Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Home
  • Home
Chapter
  • Print publication year: 2008
  • Online publication date: August 2009

19 - Clinical management of viral encephalitis

from Section III - Introduction: immunity, diagnosis, vector, and beneficial uses of neurotropic viruses
Export citation

Summary

Introduction

Most cases of viral encephalitis are acute, although a few viruses can cause chronic progressive encephalitis. Rarely, systemic virus infection may trigger post-infectious encephalomyelitis. Viral encephalitis typically reflects viral invasion of the brain parenchyma. Encephalitis patients usually have alterations in their state of consciousness. Some viruses produce “diffuse” encephalitis in which the predominant features are impaired consciousness, signs of generalized central nervous system (CNS) dysfunction such as generalized seizures, and a cerebral spinal fluid (CSF) pleocytosis. Conversely, other viruses produce “focal encephalitis,” in which altered consciousness and CSF abnormalities are accompanied by prominent focal abnormalities on neuroimaging tests or clinical examination including hemiparesis, aphasia, hemisensory loss, ataxia, focal as well as generalized seizures, and, less often, involuntary movements, visual field defects, and cranial nerve deficits. Personality changes, language, and memory disturbances and psychotic features are frequent. Viral encephalitis must be distinguished from nonviral conditions that can present a similar clinical picture, including Lyme disease, tuberculosis, syphilis, Listeria, Mycoplasma, fungal and parasitic infections, brain abscess, subdural hematoma or abscess, brain tumors, CNS vasculitis, and toxic/metabolic encephalopathies.

Viral encephalitis may be epidemic or sporadic (see also Chapter 17). Causes of epidemic viral encephalitis include the togaviruses, enteroviruses (see Chapter 17), mumps and lymphocytic choriomeningitis (LCM) virus (see Chapter 1). The toga-viruses are RNA viruses transmitted by mosquitoes or ticks (arthropod-born) (see Chapters 6, 7, and 20), with a peak incidence in the Northern Hemisphere in the warm summer months.

