Viral encephalitis

Signs and Symptoms

• Ninety percent of people with encephalitis have flu-like symptoms, such as fever, sore throat, cough, and malaise.
• If the person has meningitis and encephalitis, he or she may have a headache, stiff neck, vomiting, and be bothered by light.
• People with severe encephalitis usually have some change in consciousness, ranging from mild confusion to coma. They will often be disoriented and delusional with possible hallucinations, agitation, and personality changes.
• Up to 50% of people with encephalitis may have seizures.
• Other signs and symptoms of encephalitis depend on which area of the brain is most affected. These may include trouble using or understanding words or coordinating voluntary muscle movements, muscle weakness or partial paralysis on one side of the body, uncontrollable tremors or movements, and not being able to regulate body temperature.
• Infants may have bulging in the fontanels or soft spots on the skull.

Causes

Arboviruses, or viruses carried by insects, are some of the most common causes of viral encephalitis. Some of the major arboviruses carried by mosquitoes include:

• Eastern equine encephalitis -- This infection is rare, with only a few cases reported each year. However, about half the people who have severe symptoms die or have permanent brain damage.
• La Crosse encephalitis -- usually affects children under 16 years of age in the upper Midwestern United States. It is rarely fatal.
• St. Louis encephalitis -- People in rural Midwestern and southern United States are most affected. Many people have mild symptoms, although symptoms can be severe in people over age 60. Up to 30% of infected seniors die of the condition.
• West Nile encephalitis -- Primarily affects people in Africa and the Middle East, but outbreaks have continued to spread across the United States. Most cases are mild. Symptoms are most severe in older adults and people with weakened immune systems, and it can be fatal for them.
• Western equine encephalitis -- People in the western United States and Canada are most at risk. It usually causes a mild infection, except in children under 1 year of age, who can have permanent brain damage.

Other viruses that commonly cause viral encephalitis include:

• Herpes simplex virus type 1 (HSV-1), which is responsible for cold sores
• HSV-2, which is responsible for genital herpes
• Varicella zoster virus, which causes chicken pox and shingles
• Epstein-Barr virus, which causes mononucleosis
• Childhood viruses that can cause encephalitis include:
• Measles (rubeola), German measles (rubella), and Mumps

Not all cases of encephalitis are caused by viruses. Some other causes of encephalitis include:

• Bacteria
• Fungus
• Parasite
• Noninfectious causes, such as allergic reactions or toxins

Risk Factors

The following factors may increase your risk of becoming infected with viral encephalitis:

• Being very young or an older adult
• Being exposed to mosquitoes or ticks
• Having a weakened immune system
• Not being vaccinated against measles, mumps, and rubella
• Traveling to areas where viral encephalitis is common

Diagnosis

Encephalitis is a serious condition, so you should see a doctor if you or your child start having symptoms. You are usually diagnosed and treated in a hospital at first. After doing a physical exam, a doctor may take the following steps to diagnose the condition:

• Blood test -- finds viruses in the blood
• Spinal tap (lumbar puncture) -- finds viruses in the fluid around the brain and spinal cord
• Brain imaging -- magnetic resonance imaging (MRI) and computerized tomography (CT) scan see whether swelling is present in the brain
• Electroencephalogram (EEG) -- finds abnormal brain waves

Preventive Care

The best way to prevent encephalitis is to avoid getting viruses that cause it:

• Protect yourself from mosquitoes. Use insect repellent and wear long pants and long sleeves. The most effective bug sprays contain DEET or Picaridin. Do not apply insect repellent to children under 2 years of age.
• Make sure your child is vaccinated against diseases such as the measles, mumps, and rubella (MMR).
• Eat a healthy diet to keep your immune system healthy.

Treatment Approach

Viral encephalitis is a serious medical condition. Although there are no specific medications to treat it, people with symptoms are often given the antiviral medication acyclovir (Zovirax). It works against herpes simplex and varicella-zoster viruses.

Studies investigating complementary and alternative therapies for the treatment of encephalitis are lacking, however, some studies indicate that scalp acupuncture, along with the right medication, may help the healing process.

Treatment includes careful observation and rest, proper nutrition, and fluids, to allow the body to fight the infection. You should always see your doctor if you have symptoms of encephalitis. Do not try to treat it yourself.

