Pediatric emergency medicine trisk 2634 2634
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CSF pleocytosis. Measles encephalitis is also less common since the advent of
widespread live immunization. The onset usually occurs during the prodromal
period or after the rash has appeared. Ataxia is the most common neurologic
abnormality, and sequelae occur in up to 30% of cases. Varicella encephalitis
occurs 2 to 9 days after the onset of the rash; severe infections are uncommon,
except in the immunosuppressed host.
HSV is a relatively common cause of sporadic encephalitis. Disease in
neonates is usually caused by perinatal transmission of HSV type 2. In previously
healthy older children and adults, encephalitis more often results from infection
with HSV type 1 and may be a complication of acute primary infection or
reactivated latent infection. Early recognition of herpes encephalitis can be
difficult, but is important because specific antiviral therapy reduces the
substantial morbidity and mortality of this disease.
TABLE 97.7
AGENTS OF VIRAL ENCEPHALITIS
Arboviruses
Eastern equine encephalitis
Western equine encephalitis
St. Louis encephalitis
Japanese encephalitis
California (LaCrosse) encephalitis
West Nile
Herpesviruses
Herpes simplex
Varicella zoster
Epstein–Barr
Cytomegalovirus
Mumps
Measles
Enteroviruses
Rabies
The arthropod-borne encephalitides including St. Louis, Western equine,
Eastern equine, and California encephalitis occur in sporadic and epidemic forms,
often in late summer or early fall, and tend to cluster in localized geographic
areas. Sequelae may be severe and mortality high, especially in Eastern equine
