ID - Paediatric Encephalitis Flashcards
What is the most common cause of encephalitis?
Viral infection
- Herpes simplex type 1 - from cold sores
- Herpes simplex type 2 - from genital herpes, contracted in birth
Bacterial and fungi also possible but much rarer in UK
What are some other viral causes of encephalitis?
Varicella zoster
CMV
Epstein-Barr
All neonatal vaccine infections can cause it e.g. polio, mumps, rubella, measles
What is cytomegalovirus associated with?
Immunodeficiency
What is Epstein-Barr virus associated with?
Infectious mononucleosis
Enterovirus
Adenovirus
Influenza virus
How does paediatric encephalitis present?
Altered consciousness
Altered cognition
Unusual behaviour
Acute onset of focal neurological symptoms
Acute onset of focal seizures
Fever
How is paediatric encephalitis diagnosed?
LP - CSF for viral PCR
CT scan - if LP contraindicated
MRI Brain
ECG
Swabs - causative organism
HIV - all patients with encephalitis
What are the contraindications to an LP?
GCS under 9
Haemodynamically unstable
Active seizures
Post-ictal
How is paediatric encephalitis managed?
IV antivirals
Aciclovir - HSV and VZV
Ganciclovir - CMV
Repeat LP to ensure successful treatment before stopping antivirals
Aciclovir usually started empirically in suspected encephalitis until results available
Follow-up, support and rehabilitation
What are the complications of encephalitis?
- Lasting fatigue and prolonged recovery
- Change in personality
- Memory change or cognition
- Learning disability
- Headaches
- Chronic pain
- Movement disorders
- Sensory disturbance
- Seizures
- Hormonal imbalance
