Encephalitis is the inflammation taking place in the brain and is often due to a viral infection. The condition is considered a serious illness although with early treatment and proper management, many do not develop long-term or residual effects following the disease. In fact, many will not manifest serious signs and could appear normal within few days. However, the disease can rarely be fatal and the most serious complications are common among the infants as well as among the elderly patients.
Main causes for encephalitis-
As described above, the commonest causes for encephalitis are the viruses and among them, herpes simplex and the vericella-zoster infections seem to be the leading causes. Apart from these viruses, arboviruses or arthropod borne viruses could also cause the same although manifestations of such viral encephalitis could be relatively mild. At the same time, both bacterial and fungal infections can also cause encephalitis although such infections are relatively rare.
Place of managing patients with encephalitis-
Following detections of the disease, these patients should ideally be managed at a facility where multidisciplinary care can be provided. These include the acute management which may sometime require intensive care treatment, follow-up care which should aim at managing complications and long-term disabilities as well as rehabilitative care where the treatment aims at re-integrating the patient back into his or her normal lifestyle as much as possible.
Acute phase management-
During the acute phase, antiviral treatment should be given as soon as possible even prior to confirming the exact diagnosis due to better outcomes when the antiviral medications are started very early. The drug of choice is most often being Acyclovir which is given intravenously although sometimes drugs such as Ganciclovir could also be used.
In the acute phase, these patients may require assistance in breathing and therefore they may have to be put on a ventilator for few days. It is more so when the patient develops a coma.
Fluid management using intravenous route is another important aspect during the acute phase of the illness to avoid dehydration which may complicate the patients’ state. Due to the increased risk of developing fits, these patients may have to be given anticonvulsant medications such as phenytoin both as a treatment as well as a preventive strategy.
Because of its inflammatory nature and the probable brain swelling that it might cause, patients with encephalitis should also receive anti-inflammatory agents such as corticosteroids to reduce the brain swelling which can cause vital brain structures to be damaged due to the increasing pressure.
Following recovering from the acute stage, the patient will have to be rehabilitated and this will most often be a long-term effort in instances where complications have set in. Thus, speech therapy to re-train the patient on how to speak and swallow, physiotherapy to bring back the muscle power if it is affected and occupational therapy which can enable a person to start his or her capacity to work on its own should be initiated at the right time.
Prognosis from encephalitis-
As mentioned in the very beginning, the fatalities associated with encephalitis is rather low and in most instances, patients will recover without any residual effect or with some minor disabilities. However, moderate to serious disabilities could also take place in a significant number of patients especially among the high risk groups such as the infants, the elderly, patients with previous neurological impairment and also among those with poor immune status.
However, it should be remembered that, having a coma does not always mean the outcome will be bad although such patients have a higher risk of meeting up with fatal outcomes.