Encephalitis (Chamki Fever): Causes, Symptoms and Diagnosis

More than 130 kids have died in Bihar of India due to Encephalitis or Chamki Fever. In this article we will explain everything you need to know about this deadly disease.

WHAT IS ENCEPHALITIS?

Encephalitis is an inflammation (swelling and irritation) of the brain. This is a rare disease and most cases are found in children, the elderly, and people with a weakened immune system due to malnutrition, HIV/AIDS, cancer, etc. The majority of cases are caused by either a viral infection or the immune system mistakenly attacking brain tissue.

SYMPTOMS OF ENCEPHALITIS

Symptoms in mild cases of encephalitis usually include:

• fever
• headache
• poor appetite
• loss of energy
• a general sick feeling

Serious cases of encephalitis can cause:

• a high fever
• severe headache
• nausea and vomiting
• stiff neck
• confusion personality changes convulsions (seizures)
• problems with speech or hearing hallucinations memory loss drowsiness
• coma

It’s harder to spot some of these symptoms in infants. Important signs to look for include: vomiting a full or bulging soft spot (fontanel), crying that doesn’t stop or that seems worse when the baby is picked up or handled, body stiffness Because encephalitis can happen during or after common viral illnesses, symptoms of these illnesses can start before encephalitis happens. But often, it appears without warning.

CAUSES OF ENCEPHALITIS?

The inflammation of brain can be caused either by an infection invading the brain (infectious encephalitis) or through the immune system attacking the brain in error (post-infectious or autoimmune encephalitis). Viruses are the most frequently identified cause of infectious encephalitis (e.g. herpes viruses, enteroviruses, West Nile, Japanese encephalitis, La Crosse, St. Louis, Western equine, Eastern equine viruses and tick-borne viruses). Any virus has the potential to produce encephalitis, but not everybody who is infected with these viruses will develop encephalitis. Very rarely, bacteria, fungi or parasites can also cause encephalitis.

Some types of autoimmune encephalitis such as acute disseminated encephalomyelitis (ADEM) are caused by infection in which case the term ‘post-infectious encephalitis’ is used. Other forms of autoimmune encephalitis are associated with finding specific antibodies in blood such as VGKC complex (anti-LGI1 and Caspr2), NMDA receptor, GAD, AMPAR and GABA antibodies. Antibodies, also called immunoglobulins, are large Y-shaped proteins which identify and help remove foreign antigens such as viruses and bacteria. The reason why these antibodies are produced by the immune system in people with autoimmune encephalitis is not known in most cases. Sometimes a tumour (benign or cancerous) may generate the antibody.

DIAGNOSIS OF ENCEPHALITIS

Most kids with encephalitis need care in a hospital, usually in an intensive care unit (ICU). Doctors will watch their blood pressure, heart rate, breathing, and body fluids to prevent further swelling of the brain. Symptoms alone often do not allow sufficient ability to distinguish between the many diseases that can mimic encephalitis. Therefore, doctors perform a variety of hospital tests such as spinal tap (lumbar puncture), brain scans (computerised tomography -CT or magnetic resonance imaging – MRI), electroencephalogram (EEG) and various blood tests. Sometimes, some of the tests cannot be taken immediately because of the patient’s medical state (e.g. patient is agitated). Nevertheless, it is important that investigations are carried out as soon as possible as prompt diagnosis reduces mortality and improves the outcomes.

Treatment of patients with encephalitis has two aims. Firstly, the patient will receive specific treatment for the cause of their encephalitis: antivirals for viral types of encephalitis (aciclovir for herpes simplex encephalitis); antibiotics for bacterial types and immunomodulatory drugs for autoimmune encephalitis (e.g. steroids, intravenous immunoglobulin, plasma exchange).

Medicines:

• Antiviral drugs can treat some forms of encephalitis, such as the type caused by the herpes simplex virus.
• Corticosteroids may be used to reduce brain swelling.
• Anticonvulsants might be given to a child having seizures.
• Over-the-counter (OTC) medicines, like acetaminophen, can help with fever and headaches.

Note: Antibiotics don’t work against viruses, so aren’t used to treat most forms of encephalitis.

Can Encephalitis Be Prevented?

Encephalitis can’t be prevented, but you can avoid the illnesses that may lead to it. Immunizations protect kids from many common childhood illnesses. So follow the immunization schedule recommended by your doctor. Kids should also avoid contact with anyone who already has encephalitis. It’s also important for everyone in your family to wash their hands well and often.