Author Question: Brain Infection

Dale Asks:

I have a character who ends up in a coma for three days. The character suffers from viral encephalitis which is brought on from huge amounts of stress, and I only have a little bit of info about this. I got the idea from a real life FBI profiler who went through this, but he only went into a few paragraphs of what it was like. I was wondering if you had any info about how someone would be cared for in this condition from the time of admittance to the time of release?

Jordyn Says:

brain-cellsTo start, let’s deal with what viral encephalitis is. Encephalitis is inflammation of the brain and/or spinal cord. Viral encephalitis means the infection is caused by a virus. When this type of patient presents to the ER, it may be hard to differentiate between encephalitis and meningitis. Symptoms of both encephalitis and meningitis can be fever, photophobia (sensitivity to light), headache, stiff neck, pain upon moving the neck, nausea and vomiting, and seizures. There are other symptoms as well. This is the short list.

One thing that struck me about your question is the stress aspect and why it made this FBI agent vulnerable. Stress weakens your immune system but wouldn’t be the cause of the encephalitis. There needs to be a causative agent (like a virus or bacteria) but he was likely set up to be more vulnerable by the stress he was under.

In the ER, we’ll draw blood to see if the patient’s white count and inflammatory markers are elevated. He may get a CT of the head. We absolutely will have to get a sample of spinal fluid through a lumbar puncture. Typically we have to collect a sample of the cerebrospinal fluid for testing before we give any antibiotics or antiviral therapy. Depending on the patient’s condition, it would be determined if they need admission onto a regular floor or the ICU.

If the cause of the brain infection is of a viral nature, the medical team will likely give symptomatic support as antibiotics are ineffective against viruses. There are anti-viral agents available, but this is up to the discretion of the medical team as to whether or not their use would be beneficial for the patient.

Symptomatic support in this case would be keeping the patient hydrated, controlling pain, and frequent reassessment of his neurological status.

For more information on encephalitis check out these articles here and here.

Zika Update

On November 6th, 2016, 60 Minutes did a piece on the current state of Zika infection that I found quite intriguing. A runaway infectious virus is always good fodder for a novel, but as a healthcare provider I also feel there is a public teaching component so this blog piece serves as both. What follows is taken directly from this 60 Minutes piece and I highly encourage you to watch it.

Currently, there are 30,000 diagnosed Zika cases in the United States. It is present in every state but Alaska. Most of these cases are in Puerto Rico. Of these cases, there are approximately 1000 pregnant women in the US with the virus mostly obtained from travel. Of these pregnancies, twenty-five were born with birth defects and five ended with loss of the baby.

Zika has now been identified to be transmitted three ways: mosquito bite, blood, and sex (the very first mosquito born virus to be transmitted this way.)

Zika was first discovered in Africa in 1947 where it caused regional infections for sixty years. In 2007, it popped up in the Pacific Islands which became its launching point for worldwide infection because infected people traveled from there globally.

The infection stays in the bloodstream for approximately one week. What makes that problematic is the person can be infectious but asymptomatic. People tend to be less precautious when they think they aren’t sick.

Currently, the largest concern is infection among pregnant women where Zika has been positively linked with microcephaly– a severe brain birth defect. Infection in the first trimester is most critical though Zika has been shown to cause birth defects regardless of how far the mother is along in her pregnancy. In addition to microcephaly, Zika can cause seizures, difficulty swallowing, retinal damage which could lead to blindness, and hearing loss.

Zika infection causes a range of symptoms— the most common is what feels like the flu. However, a small number of patients go on to suffer more complicating neurological problems such as inflammation of the spinal cord and Guillain-Barre syndrome.

There is a vaccine in early clinical trials. If the vaccine proves successful, it could be available in early 2018.

Many doctors encourage women to delay pregnancy until a vaccine is available— particularly if living or traveling to a region where populations of the Aedes mosquito infected with Zika are high. If pregnant and in an area where Zika is present then good mosquito control measures.

What are your thoughts on Zika? Would you get a Zika vaccine if available?