Japanese encephalitis: Difference between revisions
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[[File:Japanese encephalitis distribution.jpg|thumb|Japanese encephalitis geographic distribution]] | [[File:Japanese encephalitis distribution.jpg|thumb|Japanese encephalitis geographic distribution]] | ||
*Mosquito-borne flavivirus | *Mosquito-borne flavivirus | ||
*One of the most common causes of encephalitis globally | *One of the most common causes of [[encephalitis]] globally | ||
*Highly endemic in parts of Asia and the Western Pacific | *Highly endemic in parts of Asia and the Western Pacific | ||
*Up to 70,000 cases, 15,000 deaths annually | *Up to 70,000 cases, 15,000 deaths annually | ||
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*[[SAH]] | *[[SAH]] | ||
*[[Lyme disease]] | *[[Lyme disease]] | ||
*Brain abscess | *[[Brain abscess]] | ||
*Bacterial [[endocarditis]] | *Bacterial [[endocarditis]] | ||
*Toxic / metabolic encephalopathy | *Toxic / metabolic encephalopathy | ||
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==Evaluation== | ==Evaluation== | ||
*Usually diagnosed by clinical suspicion | *Usually diagnosed by clinical suspicion | ||
*Lumbar puncture if any concern for [[HSV]], [[VZV]], or [[bacterial meningitis]] | *[[Lumbar puncture]] if any concern for [[HSV]], [[VZV]], or [[bacterial meningitis]] | ||
**Can test CSF for Japanese encephalitis | **Can test CSF for Japanese encephalitis | ||
==Management== | ==Management== | ||
*Supportive | *Supportive | ||
**IVF, electrolyte repletion antipyretics | **[[IVF]], [[electrolyte repletion]], antipyretics | ||
**Antiepileptics for seizures | **[[Antiepileptics]] for seizures | ||
**Depressed mental status may require intubation for airway protection | **Depressed mental status may require intubation for airway protection | ||
*Consider empiric [[acyclovir]] and [[antibiotics]] if HSV or bacterial causes not ruled out | *Consider empiric [[acyclovir]] and [[antibiotics]] if HSV or bacterial causes not ruled out | ||
Latest revision as of 22:36, 1 October 2019
Background
- Mosquito-borne flavivirus
- One of the most common causes of encephalitis globally
- Highly endemic in parts of Asia and the Western Pacific
- Up to 70,000 cases, 15,000 deaths annually
- Usually affects children in endemic areas, as most adults have been exposed and are immune
- Rare in tourists, as the vector Culex mosquito breeds primarily in rural rice paddies
Clinical Features
- 5-15 day incubation
- Sudden, high fever
- Headache
- Nuchal rigidity and other meningeal signs
- Seizure (especially in infants)
- Various pyramidal and extrapyramidal signs
Differential Diagnosis
- SAH
- Lyme disease
- Brain abscess
- Bacterial endocarditis
- Toxic / metabolic encephalopathy
Altered mental status and fever
- Infectious
- Sepsis
- Meningitis
- Encephalitis
- Cerebral malaria
- Brain abscess
- Other
Evaluation
- Usually diagnosed by clinical suspicion
- Lumbar puncture if any concern for HSV, VZV, or bacterial meningitis
- Can test CSF for Japanese encephalitis
Management
- Supportive
- IVF, electrolyte repletion, antipyretics
- Antiepileptics for seizures
- Depressed mental status may require intubation for airway protection
- Consider empiric acyclovir and antibiotics if HSV or bacterial causes not ruled out
Disposition
- Admit all but very mild illness
- Recovery can take months, some deficits may be permanent