Encephalites

Encephalitis

We had an outbreak of the coxsackie virus on the North coast last week. Umhlali Preparatory School & Dolphin Coast pre primary were closed for 2 days. The pre primay school is a few hundred meters away from us in the same street.

It set my mind off thinking about the ordeal we gone through when Anel got encephalitis.
It all started with flue symptoms, but after a week of intense headaches she was hospitalised in isolation. We had to wear masks & theatre clothes when we went into the ward to be with her. She had a sister looking only after her as they didn’t know whether the virus was contagious. The diagnosis was made that she had a virus spread to her brain. The search for which virus started, and her poor arms were poked to holes drawing more & more blood samples.
The waiting was exhausting, as the results came back, one by one negative. The me, glandualar fever, coxsackie virus and most of the terrible known viruses were also negative, and we were so relieved. On the other hand, we wanted to know what caused the encephalitis. All the possible tests were done, also where blood was grown, some for a week, 2 weeks and even 3 weeks. They were never able to tell what caused it.
During the week in hospital, they flooded her veins with antibiotics & painkillers.

She was then ready to come home. She got sick on the 2nd of May 2003, about 2 weeks into the second term of school. She wasn’t able to go to school for the whole second term. She didn’t write exams at school either. The third term, she started going back to school only half the school days. She wasn’t allowed to do any sport.
Her teachers at school was so great, and supported her, when she wasn’t feeling well. They put a bed in the deputy principal office, and she could go lie there when she felt that she couldn’t take the buzz & noice any more. There were times that her eyes were so glassy, you could almost see through them. That was how we could see that she wasn’t well.

Now this was a 15 year old girl, who was a straight A student, & she represented her province in swimming, hockey, triathlons, life saving and cross country. She was the School victrix lodorum in swimming for 6 years in a row. The school athletics victrix lodorum 2 years in a row. Suddenly she wasn’t allowed to do anything. The shock to her body caused her periods to disappear, only to start again after 2 years. She lost 10kg in a month, and was very weak. We received lots of uncalled for advice, about depression & too much stress. One afternoon, she was so dis-hearted, that I made an appointment at the specialist that treated her. We asked him straight on, whether it was caused by stress and or depression. His answer to us will always stay with me, and I have often told people the same. Stress cannot cause a virus, but the devastating consequences of the virus, can cause you to stress about your inability to achieve what came naturally before.

The end of the year Anel wrote the normal school exams, and was promoted to gr 10.
The following year she started swimming again, and also played hockey for the first team of her school. Only after 18 months, could we see the old Anel coming back, and in matric she made it through to the final rounds for kzn hockey again, although she didn’t make the team.

In 2003 there were 10 cases of encephalitis in Durban North. All the other girls lost a year of school, yet Anel managed to complete her school career in time. The staff at Northlands Girls High School were extremely helpful & understanding


What is encephalitis?
Encephalitis refers to inflammation of the brain. This may be a result of primary bacterial or viral infection, or an allergic reaction at a later stage to such an infection or to a vaccination.
This article will deal with viral encephalitis.
What causes viral encephalitis?
Viruses causing primary encephalitis may cause epidemics of the disease. These include the arboviruses, polio viruses, echoviruses or coxsackie viruses. The disease may also be sporadic, implying isolated cases, caused by viruses such as the herpes simplex virus, varicella zoster (causing chicken pox) or mumps virus.
Mosquitoes can carry arboviruses and cause encephalitis in particular areas during warm weather.
The parainfectious or post-infectious forms of encephalitis typically develop five to 10 days after the onset of a viral illness or vaccination.
Vary rarely, encephalitis occurs as a late consequence of viral infections, as may occur with measles.
Symptoms and signs of viral encephalitis
These may take three forms:
There may be no nervous system symptoms at all, with only fever and malaise present
The symptoms may be those of meningitis – fever, headache, vomiting, malaise and stiff neck and back
The symptoms may involve alteration in consciousness, personality changes, seizures and limb weakness.
How is viral encephalitis diagnosed?
Viral encephalitis must be distinguished from other infectious and non-infectious causes. The main distinction to be made is between viral and bacterial causes.
Diagnosis is usually based on examining the CSF, obtained using a procedure called a lumbar puncture. This often-uncomfortable investigation involves passing a needle into the space between the vertebrae in the spine and removing enough CSF to examine under a microscope and send for biochemical testing.
The appearance and composition of the CSF is different in viral and bacterial encephalitis.
How is viral encephalitis treated?
Generally, viruses do not respond to specific treatment. However, the herpes simplex virus, which can cause encephalitis, does respond well to treatment with acyclovir.
The patient is kept well hydrated and pain and fever are controlled.
What is the outcome of viral encephalitis?
Even very sick patients may recover completely. The acute phase of the illness lasts from a few days to a week. Recovery can be abrupt or gradual.
The disease can be complicated by salt imbalances, or problems with temperature and respiration resulting from involvement of certain parts of the brain.
Permanent neurological damage is more likely to occur in very young children, but at the same time, young children show improvement over a longer period than adults with similar infections.
When to see your doctor
Seek medical help immediately at the first signs or symptoms of encephalitis. This is particularly important if you know of cases in your area or at your child’s school.
Reviewed by Dr Andrew Rose-Innes, MD, Department of Neurology, Yale University School of Medicine, New Haven