Encephalitis and encephalitic reaction in children

Respiratory viral and bacterial infections in severe course and development of neurotoxic syndrome cause significant changes in children from the side of the central nervous system with a violation of consciousness and signs of focal lesions of the brain substance - encephalitis and encephalitic reactions.

According to clinical manifestations, it is very difficult to distinguish them. Encephalitis is characterized by a deeper lesion and clear local symptoms. What is encephalitic reaction and encephalitis in children, and we will talk in this article.

Encephalitic reactions

Encephalitic reaction is called cerebral manifestations, which develop in children against the background of toxic conditions and infectious diseases as a result of cerebral edema. Edema is caused by impaired cerebral circulation, increased permeability of the vascular wall, hypoxia (oxygen starvation of the brain substance), a shift in the acidic side of the acid-base balance in the body.

Encephalitic reactions do not have specificity, they can develop with any serious infectious disease. Most often they occur during the height of the illness, at the height of the fever. In some cases, may occur at normal temperature in the prodromal period. A distinctive feature of this syndrome is the transient nature and its short duration.

The emergence of encephalitic reaction in children is facilitated by a burdened premorbid background, functional and structural immaturity of the central nervous system:

• perinatal pathology;
• hydrocephalus;
• the propensity of the body to allergies.

Depending on the reactivity of the child's nervous system, the encephalitic reaction may end at the stage of swelling, swelling and reach reverse development, but can also cause dystrophic changes in the brain substance up to the structural defect.

Clinical manifestations of the encephalitic reaction:

• generalized convulsions - more typical for children of the first 3 years of life - may be short-lived or in the form of convulsive status;
• psychomotor agitation, impaired consciousness in the form of stunning or delirium (mental disorder with delirium, hallucinations, up to the development of coma) in older children.

With spinal puncture, an increased pressure of the cerebrospinal fluid is detected, there may be a slight increase in the protein. The prognosis is unfavorable in the development of deep coma, a decrease in muscle tone and lack of reflexes.

Encephalitis

The frequent development of encephalitis in childhood is associated with the underdevelopment of the central nervous system and the high sensitivity of the child's nervous system to intoxication.

In most cases, inflammation of the brain in children occurs with a viral infection, less often encephalitis develop against a background of purulent (bacterial) meningitis (inflammation of the meninges) or sepsis. In the course of the flow, subacute, acute and chronic encephalitis are distinguished.

For acute encephalitis is typical:

• a sudden onset;
• high fever;
• impaired consciousness;
• rave;
• convulsive syndrome;
• signs of focal lesions of the brain in the form of paresis or paralysis;
• an increase in the pressure of the cerebrospinal fluid and a change in its composition.

Encephalitis can be:

1. Primary, caused by the direct action of the pathogen on the brain tissue. Primary encephalitis includes tick-borne and mosquito encephalitis, epidemic, and also caused by herpes viruses and enteroviruses;
2. Secondary (parainfection), allergic, occurring in measles, mumps, rubella, chicken pox, or after vaccination. It does not exclude the autoimmune mechanism of the development of the process.

Encephalitis can develop in a child of any age and even during intrauterine development. Encephalitis of the fetus in the first half of pregnancy occurs with diseases of the mother and leads to congenital encephalopathy (diffuse brain damage) in the fetus. In the second half of pregnancy, the disease causes focal lesions of the brain tissue. In the newborn period, encephalitis can be caused by toxoplasma, cytomegalovirus, listeria, herpes viruses.

For encephalitis in children, polymorphism of clinical manifestations is characteristic.

Primary encephalitis

1. Epidemiological encephalitis(lethargic), the causative agent of which is still not established, can have acute and chronic course.

The main signs of the disease in acute form are:

• sleep disturbance (insuperable drowsiness, less frequent insomnia and disturbance of the rhythm of sleep);
• oculomotor disorders, eyelid drooping, double vision, strabismus, fog before the eyes, different pupil size;
• fever;
• vestibular disorders: dizziness with nausea and vomiting;
• convulsions and other neurological symptoms.

Psychosensory disorders (disturbed perception of color and shape of objects, auditory, visual, olfactory hallucinations), meningeal symptoms may be noted.

With the severity of the condition, cardiovascular and respiratory failure develop. A lethal outcome is not excluded. Currently, epidemic encephalitis is characterized by an abnormal abortive course, simulating ARVI with poorly expressed above mentioned symptoms.

