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(Pediatrics in Review. 2005;26:353-363.)
© 2005 American Academy of Pediatrics

Encephalitis

Paul Lewis, MD^*
Carol A. Glaser, DVM, MD

^* Associate Professor of Pediatrics, Oregon Health and Science University; Public Health Physician, Oregon Department of Human Services, Portland, Ore
Medical Officer, Viral and Rickettsial Disease Laboratory, State of California, Richmond, Calif

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Understand the breadth of pathogens that cause encephalitis.
   
2. Describe the typical laboratory and imaging findings in encephalitis.
   
3. Discuss the challenge of making a specific etiologic diagnosis in patients who have encephalitis.
   
4. Recognize the importance of testing for treatable causes of encephalitis.
   
5. Explain the methods for diagnosing encephalitis caused by herpes simplex virus, Epstein-Barr virus, West Nile virus, influenza, rabies, enterovirus, Bartonella henselae, and Mycoplasma pneumoniae.
   

	Introduction

 
Encephalitis is a distressing illness for patients and their families. The onset often is acute, symptoms may progress rapidly, and previously healthy children become debilitated. In addition, even experienced physicians often are uncertain about the cause, appropriate therapy, and prognosis. A thorough and accurate review is difficult because the syndrome is complex and the number of etiologic agents and mimics of encephalitis are vast. Unfortunately, current knowledge of encephalitis is based largely on case reports and small series; high-quality evidence-based data are limited. Most important, the majority of cases have an unknown cause, which makes generalizations about encephalitis inherently problematic. This article focuses on encephalitis in immunocompetent children beyond the neonatal age group.

	Challenges and Definitions

 
The first challenge in discussing encephalitis is to develop practical definitions. When brain tissue is available from biopsy or autopsy, inflammatory cell infiltrate of the brain defines encephalitis. In practice, brain tissue rarely is obtained before death, and the diagnosis must be deduced from history, and physical examination plus laboratory and imaging data. This review defines encephalitis as acute central nervous system (CNS) dysfunction with radiographic or laboratory evidence of brain inflammation. CNS dysfunction includes seizures, focal neurologic findings, and alteration in mental status.

The second challenge is to determine the significance of an infectious agent found outside of the CNS in the setting of encephalitis. Many reports and series identify . . . [Full Text of this Article]

This article has been cited by other articles:

				L. J. Christie, S. Honarmand, D. F. Talkington, S. S. Gavali, C. Preas, C.-Y. Pan, S. Yagi, and C. A. Glaser Pediatric Encephalitis: What Is the Role of Mycoplasma pneumoniae? Pediatrics, August 1, 2007; 120(2): 305 - 313. [Abstract] [Full Text] [PDF]

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