Diagnosis and Management Viral Encephalitis in Pediatric Patients: An Overview

Abstract

Viral encephalitis is characterized by inflammation of the brain tissue caused by viral agents and often co-exists with viral meningitis. The progression involves viruses penetrating the host's body, initially outside the central nervous system (CNS), and then navigating to the brain and spinal cord either via the bloodstream or retracing along nerve endings. The younger demographic demonstrates a higher predisposition to viral encephalitis compared to their older counterparts. In Western regions, herpes simplex encephalitis (HSE) emerges as the predominant spontaneous form of this acute inflammation. To diagnose HSE, magnetic resonance imaging (MRI) remains a cornerstone tool, further enhanced by the polymerase chain reaction (PCR) assessment to detect the virus in cerebrospinal fluid, which is considered one of the most sensitive methods to detect Viral etiologies and unlike cultures it does not require 1 to 28 days for virus detection. An integrative diagnosis melds insights from clinical, laboratory, neuroimaging, and electrophysiologic sources. Distinguishing encephalitis from other encephalopathies necessitates key markers, such as the onset of fever, cerebrospinal fluid (CSF) pleocytosis, or MRI/EEG anomalies indicative of encephalitis. The clinical presentation often includes neuropsychiatric signs, like behavioral shifts, hallucinations, and cognitive decline. PCR stands out for its ability to detect challenging microorganisms swiftly and economically. When viral encephalitis is suspected, primary interventions encompass supportive care, rectifying imbalances in electrolytes, and maintaining organ functions, along with the management of seizures. Initiating empirical acyclovir therapy at the onset of symptoms, even preceding test results, is recommended. Post-infection care, particularly for children, focuses on rehabilitation through diverse therapeutic interventions, which is vital to avoid post-discharge manifestation.