Acute viral encephalitis in children: Treatment and prevention
- Hordur S Hardarson, MD
Hordur S Hardarson, MD
- Landspitali University Hospital
- Section Editors
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Douglas R Nordli, Jr, MD
Douglas R Nordli, Jr, MD
- Section Editor — Pediatric Neurology
- Chief of Neurology
- Children’s Hospital Los Angeles
- Vice Chair of Neurology
- USC Keck School of Medicine
Viral infection of the central nervous system (CNS) most often leads to meningitis, meningoencephalitis, or encephalitis, in descending order of frequency . Encephalitis is inflammation of the brain parenchyma, manifest by neurologic dysfunction (eg, altered mental status, behavior, or personality; motor or sensory deficits; speech or movement disorders; seizure) and evidence of CNS inflammation (eg, cerebrospinal fluid pleocytosis and/or findings consistent with encephalitis on neuroimaging or electroencephalogram) .
The treatment and prevention of viral encephalitis in children will be discussed here. The pathogenesis, etiology, clinical manifestations, and diagnosis of viral encephalitis in children are discussed separately. (See "Acute viral encephalitis in children: Pathogenesis, incidence, and etiology" and "Acute viral encephalitis in children: Clinical manifestations and diagnosis".)
Central nervous system (CNS) infections are described according to the site of infection:
●Encephalitis – Encephalitis is inflammation of the brain parenchyma and is associated with neurologic dysfunction. Characteristic clinical features include altered mental status (decreased level of consciousness, lethargy, personality change, unusual behavior), seizures, and/or focal neurologic signs, often accompanied by fever, headache, nausea, and vomiting . (See "Acute viral encephalitis in children: Clinical manifestations and diagnosis", section on 'Clinical features'.)
●Meningitis – Meningitis is inflammation of the meninges and is typically manifested by fever, headache, nausea, vomiting, photophobia, and stiff neck. (See "Viral meningitis: Clinical features and diagnosis in children", section on 'Clinical features'.)
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- OVERVIEW OF TREATMENT
- SUPPORTIVE CARE
- Management of complications
- EMPIRIC THERAPY
- Empiric acyclovir
- - Dose
- - Duration
- Empiric antibiotics
- - Bacterial meningitis
- - Rickettsial infection
- - Ehrlichiosis
- Other empiric therapy
- SPECIFIC THERAPY
- ADJUNCTIVE THERAPIES
- Neurologic sequelae
- Outcomes of specific viral pathogens
- LONG-TERM FOLLOW-UP
- PREVENTION AND CONTROL
- Primary prevention
- Infection control
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS