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Epidemic encephalitis: clinical features, diagnosis, modern treatment methods
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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-83-84
Raikova Svetlana, 4th year student of the medical faculty
Shevchenko Petr,
Candidate of Medical Sciences, Associate Professor, SM
Karpov Sergey, Doctor of Medical Sciences, professor Potapova Irina, clinical intern Maulanberdinova Svetlana, clinical intern
Stavropol State Medical University, Russia Department of neurology, neurosurgery and medical genetics
E-mail: [email protected]
Epidemic encephalitis: clinical features, diagnosis, modern treatment methods
Abstract: Epidemic encephalitis was first described by Viennese neurologist Professor KA Economo in 1915 during an epidemic in Austria. In 1918-1926 the disease was mass distributed and enveloped in a pandemic a number of European countries. However, according to the authors [1,2,7] many etiology and pathogenesis questions, diagnosis and drug therapy are still not fully studied and this makes scientists turn to this problem again. Objective: To analyze the modern methods of diagnosis and treatment in the clinic of epidemic encephalitis.
Keywords: epidemic encephalitis, encephalitis, modern treatment methods.
The acute stage of the disease begins with fever which reaches up to 38-39 °C. In addition to fever patients have a headache, muscle pain, nausea and vomiting, and they suffer from intoxication symptoms such as weakness, lethargy, catarrhal phenomena in the upper respiratory tract. The fever period lasts about 14 days. Neurological symptoms, such as drowsiness, start developing. The patient sleeps for two — three weeks with only short periods of awakening [6]. Pathological insomnia is registered in rare cases [2]. The patient can sleep neither during the night nor during the daytime. This can cause sleep and wakefulness disorders, which means the patient is constantly sleeping during the day and is awake at night. Insomnia and pathological sleepiness can replace each other. A characteristic symptom of the acute phase of the disease is considered to be the affection of the nuclei of oculomotor nerves such as drooping eyelids, diplopia, anisocoria, vision palsy and blurred vision due to paresis of accommodation. The photoreaction of pupils to light is missing, which is the main pathognomonic symptom of epidemic lethargic encephalitis [2; 5].
The chronic stage of the disease is characterized by extrapyramidal disorders that manifest in hyperkinesis such as choreoatheto-sis, athetosis, myoclonus, eye seizures and akinetic-rigid syndrome which includes amimia, akinesia and tendency to catatonia [6].
Mental disorders such as visual, auditory and olfactory hallucinations and changes in perception can occur in the acute stage of the disease. Disorders of the cardiovascular system, hyperthermia, consciousness disorder, respiratory rate and respiratory rhythm
disorders may develop and it can lead to death due to heart and breathing failure in severe forms of the disease.
It is impossible to determine the epidemic encephalitis incubation period definitely. The acute stage lasts from 2 days to 4 months. Almost half of the cases of the acute phase is transformed into a chronic one, which is characterized by parkinsonism, slurred speech and slowness. Besides parkinsonism frequent endocrine disorders, such as infantilism, diabetes insipidus, menstrual disorders and obesity can develop. These pathological changes can cause mental disabilities, children suffer from increased aggression, eroticism, agitation [1].
Thus, it is found that the basis for diagnosis of epidemic encephalitis is a combination of sleep disorders with psychosensory disorders and symptoms of oculomotor nerves. The cerebrospi-nal fluid in the acute stage of the most patients has pleocytosis-40 cells in 1 mm and a slight increase in protein and glucose content. The blood analysis shows leukocytosis with an increase in the number of lymphocytes and eosinophils, as well as an increase in ESR [1; 2].
The diagnosis of the chronic phase of the epidemic encephalitis is based on Parkinson's syndrome, endocrine disorders of central genesis, mental disorders. Today this disease occurs rarely and develops atypically. The majority of cases happen in winter and spring. Epidemic encephalitis affects all age groups of people, including children and the elderly, but people within the age group from 20 to 40 have more risk to catch this disease. Not clear asymptomatic and
Section 7. Medical science
atypical forms play a great role in the epidemiology of this disease, which prevail over the symptomatic cases [3].