When chronic form of epidemic encephalitis in children develop disorders of the psyche and intellect, pronounced maliciousness, deceit, propensity to vagrancy, theft, increased eroticism. Parkinsonism develops less often.

1. Enteroviral encephalitis: the disease can occur in the form of sporadic cases or epidemic outbreaks. It is often combined with serous meningitis. Encephalitis is manifested by gait disturbance, vestibular disorders, oculomotor disorders, uncoordinated movements.

Symptomatic reminds of epidemic encephalitis, but with a more favorable course, complete recovery and reverse development of symptoms throughout the month. Flows in children only in acute form.

1. Influenza encephalitis: children can develop on the first week or 2-3 weeks after the onset of the disease. Provoke the emergence of encephalitis can fatigue, "on the legs" carried the flu. Especially unfavorable is the combination of different types of influenza viruses or influenza virus with bacterial flora.

Clinical manifestations of influenza encephalitis are diverse, can be combined with meningeal symptoms (with the development of meningoencephalitis). Neurological symptoms depend on the localization of the lesion: the vestibular form, the cerebellar (with motor and coordination impairments) can develop.

The primary lesion of the diencephalic region is manifested by symptoms of VSD, asthenic and depressive syndrome, vascular crises. But there are also cases of brain hemispheres with paresis and paralysis, with a mental syndrome, with damage to the brainstem part of the brain and a violation of the function of the respiratory and vasomotor centers.

1. Tick-borne encephalitisis also a viral infection transmitted by bites of ixodid mites in the spring-summer season. Children can become infected by eating raw goat milk. Manifestations of the disease in children appear after 1-3 weeks.

The onset is acute, severe fever. Muscular weakness, nausea, headache are also noted. There may be epileptic seizures. Developing paralysis swallowing, paresis / paralysis of the neck and extremities. There may be erased forms with less severe symptoms.

1. Herpetic encephalitis, accounting for 10% of the number of childhood encephalitis, are characterized by extremely severe course. In newborns, the infection is generalized (sepsis develops). In addition to infectious manifestations, general cerebral symptoms (severe headache, photophobia, vomiting, neck stiffness), paresis and paralysis, seizures of epilepsy appear.

Secondary encephalitis

Varicella can have a severe course and is complicated by the development of encephalitis in a child.

They differ delayed occurrence of neurological manifestations and diffuse CNS lesion, the development of foci in the white brain substance.

1. Measles encephalitisdevelops on the 3-4 day rashes. Characteristic symptoms are impaired consciousness, seizures, the rapid appearance of paresis and paralysis. Possible the appearance of hallucinations, Parkinson's syndrome. The function of the pelvic organs is impaired. Inflammation can spread to the meninges with the development of meningoencephalitis.
2. Ventricular encephalitis:Neurological signs appear on the 3rd-8th day of the rash, but may also occur in a more distant period. Against the background of high temperature, convulsions, sensitivity disorders, vomiting appear, the consciousness and functions of the pelvic organs, there are frequent dizziness, shaky gait, trembling of the head, speech is broken up to aphasia.
3. Rubella encephalitis:neurologic symptoms appear on the 3-4th day of the rash, and may appear on the 1-15th day of the disease. Less often, encephalitis occurs even before the onset of a rash in 1-12 days, starting with a high fever. The edema of the brain leads to headache, vomiting, and loss of consciousness. Seizures are tonic-clonic (that is, in the form of twitchings and muscle tone increase). Damage to the cranial nerves, developing paresis, cerebellar disorders (violations of gait and coordination). Consciousness can be broken to varying degrees: from confusion to coma.
4. Encephalitis after DTP vaccinationdiffers in a variety of symptoms: convulsions, hallucinations, paresis / paralysis, lesions of the cranial nerves, atrophy of the optic nerves. In children, the disease is characterized by a severe course with a high risk of death. At survival the child lags behind in development, epileptic attacks can be noted.
5. Encephalitis after rabies vaccinations(against rabies after the bite of animals) often occurs at school-age children and very rarely in the first years of life. The course of the disease can be acute and subacute. Symptomatology of the disease is different: it can develop encephalomyelitis, encephalopolyradiculoneuritis. The most serious complication is the paralysis of Landry - ascending paralysis, beginning with the lower extremities.
6. Leukoencephalitisin children represent a group of diseases in which the destruction of the myelin sheath occurs, degenerative processes in nerve cells, the predominant defeat of white matter in the brain. The cause and mechanism of leukoencephalitis development have not been established.

