JAPANESE ENCEPHALITIS

Encephalitis is an uncommon but serious condition in

which the brain becomes inflamed (swollen).

It can be life-threatening and requires urgent treatment

in hospital.
Anyone can be affected, but the very young and very old
are most at risk.

Symptoms of encephalitis

Encephalitis sometimes starts off with flu-like symptoms,

such as a high temperature and headache, but these don't
always occur.
More serious symptoms develop over hours, days or
weeks, including:
confusion or disorientation

seizures (fits)

changes in personality and behaviour

difficulty speaking

weakness or loss of movement in some parts of the

body
loss of consciousness

Dial 999 for an ambulance immediately if you or someone

else has these more serious symptoms.
Read more about the symptoms of encephalitis and how
encephalitis is diagnosed.

Causes of encephalitis
It's not always clear what causes encephalitis, but it can
be caused by:
viral infections several common viruses can spread

to the brain and cause encephalitis in rare cases,

including the herpes simplex virus (which
causes cold sores and genital herpes) and
the chickenpox virus
a problem with the immune system (the body's

defence against infection) sometimes something

goes wrong with the immune system and it
mistakenly attacks the brain, causing it to become
inflamed
bacterial or fungal infections these are much rarer

causes of encephalitis than viral infections

Some types of encephalitis are spread by mosquitoes
(such as Japanese encephalitis), ticks (such as tick-borne
encephalitis) and mammals (such as rabies).
You can't catch encephalitis from someone else.
Read more about the causes of encephalitis.

Treatments for encephalitis

Encephalitis needs to be treated in a hospital. The earlier
treatment is started, the more successful it's likely to be.
Treatment depends on the underlying cause, but may
include:
antiviral medication

steroid injections

treatments to help control the immune system

antibiotics or antifungal medication

painkillers to reduce discomfort or a fever

medication to control seizures (fits)

support with breathing, such as oxygen through a

face mask or a breathing machine (ventilator)

How long someone with encephalitis needs to stay in
hospital can range from a few days to several weeks or
even months.
Read more about how encephalitis is treated.

Recovering from encephalitis

Some people will eventually make a full recovery from
encephalitis, although this can be a long and frustrating
process.
But many people never make a full recovery and are left
with long-term problems due to damage to their brain.
Common complications include:
memory loss

frequent seizures

personality and behavioural changes

 problems with attention, concentration, planning
and problem solving
persistent tiredness

These problems can have a significant impact on the life

of the affected person, as well as their family and friends.
But help and support is available.
Read more about the complications of encephalitis.
Preventing encephalitis
It's not always possible to prevent encephalitis, but some
of the infections that cause it can be prevented with
vaccinations.
These include the:
MMR (measles, mumps and rubella) vaccine a

routine vaccination offered to all children in England

Japanese encephalitis vaccine recommended for

travellers to at-risk areas, such as parts of Asia

tick-borne encephalitis vaccine recommended for

travellers to certain parts of Europe (but not the UK)

and Asia
rabies vaccination recommended for travellers

to at-risk areas where access to medical care is likely

to be limited
Speak to your GP if you're not sure whether your
vaccinations are up to date, or you're planning to travel
abroad and don't know if you need any vaccinations.
Symptoms of encephalitis may be mild to begin with,
but can become more serious over hours or days.
Occasionally the symptoms may develop gradually over
several weeks or even months.
Early symptoms
The first symptoms of encephalitis can be similar to flu,
such as:
a high temperature (fever) of 38C (100.4F) or above

a headache

feeling and being sick

aching muscles and joints

Some people may also have a spotty or blistery rash on

their skin.
But these early symptoms don't always appear and
sometimes the first signs of encephalitis may be the more
serious symptoms listed below.
Serious symptoms
More severe symptoms develop when the brain is
affected, such as:
confusion or disorientation

drowsiness

seizures (fits)

changes in personality and behaviour, such as feeling

very agitated
difficulty speaking

weakness or loss of movement in some parts of the

body
 seeing and hearing things that aren't there
(hallucinations)
loss of sensation in certain parts of the body

involuntary eye movements, such as side-to-side eye

movement
vision problems

loss of consciousness

There may also be symptoms of meningitis, such as a

severe headache, sensitivity to bright lights, a stiff neck
and a spotty rash that doesn't fade when a glass is pressed
against it.
When to get medical advice
Dial 999 immediately to request an ambulance if you or
someone else has serious symptoms of encephalitis.
It's a medical emergency that needs to be seen in hospital
as soon as possible.
Read about how encephalitis is diagnosed and how
encephalitis is treated.
It's not always clear what causes encephalitis. When a
cause is found, it's usually an infection or a problem
with the immune system (the body's natural
defences).
Some of the main causes are outlined below.
Infections
Encephalitis can occur if an infection spreads to the
brain.
Many of the infections associated with the condition are
quite common and are usually mild. Encephalitis only
occurs in rare cases.
The condition is most often due to a virus, such as:
herpes simplex viruses, which cause cold

sores and genital herpes(this is the most common

cause of encephalitis)
the varicella zoster virus, which

causes chickenpox and shingles

measles, mumpsand rubella viruses

viruses spread by animals, such as tick-borne

encephalitis, Japanese encephalitis, rabies (and

possibly Zika virus)
Encephalitis caused by a virus is known as "viral
encephalitis". In rare cases, encephalitis is caused by
bacteria, fungi or parasites.
You can catch these infections from someone else, but
encephalitis itself isn't spread from person to person.

Problems with the immune system

The immune system protects the body from illness and
infection. When germs enter the body, the immune
system attacks them to stop them causing a serious
infection.
But very rarely something goes wrong with the immune
system and it mistakenly attacks the brain, causing
encephalitis.
This can be triggered by:
 a previous infection in another part of the body
(which usually occurs a few weeks earlier), such as
one of the infections mentioned above
a non-cancerous or cancerous growth (tumour)
somewhere in the body
a vaccination (this is very rare and the benefits of
being vaccinated far outweigh the risk of
encephalitis)
an unknown cause

Encephalitis due to a reaction to a previous infection is

known as "post-infectious encephalitis". If it's caused by a
tumour or the cause is unknown, it's called "autoimmune
encephalitis".
The symptoms of encephalitis can have a number
of possible causes, so several tests may be needed to
diagnose it.
The main tests used are outlined below.

Brain scans
A scan of the brain can help show whether you have
encephalitis or another problem such as a stroke, brain
tumour or brain aneurysm (a swelling in an artery).
The two main types of scan used are:
a CT scan several X-rays are taken from different

angles and are put together by a computer to create a

detailed image of the brain
 an MRI scan strong magnetic fields and radio
waves are used to produce a detailed image of the
brain

Lumbar puncture
A lumbar puncture is a procedure to remove some fluid
from around the spinal cord (the nerves running up the
spine) so it can be checked for signs of encephalitis.
For the procedure:
you lie on one side and bring your knees up towards

your chin
local anaesthetic is used to numb your lower back

a needle is inserted into the lower part of your

spine and a sample of fluid is removed

The sample will be checked for signs of infection or a
problem with your immune system, which are the
main causes of encephalitis.
Other tests
Several other tests may also be needed to help diagnose
encephalitis and check for an underlying cause.
These may include:
an electroencephalogram (EEG) small electrodes

are placed on your scalp, which pick up the electrical

signals from your brain and show abnormal brain
activity
tests of your blood, urine or other bodily fluids to

check for an infection

Encephalitis needs to be treated urgently. Treatment
involves tackling the underlying cause, relieving
symptoms and supporting bodily functions.
It's treated in hospital usually in an intensive care unit
(ICU), which is for people who are very ill and need extra
care.
How long someone with encephalitis needs to stay in
hospital can range from a few days to several weeks or
even months.
This depends on how well treatment works and if
any complications of encephalitis occur.
Treating the cause
If a cause of encephalitis is found, treatment to deal with
this will start immediately.
Possible treatments include:
antiviral medication used if encephalitis is caused

by the herpes simplex or chickenpox viruses; it's

usually given into a vein three times a day for two to
three weeks
steroid injections used if encephalitis is caused by a

problem with the immune system and sometimes in

cases linked to the chickenpox virus; treatment is
usually for a few days
immunoglobulin therapy medication that helps

control the immune system, which may be needed if

steroids don't help
 plasmapheresis a procedure which removes the
substances that are attacking the brain from the
blood, which may be needed if immunoglobulin
therapy doesn't help
surgery to remove abnormal growths (tumours)

done if encephalitis was triggered by a tumour

somewhere in the body
antibiotics or antifungal medication used if

encephalitis is caused by a bacterial or antifungal

infection
If there's no treatment for the underlying cause,
treatment is given to support the body, relieve
symptoms, and allow the best chance of recovery (see
below).

Other treatments
Encephalitis puts a lot of strain on the body and can
cause a range of unpleasant symptoms.
Most people need treatment to relieve these symptoms
and to support certain bodily functions until they're
feeling better.
This may involve:
fluids given into a vein to prevent dehydration

painkillers to reduce discomfort or a fever

medication to control seizures (fits)

 medication to help the person relax if they're very
agitated
oxygen given through a face mask to support the

lungs sometimes a machine called a ventilator may

be used to control breathing
medication to prevent a build-up of pressure inside

the skull
Occasionally, surgery to remove a small piece of the skull
may be needed if the pressure inside increases and
medication isn't helping.
Encephalitis is a serious condition and, although some
people will make a good recovery, it can cause
persistent problems and can be fatal.
For example, encephalitis due to the herpes simplex virus
(the most common type of encephalitis) is fatal in one
in five cases even if treated, and causes persistent
problems in around half the people who have it.
The chances of successful treatment are much better if
encephalitis is diagnosed and treated quickly.

Common complications
Long-term problems can occur after encephalitis as a
result of damage to the brain.
Some of the most common complications include:
memory problems

personality and behavioural changes

 speech and language problems
swallowing problems

repeated seizures (fits) known as epilepsy

emotional and psychological problems, such as

anxiety, depressionand mood swings

problems with attention, concentrating, planning

and problem solving

problems with balance, co-ordination and movement

persistent tiredness

These problems can have a significant impact on the life

of the affected person, as well as their family, friends and
carers.

Support and rehabilitation

Recovering from encephalitis can be a long, slow and
difficult process. Many people will never make a full
recovery.
Specialised services are available to aid recovery and help
the person adapt to any persistent problems this is
known as rehabilitation.
This may involve support from:
a neuropsychologist a specialist in brain injuries

and rehabilitation
an occupational therapist who can identify

problem areas in the person's everyday life and work

out practical solutions
 a physiotherapist who can help with movement
problems
a speech and language therapist who can help with

communication
Before leaving hospital, the health and care needs of the
affected person will be assessed and an individual care
plan drawn up to meet those needs.
This should involve a discussion with the affected person
and anyone likely to be involved in their care, such as
close family members.
See the care and support section for useful information
and advice about caring for someone, including
information that may be useful if you're new to caring.