Related content

Powered by UNSILO
References
Breeden, C. J., Hall, T. C., and Tyler, H. R., Ann Intern Med, 65 (1966) 1050–6.
Boston Interhospital Virus Study Group, N Engl J Med, 292 (1975) 599–603.
Whitley, R. J., Soong, S. J., Dolin, R., et al., N Engl J Med, 297 (1977) 289–94.
Whitley, R. J., Soong, S. J., Hirsch, M. S., et al., N Engl J Med, 304 (1981) 313–8.
Whitley, R. J., Alford, C. A., Hirsch, M. S., et al., N Engl J Med, 314 (1986) 144–9.
Whitley, R. J., Alford, C. A., Hirsch, R. T., et al., Infection, 15 (Suppl 1) (1987) S3–8.
Skoldenberg, B., Forsgren, M., Alestig, K., et al., Lancet, 2 (1984) 707–11.
Cinque, P., Cleator, G. M., Weber, T., et al., J Neurol Neurosurg Psychiatry, 61 (1996) 339–45.
Tyler, K. L., Herpes, 11 (Suppl 2) (2005) 57A–64A.
Steiner, I., Budka, H., Chaudhuri, A., et al., Eur J Neurol, 12 (2005) 33–43.
VanLandingham, K. E., Marsteller, B., Ross, G. W., et al., JAMA, 259 (1988) 1051–3.
Ito, Y., Kimura, H., Yabuta, Y., et al., Clin Infect Dis, 30 (2000) 185–7.
Benson, P. C. and Swadron, S. P., Ann Emerg Med, 47 (2006) 100–5.
Gordon, B., Selnes, O. A., Hart, J., et al., Arch Neurol, 47 (1990) 646–7.
Perry, C. M. and Faulds, D., Drugs, 52 (1996) 754–72.
MacDougall, C. and Guglielmo, B. J., J Antimicrob Chemother, 53 (2004) 899–901.
Chan, P. K., Chow, P. C., Mak, A. W., et al., Hong Kong Med J, 6 (2000) 119–21.
Meyding-Lamade, U. K., Oberlinner, C., Rau, P. R., et al., J Neurovirol, 9 (2003) 118–25.
Thompson, K. A., Blessing, W. W., and Wesselingh, S. L., J Neurovirol, 6 (2000) 25–32.
Nakano, A., Yamasaki, R., Miyazaki, S., et al., Eur Neurol, 50 (2003) 225–9.
Kamei, S., Sekizawa, T., Shiota, H., et al., J Neurol Neurosurg Psychiatry, 76 (2005) 1544–9.
Wintergerst, U., Kugler, K., Harms, F., et al., Eur J Med Res, 10 (2005) 527–31.
Page, L. K., Tyler, H. R., and Shillito, J., J Neurosurg, 27 (1967) 346–52.
Ebel, H., Kuchta, J., Balogh, A., et al., Childs Nerv Syst, 15 (1999) 84–6.
Yan, H.-J., Surg Neurol, 57 (2002) 20–4.
Kimberlin, D., Herpes, 11 (Suppl 2) (2004) 65A–76A.
Whitley, R. J., Nahmias, A. J., Soong, S. J., et al., Pediatrics, 66 (1980) 495–501.
Whitley, R. J., Yeager, A., Kartus, P., et al., Pediatrics, 72 (1983) 778–85.
Whitley, R. J., Arvin, A., Prober, C., et al., N Engl J Med, 324 (1991) 444–9.
Kimberlin, D. W., Lin, C.-Y., Jacobs, R. F., Powell, D. A., et al., Pediatrics, 108 (2001) 230–8.
Kimberlin, D., Powell, D., Gruber, W., et al., Pediatr Infect Dis J, 15 (1996) 247–54.
Bergstrom, T. and Alestig, K., Scand J Infect Dis, 22 (1990) 239–40.
Berger, J. R., Lancet, 337 (1991) 1360–1.
Schlesinger, Y., Tebas, P., Gaudreault-Keener, M., et al., Clin Infect Dis, 20 (1995) 842–8.
Kohlhoff, S. A., Marciano, T. A., and Rawstron, S. A., Acta Paediatr, 93 (2004) 1123–4.
Mommeja-Marin, H., Lafaurie, M., Scieux, C., et al., Clin Infect Dis, 37 (2003) 1527–33.
Tyler, K. L., Tedder, D. G., Yamamoto, L. J., et al., Neurology, 45 (1995) 2246–50.
Chu, K., Kang, D. W., Lee, J. J., et al., Arch Neurol, 59 (2002) 460–3.
Tang, J. W., Coward, L. J., Davies, N. W., et al., J Neurol Neurosurg Psychiatry, 74 (2003) 1323–5.
Nakajima, H., Furutama, D., Kimura, F., et al., Eur Neurol, 39 (1998) 163–7.
Gobbi, C., Tosi, C., Stadler, C., et al., Eur Neurol, 46 (2001) 215–8.
Eberhardt, O., Kuker, W., Dichgans, J., et al., Neurology, 63 (2004) 758–9.
Silva, S. M., Mark, A. S., Gilden, D. H., et al., Neurology, 47 (1996) 929–31.