Always tell your health care provider about the herbs and supplements you are using or considering using, as some supplements may interfere with other medicines.

Medications

Medications used to treat viral encephalitis include:

• Acyclovir (Zovirax) -- treats encephalitis caused by HSV, VZV, and EBV
• Ganciclovir (Cytovene) -- treats encephalitis caused by cytomegalovirus and HSV1
• Anticonvulsant medications -- prevent and treat seizures that may happen with encephalitis

Nutrition and Dietary Supplements

There aren't any vitamins or supplements that relieve the symptoms of encephalitis, however, following these tips may help your overall health as you recover:

• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Avoid refined foods, such as white breads, pastas, and especially sugar.  
• Use healthy oils in foods, such as olive oil or vegetable oil.
• Avoid caffeine, alcohol, and tobacco.
• Drink 6 to 8 glasses of filtered water daily.

These supplements may also help improve your overall health:

• Omega-3 fatty acids, such as fish oil, 1 to 3 times daily, to help reduce inflammation and boost the immune system. Fish oil may increase the risk of bleeding, especially if you take blood-thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.
• Vitamin C, 500 - 1,000 mg, 1 to 3 times daily, as an antioxidant and to boost the immune system.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 to 10 billion CFUs (colony forming units) a day, for digestive and immune system health. If you are taking antibiotics, probiotics may help you avoid some side effects, such as diarrhea. People with autoimmune diseases, such as rheumatoid arthritis or psoriasis, should ask their doctor before taking probiotics.

Herbs

Herbs may strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

No herbs have been shown to help treat encephalitis. These herbs may help strengthen the immune system. Ask your doctor before taking them:

• Green tea (Camellia sinensis) standardized extract, 250 to 500 mg daily. This antioxidant may help reduce inflammation and boost the immune system. Use caffeine-free products. You may also make teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg, 3 times per day. This herb may reduce inflammation and fight viruses. Cat’s claw can interfere with some medications, so ask your doctor before taking it. People with leukemia or autoimmune diseases, such as rheumatoid arthritis or lupus, should not take cat’s claw.
• Garlic (Allium sativum), standardized extract, 400 mg, 2 to 3 times daily, to boost the immune system. Garlic can increase the risk of bleeding, especially if you take blood-thinners such as warfarin (Coumadin), clopidogrel (Plavix), and aspirin. It can also interfere with a number of medications. People with ulcers should ask their doctor before taking garlic.
• Astragalus (Astragalus membranaceus) standardized extract, 250 to 500 mg, 4 times daily to boost the immune system and fight viruses. Astragalus interacts with lithium and maybe with some other medications, as well. People with autoimmune diseases, such as rheumatoid arthritis or psoriasis, should ask their doctor before taking astragalus.
• Elderberry (Sambucus nigra) to boost the immune system and fight viruses. People with autoimmune diseases should ask their doctor before taking elderberry.

Acupuncture

A study of a small number of people with complications from encephalitis suggests that acupuncture on the scalp may reduce severe complications and symptoms. Some practitioners believe that scalp acupuncture works for people with encephalitis because all meridians converge at the head and the method can stimulate and regulate qi (energy) throughout the entire body. More research is needed.

Other Considerations

Pregnancy

Most cases of encephalitis in newborns are caused by when the baby passes through the birth canal of a mother who is infected with herpes simplex virus 2 (HSV-2). This infection in newborns is often severe and fatal. Pregnant women with a history of HSV-2 infection may be advised to have a cesarean section, even if there is no sign of an active infection.

Prognosis and Complications

Full recovery from encephalitis can take weeks or months. People recovering from serious cases may have complications ranging from fatigue and trouble concentrating to tremors and personality changes.

The most severe problems from encephalitis come from the destruction of nerve cells in the brain. Complications depend on the person's immune system -- whether it is healthy or weak -- and what infection caused the encephalitis. For example, many of those infected with Eastern equine encephalitis and St. Louis encephalitis have permanent brain damage, including problems with memory, speech, vision, hearing, muscle control, and sensation, and a low survival rate. Those infected with Epstein-Barr or varicella zoster rarely have any serious complications.

Most cases of encephalitis are mild and people make a full recovery.

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