ENCEPHALITIS

ENCEPHALITIS
• Submitted to- • Submitted by-

• Mr Nayan Paul • Ms Farah Naaz
• Clinical Instructor • M.Sc Nursing I Yr
• Medical-Surgical Nursing • Medical-Surgical Nursing
• College of Nursing • College of Nursing
• KGMU, Lucknow • KGMU, Lucknow
ENCEPHALITIS
INTRODUCTION
• Encephalitis is an inflammation of brain tissue.

• It is typically accompanied by meningeal
inﬂammation (Meningoencephalitis).
• Types of encephalitis-
1. Herpes Simplex Virus Encephalitis
2. Arthropod-Borne Virus Encephalitis
3. Fungal Encephalitis
HERPES SIMPLEX VIRUS ENCEPHALITIS
HERPES SIMPLEX VIRUS ENCEPHALITIS
• Herpes simplex virus (HSV) is the most common cause of

acute encephalitis.
• There are two herpes simplex viruses, HSV-1 and HSV-2.
• HSV-1 typically affects children and adults.
• HSV-2 most commonly affects neonates.
PATHOPHYSIOLOGY
HSV-1 (Direct spread)
Trigeminal or olfactory nerve
Virus reactivate in the brain tissue
Encephalitis
CLINICAL MANIFESTATIONS
Fever
Initial
Hallucinations symptoms Headache
Confusion
FOCAL NEUROLOGIC SYMPTOMS-
• Fever
• Headache
• Behavioural changes
• Focal seizures
• Dysphasia
• Hemiparesis
• Altered LOC
ASSESSMENT AND DIAGNOSIS
• EEG
• CSF Examination
• MRI ( for detection of early changes caused by HSV-1)
shows edema in the frontal and temporal lobes
• Lumbar Puncture reveals high opening pressure, glucose
within normal limits and high protein levels in CSF.
• Polymerase chain reaction (PCR) is the standard test for
diagnosis of HSV-1 Encephalitis. It identifies bands of HSV-
1 in the CSF. Validity of PCR is high between the 3rd and
10th days after symptom onset.
MRI SCAN IMAGE
MEDICAL MANAGEMENT
• Antiviral agents ( acyclovir or ganciclovir ) are the

medications of choice.
• Mode of action is inhibition of viral DNA replication.
• To prevent relapse, treatment should continue for upto 3
weeks.
• Slow IV administration over 1 hour to prevent
crystallization of medication in urine.
• Dose of acyclovir reduced for patients with renal
insufficiency.
NURSING MANAGEMENT
 Assessment of neurologic function

 Comfort measures to reduce headache include dimming
the lights, limiting noise and visitors and administering
analgesics.
 Opioid analgesic medications masks symptoms ; therefore,
they are used cautiously.
 Injury prevention is key in light of the potential for falls or
seizures
NURSING MANAGEMENT CONT…
• Monitoring of blood chemistry test results and urinary

output for presence of renal complications related to
antiviral therapy.
ARTHROPOD-BORNE VIRUS
ENCEPHALITIS
ARTHROPOD – BORNE VIRUS ENCEPHALITIS
• Arthropod-borne viruses or arboviruses , are maintained in nature
through biologic transmission between susceptible vertebrae
hosts by blood feeding arthropods.
• Arthropod vectors transmit several types of viruses that cause

encephalitis
• Arbovirus infection occurs in specific geographic areas during the

summer and fall. The five main types of arboviral encephalitis that
occur are LaCrosse encephalitis, West Nile encephalitis, St. Louis
encephalitis, Western equine encephalitis, and Eastern equine
encephalitis.
PATHOPHYSIOLOGY
Viral replication(site of mosquito bite)
Immune response attempts to control viral replication
Immune response inadequate (viraemia)
Virus gains access to CNS via olfactory tract
Encephalitis
• Some cases have only flu-like symptoms (i.e. headache and fever) but
others progressing to specific neurologic manifestations.
• St. Louis and West Nile virus encephalitis commonly affects adults.
 Incubation period : 5-15 days
 Onset of symptoms is abrupt with fever, headache, dizziness and
tremors.
 Coma can occur in severe cases
 Mortality increases with age.
• Seizures , poor prognostic indicator, more common in St Louis type.
• preliminary diagnosis- clinical presentation, location and dates of
recent travel.
• Neuroimaging
• CSF Evaluation
• MRI Scan – Inflammation of basal ganglia (St. Louis encephalitis)
Inflammation of periventricular area ( West Nile
encephalitis)
• Immunoglobulin M antibodies to West Nile virus observed in
serum and CSF.
• EEG
MRI SCAN IMAGE
MRI SCAN IMAGE
MEDICAL MANAGEMENT
• No specific medication.
• Symptom management is key
• Controlling the seizures and increased ICP are the major
components.
• Interferon may be useful in St. Louis encephalitis
• Neuropsychiatric complications such as emotional
outbursts and other behavioural changes , occur
frequently.
NURSING MANAGEMENT
• If the patient is very ill, hospitalization may be required.