It is believed that the trigger mechanism to the process of destruction of myelin can be the effect of various pathogens. It has been established that rubella, measles, enterovirus and herpesviruses, chlamydia and borrelia viruses can be found in the body for many years. In this case, they are able to disrupt the metabolic processes in the central nervous system, cause a chronic inflammatory process, which will lead to degenerative changes and demyelination. It is impossible to belittle the role of autoimmune processes.

At a younger age, children leukoencephalitis proceed quickly and maliciously. The manifestation of the disease is fever, convulsive syndrome (with local or generalized convulsions), spastic paresis of the upper and lower extremities, deep dementia, impaired consciousness up to coma, blindness, deafness and other severe lesions. Mortality reaches 90-100%.

At the older age the disease proceeds according to the type of pseudo-tumoral process with the development of hypertensive syndrome (increased intracranial pressure). But there are also forms with the reverse development of symptoms. In this case, relapses are not excluded.

Diagnostics

In diagnostics, in addition to examining the neurologist, hardware and laboratory methods are used:

• MRI of the brain or CT (to detect foci of inflammation in the brain);
• dopplerography of cerebral vessels;
• analysis of cerebrospinal fluid (may contain an increased number of lymphocytes, elevated levels of protein and sugar);
• ELISA blood tests for the detection of antibodies to pathogens;
• PCR of blood and cerebrospinal fluid for detection of pathogens;
• swabs from the nasopharynx for virological analysis in order to identify the pathogen.

Treatment

Treatment is carried out in a hospital.

In tick-borne encephalitis, the introduction of anti-malignant y-globulin, Ribonuclease during the fever period and 2 days after the temperature normalization is prescribed in the first 3 days of the disease. Antibiotics (benzylpenicillin, doxycycline, ceftriaxone, claforan) are administered at age dosage intravenously. The duration of the course of antibacterial drugs up to 1 month. When the process is chronicized, cefalosporin treatment courses are repeated.

Antibiotics are also used for virus-bacterial encephalitis (Cefotaxime, Meropenem, Ceftriaxone, Fortum, etc.).

In herpetic encephalitis (caused by herpes simplex viruses and shingles), encephalitis with chicken pox is prescribed antiviral drug Acyclovir.

Disintoxication therapy (intravenous drip of solutions of Reosorbilakt, Reopoliglyukin and glucose-salt solutions), diuretic preparations for removal of cerebral edema is carried out. Simultaneously, symptomatic therapy is prescribed: vitamins C, group B, neuroprotectors (Piracetam, Instenon, Ceraxon, Pantogam), anticonvulsant therapy (Seduxen, Relanium, Sodium oxybutyrate), antipyretic drugs with fever. In some cases, glucocorticosteroids with potassium preparations are prescribed.

When developing paralysis, proserine and calcium preparations are prescribed. In the case of hyperkinesis, Parcocan, Cyclodol, Levodopa are used. In the absence of the effect of conservative therapy, stereotactic operations are performed.

In order to prevent residual effects in the recovery period, physiotherapy, massage, exercise therapy are prescribed.

With secondary encephalitis (measles, rubella), active antiallergic therapy is performed. Assign corticosteroids (Prednisolone, Hydrocortisone) for up to 2-4 weeks, regardless of severity, desensitizing agents (Tavegil, Claritin, Suprastin), in high doses of vitamin C. A monthly course of nootropics and symptomatic treatment are performed.

With complications from the central nervous system for DTP vaccination, all subsequent vaccinations are canceled. In the event of convulsive seizures, anticonvulsant therapy is performed for 3 years after the cramping of seizures. Given the threat of epilepsy, the children of this group are on dispensary records.

In encephalitis, after an anti-rabies vaccination, active desensitizing therapy is performed: corticosteroids under the cover of antibiotics and potassium preparations, antihistamines (Diazolin, Suprastin, etc.), diuretics (Mannitol, Lasix, Diakarb), vitamin therapy, anticonvulsants.

Prevention

Specific prevention is carried out only against tick-borne encephalitis in the form of vaccinations. As nonspecific prophylaxis it is necessary to engage in general strengthening measures that increase the immunity of the child.

Resume for parents

Encephalitis and encephalitic reactions are serious lesions of the nervous system, which often lead to death or to severe residual effects in the form of paralysis, epileptic seizures, visual and hearing impairment, and loss of intelligence.

Separation of encephalitis and encephalitic reactions is conditional. At the slightest clinical manifestations, which allow you to suspect these diseases, you need to call an ambulance, hospitalize and treat the child. Treatment can be carried out in the neurological and infectious departments.