Gilden, D. H., Lipton, H. L., Wolf, J. S., et al., N Engl J Med, 347 (2002) 1500–3.
Kronenberg, A., Schupbach, R., Schuknecht, B., et al., Clin Infect Dis, 35 (2002) 330–3.
Cohen, B. A., Neurology, 46 (1996) 444–50.
Whitley, R. J., Jacobson, M. A., Friedberg, D. N., et al., Arch Intern. Med., 158 (1998) 957–69.
Cinque, P., Cleator, G. M., Weber, T., et al., J Neurovirol, 4 (1998) 120–32.
Anduze-Faris, B. M., Fillet, A.-M., Gozlan, J., et al., AIDS, 14 (2000) 518–24.
Kim, Y. S. and Hollander, H., Clin Infect Dis, 17 (1993) 32–7.
Cinque, P., Baldanti, F., Vago, L., et al., J Infect Dis, 171 (1995) 1603–6.
Sadler, M., Morris-Jones, S., Nelson, M., et al., AIDS, 11 (1997) 1293–4.
Seo, S. K., Regan, A., Cihlar, T., et al., Clin Infect Dis, 33 (2001) e105–9.
Anders, H. J., Weiss, N., Bogner, J. R., et al., J Infect, 36 (1998) 29–33.
Tokumoto, J. and Hollander, H., Clin Infect Dis, 17 (1993) 854–6.
Smith, I. L., Shinkai, M., Freeman, W. R., et al., J Infect Dis, 173 (1996) 1481–4.
Benson, C. A., Kaplan, J. E., Masur, H., et al., Clin Infect Dis, 40 (Suppl 3) (2005) S131–5.
Griffiths, P., Herpes, 11 (Suppl 2) (2004) 95A–103A.
Miller, G. G., Boivin, G., Dummer, J. S., et al., Clin Infect Dis, 42 (2006) e26–9.
Julin, J. E., Burik, J. H., Krivit, W., et al., Transpl Infect Dis, 4 (2002) 201–6.
Cohen, B. A., McArthur, J. C., Grohman, S., et al., AIDS, 43 (1993) 493–9.
Spector, S. A., McKinley, G. F., Lalezari, J. P., et al., N Engl J Med, 334 (1996) 1491–7.
Berman, S. M. and Kim, R. C., Am J Med, 96 (1994) 415–9.
Limaye, A. P., Corey, L., Koelle, D. M., et al., Lancet, 356 (2000) 645–9.
Hu, H., Jabs, D. A., Forman, M. S., et al., J Infect Dis, 185 (2002) 861–7.
Youle, M. S., Gazzard, B. G., Johnson, M. A., et al., AIDS, 8 (1994) 641–9.
Feinberg, J. E., Hurwitz, S., Cooper, D., et al., J Infect Dis, 177 (1998) 48–56.
Whitley, R. J., Cloud, G., Gruber, W., et al., J Infect Dis, 175 (1997) 1080–6.
Kimberlin, D. W., Lin, C.-Y., Sanchez, P. J., et al., J Pediatr, 143 (2003) 16–25.
Mookerjee, B. P. and Vogelsang, G., Bone Marrow Transplant, 20 (1997) 905–6.
Nash, P. J., Avery, R. K., Tang, W. H., et al., Am J Transplant, 4 (2004) 1200–3.
Cole, P. D., Stiles, J., Boulad, F., et al., Clin Infect Dis, 27 (1998) 653–4.
Bethge, W., Beck, R., Jahn, G., et al., Bone Marrow Transplant, 24 (1999) 1245–8.
Tiacci, E., Luppi, M., Barozzi, P., et al., Haematologica, 85 (2000) 94–7.
Benito, N., Ricart, M. J., Pumarola, T., et al., Am J Transplant, 4 (2004) 1197–9.
Singh, N. and Paterson, D. L., Transplantation, 69 (2000) 2474–9.
Yoshihara, S., Kato, R., Inoue, T., et al., Transplantation, 77 (2004) 835–8.
Novoa, L. A., Nagra, R. M., Nakawatase, T., et al., J Med Virol, 52 (1997) 301–8.
Beovic, B., Pecaric-Meglic, N., Marin, J., et al., Scand J Infect Dis, 33 (2001) 942–4.
Portolani, M., Pecorari, M., Tamassia, M. G., et al., J Med Virol, 65 (2001) 133–7.
Birnbaum, T., Padovan, C. S., Sporer, B., et al., Clin Infect Dis, 40 (2005) 887–9.
Denes, E., Magy, L., Pradeau, K., et al., Emerg Infect Dis, 10 (2004) 729–31.
Zerr, D. M., Gupta, D., Huang, M. L., et al., Clin Infect Dis, 34 (2002) 309–17.
Romero, J. R., Exp Opin Invest Drugs, 10 (2001) 369–79.
Nath, A. In Johnson, R. T., Griffin, J. W., and McArthur, J. C. (Eds.), Current therapy in neurologic disease, 7th ed., Mosby Elsevier, Philadelphia, 2006, pp. 144–54.