• Assessment of neurologic status to identify the patient’s
condition
• Injury prevention is key in light of the potential for falls or
seizure
• Arboviral encephalitis may result in death or life-long
residual health issues. The family will need support and
teaching to cope with these outcomes.
• Public education addressing the prevention of arboviral

encephalitis is a key nursing role-
 Clothing that provides coverage

Insect repellants containing 25% - 30% diethyltoluamide (DEET)
Remaining indoors at dawn and dusk
Screens at home
Standing water should be removed.
Cases must be reported at local health department.
FUNGAL ENCEPHALITIS
FUNGAL ENCEPHALITIS
• Fungal infections of the CNS occur rarely in healthy people
• The presentation of fungal encephalitis is related to geographic area

and a compromised immune system .
• The common fungi found around the world that can infect the CNS
include Cryptococcus neoformans, Histoplasma capsulatum,
Aspergillus fumigatus, Blastomyces dermatiditis, and Candida
albicans. Other fungi are found only in certain regions: Coccidioides
immitis
PATHOPHYSIOLOGY
Fungal spores enter the body via inhalation
Infect lungs
Vague respiratory symptoms or pneumonitis
Fungi may enter bloodstream (fungaemia)
Fungus spreads to CNS
encephalitis
Cranial
Fever
nerve
dysfunctio Malaise
n
COMMON
SYMPTOMS
Change
in LOC Headache
Meninge
al signs
CLINICAL MANIFESTATIONS CONT…
• Other symptoms-
• Increased ICP (C. neoformans and C. immites)
• Seizures (H. capsulatum)
• Ischemic or haemorrhagic strokes ( A. fumigatus )

• History of immunosuppression associated with AIDS or

immunosuppressive medications.
• Occupational and travel history
• CSF- elevated WBC and protein levels, decreased glucose
levels.
• Neuroimaging
• MRI (study of choice)
ASSESSMENT CONT…
• Identification based on type of fungi-

• H. capsulatum and C. immitis – fungal antibodies in
serologic tests
• C. neoformans – identified in CSF fungal cultures.
• Candida – cultured from blood or CSF
• B. dermatiditis – cisternal or ventricular cultures of CSF
• A. fumigatus – lung biopsy
MEDICAL MANAGEMENT
• Antiseizure medications
• Lumbar puncture or shunting of CSF for increased ICP
• Antifungal agents
• Amphotericin B for infection that does not respond to
conventional therapy. Adverse reactions include- fever,
nausea, vomiting , anaemia, uraemia and electrolyte
abnormalities. Renal insufficiency is a serious reaction to
this drug.
MEDICAL MANAGEMENT CONT…
• Fluconazole or flucytosine may be administered orally in

conjunction with Amphotericin B as maintenance therapy.
• Side effects of fluconazole- nausea, vomiting and transient
increase in liver enzymes.
• Most adverse reaction to flucystosine is bone marrow
depression. Patients receiving flucytosine should have
leukocyte and platelet counts monitored.
NURSING MANAGEMENT
• Identification of increased ICP to ensure early control and

management.
• Administering non-opioid analgesics, limiting
environmental stimuli and positioning may optimize
patient’s comfort.
• Administering diphenhydramine ( benadryl) and
acetaminophen (Tylenol) approx. 30 mins before giving
amphotericin B may prevent flu-like side-effects.
• Monitoring levels of serum creatinine and BUN to alert

regarding renal insufficiency.
• If renal insufficiency develops, dose may be reduced.
• Providing support to patient and family to cope with

illness.
BIBLIOGRAPHY
Bare G Brenda, Smeltzer C Suzanne, “Textbook Of Medical-Surgical Nursing”,
10th edition (2004), published by Lippincott Williams and Wilkins.
Black M Joyce, Hawks Hokanson Jane, “ Textbook Of Medical Surgical

Nursing”, 7th edition (2005), published by Elsevier.
Chintamani, “Lewis’ Medical Surgical Nursing”, 1 st edition (2011), published by

Elsevier.
Hinkle H. Jenice, Cheever H.kerry, “textbook of medical-surgical nursing’ , 13 th

edition (2016), published by wolters kluver.
ASSIGNMENT
• ‘Make Nursing care plan for a patient with HSV-1

encephalitis’.
THANK YOU

ENCEPHALITIS

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ENCEPHALITIS

• Submitted to- • Submitted by-

• Encephalitis is an inflammation of brain tissue.

• Herpes simplex virus (HSV) is the most common cause of

Trigeminal or olfactory nerve

Virus reactivate in the brain tissue

• Antiviral agents ( acyclovir or ganciclovir ) are the

 Assessment of neurologic function

• Monitoring of blood chemistry test results and urinary

• Arthropod vectors transmit several types of viruses that cause

• Arbovirus infection occurs in specific geographic areas during the

Viral replication(site of mosquito bite)

Immune response attempts to control viral replication

Immune response inadequate (viraemia)

Virus gains access to CNS via olfactory tract

• If the patient is very ill, hospitalization may be required.

• Public education addressing the prevention of arboviral

 Clothing that provides coverage

• Fungal infections of the CNS occur rarely in healthy people

• The presentation of fungal encephalitis is related to geographic area

Fungal spores enter the body via inhalation

Vague respiratory symptoms or pneumonitis

Fungi may enter bloodstream (fungaemia)

Fungus spreads to CNS

• Seizures (H. capsulatum)

• Ischemic or haemorrhagic strokes ( A. fumigatus )

• History of immunosuppression associated with AIDS or

• Identification based on type of fungi-

• Fluconazole or flucytosine may be administered orally in

• Identification of increased ICP to ensure early control and

• Monitoring levels of serum creatinine and BUN to alert

• If renal insufficiency develops, dose may be reduced.

• Providing support to patient and family to cope with

Black M Joyce, Hawks Hokanson Jane, “ Textbook Of Medical Surgical

Chintamani, “Lewis’ Medical Surgical Nursing”, 1 st edition (2011), published by

Hinkle H. Jenice, Cheever H.kerry, “textbook of medical-surgical nursing’ , 13 th

• ‘Make Nursing care plan for a patient with HSV-1

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