The treatment of epidemic encephalitis at any stage is inefficient and very difficult. There are no specific drugs today. If the disease is identified in the acute form, anti-viral medicine is prescribed, usually Interferon Gamma Globulin. The treatment in the chronic stage of epidemic encephalitis is done with drugs of the cholino-lytic range, mostly synthetic compounds Cyclodol or Tropatsin. It is prescribed 1 mg or 2 mg of Cyclodol 2-3 times a day. In the case of side effects such as dryness in the mouth, accommodation disorder, palpitations, dizziness the dose should be reduced. They prescribe 10-12.5 mg Tropatsin 1-2 times a day, it is possible to increase the medicine up to 20 mg if there are no side effects; the daily dose can be 20-50 or even 75 mg.
A more effective method of treatment in many cases of Parkinson's disease is taking L-Dopa, a dopamine predecessor. The drug gets into the blood-brain barrier and compensates for the lack of dopamine in the basal ganglia. The effect of L-Dopa treatment does not depend on the etiology of the disease, its duration, age or sex of patients and the severity of symptoms. The most effective treatment is using L-Dopa in combination with the previously used antiparkinsonian medicine — Cyclodol and its analogs, as well as some of the antisensitizers such as Dimedrolom, Suprastin.
L-Dopa treatment is used in a certain pattern, which provides a gradual increase in dosage, and amount of drug within a few weeks. It starts with the initial dose of 0,125 g per day with gradual increase up to 0.25 g. A good therapeutic effect is reached when using different dosages, generally starting with 2g per day and increasing the dose up to 5-6 g. per day. The drug effectiveness is
reduced when it is used long term, a patient may experience the on-off effect, when the state of stiffness is immediately replaced by the state of hypotension and hyperkinesis and vice versa. Positive results of L-DOPA treatment and its derivatives is observed in approximately 70% of patients. Some of them return to their normal life, even restart working.
In recent years a number of drugs such as Midantan and some other antidepressants are used for the treatment of patients with Parkinson's disease. But they are less effective than L-DOPA, though they can be successfully applied in a complex treatment in combination with L-Dopa, especially Midantan. For some patients, especially those suffering from hyperkinetic forms, a surgical treatment is necessary. It consists of stereotactic operations aimed at destroying mainly the ventrolateral nucleus thalamus [1; 2].
There are also different methods of surgical treatment of Parkinson's disease, in which the chemicals (Novocaine and Alcohol) destroy thalamo subcortical connections. This leads to a decrease in muscle tone and disappearance of hyperkinesis.
Conclusion: Sporadic cases of epidemic encephalitis exist nowadays. Potentially they can cause an epidemic. The causative agent of epidemic encephalitis is transmitted by droplet infection. This disease is contagious, and in each case the patient must be isolated. The treatment is symptomatic. Antiviral drugs such as De-oxyribonuclease, dehydrating agents, B vitamins and ascorbic acid are the most effective forms of the therapy in the acute phase of the disease today. Neurotrophic and neuroprotective drugs are used in the chronic form of the disease, they are also effective for the treatment of the secondary parkinsonism, symptomatic epilepsy, the correction of the endocrine and autonomic disorders.
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7. Arvind K., Deepti Sh., Rashmi K., Mohammad Z. I., Usha K. Misra, Tapan N. Dhole. An epidemic of encephalitis associated with human enterovirus B in Uttar Pradesh, India. Journal of Clinical Virology, - 2011-06-01, - Volume 51, - Issue 2, - P. 142-145.
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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-84-88
Okhunov Аlisher Оripovich, Bozaripov Soyib Jonibekovich, Sattarov Оybek Тokhirovich, Tashkent Medical Academy E-mail: [email protected]
The condition of endothelial system under nephropathy genesis
Abstract:
The aim: to define interchange condition of nitrogen oxide components in blood within different variants of nephropathy. Methods: there were used 40 rabbits of both sexes by weight 1500-2500 gr. Animals were divided into 4 groups: 1) control group — 10 intacted rabbits; 2) the first group — rabbits with chronic nephropathy; 3) the second group — rabbits with
