ENCEPHALITIS Flashcards
Is an acute inflammatory process of the brain tissue
Encephalitis
Often involves the meninges-meningoencephalitis
Encephalitis
Etiology of Encephalitis
-Viral
-Tick-Borne
- Fungal
Epidemiology of Encephalitis
Japanese Encephalitis is the most common viral encephalitis outside US, occurring in Japan, SE Asia, and India
Herpes Simplex Encephalitis Causative Agent
- Herpes Simplex Virus Type-1 (HSV-1)
- Herpes Simplex Virus Type-2 (HSV-2)
Mode of Transmission of Herpes Simplex Virus Type-1 (HSV-1)
Direct contact with sores, saliva, or surfaces
Mode of Transmission of Herpes Simplex Virus Type-2 (HSV-2)
Sexual Contact
Initial Clinical Manifestations of Herpes Simplex Encephalitis
-Fever
- Headache
- Confusion
- Hallucinations
Focal Neurologic Manifestations of Herpes Simplex Encephalitis
-Behavioral Changes
- Focal seizures
- Dysphasia
- Hemiparesis
- Altered LOC
Diagnostics for Herpes Simplex Encephalitis
-CSF ANALYSIS
-Polymerase Chain Reaction (PCR)
CSF Analysis
-High opening pressure
- Glucose within normal
- High protein
Polymerase Chain Reaction (PCR)
-Standard test for early diagnosis of HSV encephalitis
- Identifies DNA bands of HSV-1 in the CSF
-Specimen: Blood or CSF
- High validity between 3rd and 10th day of symptom onset
What’s the specimen of Polymerase Chain Reaction
Blood or CSF
Standard test for early diagnosis of HSV encephalitis
Polymerase Chain Reaction
Medical Management of Herpes Simplex Encephalitis
Antiviral Therapy
*DOC: Acyclovir (Zovirax)
Ganciclovir (Cytovene)
Mechanisms of Action of Acyclovir and Ganciclovir
Inhibits viral DNA Replication
Nursing responsibilities of Antiviral drug
-Administer early in the course of disease
- Continue treatment up to 3 weeks to prevent relapse
- Administer via slow IV over 1 hour to prevent crystallization of medication in urine
Nursing Management of Herpes Simplex Encephalitis
-Provide comfort measures
*Dimming lights
* Limiting noise and visitor
* Clustering nursing care
* Administer analgesics, as ordered
-Promote injury prevention and safety (Seizure precautions)
-Monitor blood chemistries and urinary output
Leading cause of vaccine-preventable encephalitis in Asia and the western Pacific
Japanese Encephalitis
Causative Agent of Japanese Encephalitis
Japanese Encephalitis, a flavivirus
Vector of Japanese Encephalitis
mosquito-culex spp.
Mode of Transmission of Japanese Encephalitis
vector-borne
Incubation period of Japanese Encephalitis
5-15 days
Prevalence of Japanese Encephalitis
*Rural agricultural areas-rice production and flooding irrigation
* Temperate- seasonal
* Subtropics and Tropics: year-round
Initial Clinical Manifestations of Japanese Encephalitis
-Fever
- Headache
- Vomiting
Late Clinical Manifestations of Japanese Encephalitis
-Mental Status changes
- neurologic symptoms
- Weakness
- Parkinsonian syndrome
- Seizure (esp. in children)
Diagnostic Test for Japanese Encephalitis
- Virus-specific IgM antibodies
- Confirmatory neutralizing antibody testing
Specimen for Virus-specific IgM antibodies
serum or CSF
Virus-specific IgM antibodies
-Specimen: serum or CSF
- Detectable 3 to 8 days after onset of illness and persist for 30 to 90 days
Confirmatory neutralizing antibody testing
-Performed on patients with (+) JE virus IgM antibodies
-Available on CDC and few specialized reference laboratories
Medical Management of Japanese Encephalitis
-Close Observation
- Supportive Care
-Symptomatic Treatment
-Rest
- Fluids
-Analgesic, as ordered
- Antipyretics, as ordered
Rarely seen among healthy individuals
Fungal Encephalitis
Infections are related to geographical location or compromised immune system
Fungal Encephalitis
Causative Agents of Fungal Encephalitis
-Cryptococcus neoformans- exposure to bird droppings
-Blastomyces dermatitidis
-Histoplasma capsulatum
-Aspergillus fumigatus
-Candida spp.
-Coccidioides immitis
Pathophysiology of Fungal Encephalitis
- Spored enter via inhalation
- Once the spores enters via inhalation, it initially infects the lungs which leads to respiratory symptoms
- Fungi enters blood stream
- Once entered, it becomes fungemia
- Fungemia overwhelms immune system
- Fungus spreads to CNS
Clinical Manifestations of Fungal Encephalitis
-Fever
- Malaise
- Headache
- Meningeal Signs
- Changes in LOC
- Increased ICP symptoms
- Seizures (common in H. capsulatum)
-C. Neoformans is involved with specific skin lesion
Diagnostics of Fungal Encephalitis
-CSF Analysis
-Elevated WBC and protein levels
- Decreased glucose level
C. Neoformans
Mostly involved with specific skin lesion
-Lesions are mostly found on head and neck
- First present as painless papules or pustules, which then become nodules that may ulcerate
Medical Management of Fungal Encephalitis
-Anticonvulsants, if with seizure
-Repeated lumbar puncture or CSF shunting to prevent increase in ICP
It allows excess CSF that has built-up inside the skull to drain out into another part of the body
Ventriculoperitoneal (VP) Shunt
A piece of soft, flexible plastic tubing
Shunt
Antifungal Therapy for Fungal Encephalitis
*Competent immune system- given for a specific period to cure infection
*Immunocompromised- given until infection is controlled, then shifted to maintenance dosing for an indefinite period
Drugs for Fungal Encephalitis
- Amphotericin B
- Fluconazole (Diflucan) or Flucystosine (Ancobon)
Amphotericin B
-Given via IV route
- Do not give concurrently with any other drug
Side Effect of Amphotericin B
-Fever
- Nausea and Vomiting
- Anemia
- Uremia
- Electrolyte abnormalities (especially potassium and magnesium)
Nursing Management for Amphotericin B
-Diphenhydramine (Benadryl) and Paracetamol (Biogesic), as ordered 30 minutes before administration may prevent flu-like symptoms
Fluconazole (Diflucan) or Flucytosine (Ancobon)
-Given orally in conjuction with Amphotericin B as maintenance therapy
Side Effects of Fluconazole and Flucytosine
-Nausea
- Vomiting
- Transient increase in liver enzymes
For bone marrow depression
Flucytosine (Ancobon)
Nursing Management of Fluconazole and Flucytosine
Monitor leukocyte and platelet count regularly for patients receiving Flucytosine (ancobon)
