trip and do not know what vaccinations you need to do, you can contact the embassy of the country where you need to give all the necessary information.
Doctor neurologist Kobzeva S.V.