Pediatric Encephalitis

What Are the Types of Encephalitis in Children?

The cause of brain inflammation determines the pediatric encephalitis type. The two most common types are:

• Infectious encephalitis typically occurs from a viral infection in the brain. Less commonly, bacteria, fungi or parasites may cause infectious encephalitis.
• Autoimmune encephalitis is a type of neuroimmune brain disorder. It occurs when your child’s immune system mistakenly attacks and damages healthy brain cells instead of keeping them healthy. 

The different types of autoimmune encephalitis include:

• Acute disseminated encephalomyelitis (ADEM): ADEM typically occurs after a child has had a viral or bacterial infection. The immune response to the infection causes severe inflammation in the brain and spinal cord.
• Anti-NMDA receptor encephalitis: This type occurs when antibodies (proteins) bind to and activate N-methyl-D-aspartate (NMDA) receptors in the brain. A child may have seizures and other neurologic problems.

What Causes Encephalitis in Children?

Encephalitis occurs when an infection or the immune system attacks the brain, causing inflammation. There are many causes of infectious encephalitis. The exact cause of autoimmune encephalitis is unclear.

Causes of Viral Encephalitis

Viruses are the most common cause of encephalitis in children. Viral infections that can cause pediatric encephalitis include:

• Chickenpox
• Cold, flu, viral pneumonia and respiratory syncytial virus (RSV)
• Enterovirus, including hand-foot-and-mouth disease
• Epstein-Barr virus and mononucleosis
• Herpes simplex virus (HSV)
• Measles, mumps and rubella
• Rabies
• West Nile virus

Causes of Bacterial Encephalitis

Bacterial infections that can cause pediatric encephalitis include:

• Bacterial pneumonia
• Lyme disease
• Meningitis
• Sinusitis (sinus infection)
• Tuberculosis (TB)

Causes of Fungal Encephalitis

Fungal infections that can cause pediatric encephalitis include:

• Cryptococcosis
• Histoplasmosis
• Yeast infections (candidiasis) 

Causes of Parasitic Encephalitis

Parasitic infections that can cause pediatric encephalitis include:

• Malaria
• Toxoplasmosis

What Are the Signs and Symptoms of Pediatric Encephalitis? 

Infectious encephalitis and autoimmune encephalitis share similar symptoms, such as fever, fatigue and headaches. These symptoms can be easy to dismiss as the flu or another illness. Seizures can also occur as the condition worsens. 

Encephalitis symptoms include:

• Behavioral or personality changes
• Confusion or memory loss
• Difficulty talking or speaking gibberish
• Fainting
• Muscle weakness or paralysis
• Nausea and vomiting
• Pee and/or poop accidents
• Sensitivity to lights and sounds
• Sleep problems
• Stiff neck

Signs of Autoimmune Encephalitis

Autoimmune encephalitis causes a more gradual onset of symptoms. However, the symptoms can quickly become severe. A child may have:

• Seizures
• Disruption of normal sleep patterns
• Hallucinations, paranoia or psychosis
• Tremors, tics or involuntary movements
• Balance problems, clumsy actions or difficulty walking
• Vision changes
• Loss of consciousness

What Are the Complications of Pediatric Encephalitis?

Encephalitis can cause long-term complications, such as:

• Behavioral changes and developmental delays
• Difficulty walking, talking, eating or completing daily tasks
• Epilepsy 

How Is Encephalitis in Children Diagnosed?

Your child’s care may start in an emergency department. Lurie Children’s emergency care teams are highly skilled at detecting signs of encephalitis in children. They work closely with Lurie Children’s pediatric neurologists to fast-track a diagnosis. Seeking care with providers who are familiar with encephalitis is key to starting treatments that minimize the risk of brain injury. 

Your child may get one or more of these diagnostic tests:

• Blood tests to check for viruses, bacteria and other infections that cause encephalitis, as well as antibodies that cause autoimmune encephalitis
• Electroencephalogram (EEG), including continuous video EEG, to monitor brain activity and seizures
• Imaging tests, including brain MRIs, to look for signs of inflammation and swelling
• Lumbar puncture (spinal tap) to look for signs of infection and inflammation in cerebrospinal (brain and spinal cord) fluid 

How Is Encephalitis Treated?

Children with encephalitis need immediate medical care. Treatments depend on the cause, type and symptoms. We immediately start IVs of antivirals for potential viral causes and antibiotics for potential bacterial infections while waiting for lab results. We get lab results within 48 hours and then modify treatments, as needed.

If your child is having repeated seizures that are difficult to control, they’ll receive care in the Lefkofsky Pediatric Intensive Care Unit (PICU). If needed, our experts will sedate your child and place a breathing tube to help them rest while they receive IV antiseizure medications. Your child will continue to receive IV antibiotics and antivirals until we have lab results.

Our initial focus is on easing inflammation that could injure the brain. Your child may need:

• Antibiotic, antiviral, antifungal or antiparasitic medication to treat infectious encephalopathy 
• Steroids and immunosuppressants to treat autoimmune encephalopathy
• Neurosurgery (in rare cases) to remove fluids and ease pressure on the brain

Other Encephalitis Therapies

Encephalitis affects every child differently. Children who need longer inpatient treatments, or who develop seizures or developmental delays, may need:

• Rehabilitative services, such as physical therapy and occupational therapy, which start while your child is in our hospital, even if they’re sedated in the PICU
• Inpatient rehabilitation with Lurie Children’s specialists and partners such as the Shirley Ryan AbilityLab
• Speech therapy to address speech impairments and feeding and swallowing problems 
• Clinical nutrition services to aid recovery, including one of the nation’s largest Ketogenic Diet Therapy Programs for children experiencing chronic, treatment-resistant seizures

What Is Lurie Children’s Approach to Caring for Children With Encephalitis?

Lurie Children’s provides an interdisciplinary approach to caring for children with encephalitis. We’re ranked among the top 10 children’s hospitals for pediatric neurology and neurosurgery by U.S. News & World Report. 

Our specialized services include:

• Dedicated team of specialists: We bring together a team of experts to aid your child’s recovery. Your child’s care team may include specialists in neurology, neurocritical care, neuroimmunology, rheumatology, infectious diseases, genetics and neurosurgery.
• Advanced seizure therapies: Lurie Children’s nationally recognized Pediatric Epilepsy Center provides high-level care. Many children benefit from our Ketogenic Diet Therapy Program, one of the largest and most comprehensive in the country. 
• Autoimmune disease care: Children with autoimmune encephalitis see experts in rheumatology and autoimmune disease. They will also receive care in our dedicated Neuroimmunology Clinic. 
• Developmental services: Our Division of Developmental and Behavioral Pediatrics helps families manage learning disabilities and behavioral issues. We offer neuropsychological testing and work with schools to ensure your child gets the educational support they need.
• Research and clinical trials: Our team of physician-scientists is active in pediatric neurology research and clinical trials. Your child may benefit from promising new therapies available at a select few centers.

Lurie Children’s Pediatric Neurocritical Care Program

Lurie Children’s Ruth D. and Ken M. Davee Pediatric Neurocritical Care Program’s interdisciplinary care team improves outcomes for children who have brain and nerve complications from critical illnesses, such as severe encephalitis. Your child benefits from advanced treatments and services designed to help them enjoy life to the fullest.

Learn more about our Neurocritical Care Program