Viral encephalitis and bacterial encephalitis differences

Written by Zhang Hui
Neurology
Updated on September 01, 2024
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There are significant differences between viral encephalitis and bacterial encephalitis in clinical settings.

Firstly, their clinical symptoms differ; the fever in viral encephalitis is generally lower than that in bacterial encephalitis, where there may be widespread chills and persistent high fever.

From another perspective, laboratory tests also help differentiate the two. In viral encephalitis, a routine blood test shows no increase in white blood cells, mainly an increase in the proportion of lymphocytes. In contrast, bacterial encephalitis is characterized by a significant increase in white blood cells, which aids in distinguishing the two.

Furthermore, an essential diagnostic tool is the lumbar puncture, through which cerebrospinal fluid can be tested. In viral encephalitis, the white blood cell count in the cerebrospinal fluid is slightly increased; in bacterial encephalitis, it is significantly increased. The cerebrospinal fluid in viral encephalitis has a slight increase in protein content with no significant change in chloride levels; however, in bacterial encephalitis, the protein content in the cerebrospinal fluid is notably higher, and there is a significant decrease in chloride levels.

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Written by Zhang Hui
Neurology
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How is encephalitis caused?

Encephalitis generally occurs when pathogens invade the central nervous system of the brain, resulting in corresponding clinical manifestations. Patients may exhibit symptoms such as headache, fever, nausea, vomiting, and even paralysis of limbs and cognitive impairments. Patients become confused, with reduced computational and comprehension abilities. Some may also exhibit psychiatric symptoms and even experience seizures and other manifestations of epilepsy. Encephalitis is caused by pathogens, commonly viruses. Viral infections that lead to what is known as viral encephalitis can spread through the bloodstream to the brain and cause illness. Additionally, bacterial infections can also cause encephalitis. There are mainly two routes for bacterial infections: one is through bloodstream transmission leading to inflammation of the nervous system, and the other can occur directly, for example, from inflammation of the mastoids, tonsils, or cavernous sinus, where bacteria directly invade the brain, leading to the respective clinical manifestations. Furthermore, tuberculosis can also infect and cause tuberculous encephalitis, meningitis, and similar conditions.

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Written by Zhang Hui
Neurology
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How is encephalitis diagnosed?

The diagnosis of encephalitis cannot rely solely on auxiliary examinations; it must depend on the patient's medical history, clinical manifestations, and corresponding physical examination. If a patient presents with fever, headache, nausea, vomiting, and signs of nuchal rigidity upon examination, the possibility of encephalitis should be considered. Additionally, severe cases of encephalitis may exhibit seizures, cognitive changes, and personality alterations. Auxiliary examinations mainly include three types: the first type is imaging studies, primarily brain MRI, which can clearly identify the specific areas of the brain affected and determine which brain lobe is damaged. The second important examination is an electroencephalogram (EEG), which can detect diffuse slow waves, especially a significant presence of delta waves, highly indicative of encephalitis. The third important auxiliary examination is lumbar puncture for cerebrospinal fluid analysis; an increase in white blood cells and protein in the cerebrospinal fluid also suggests inflammation within the skull. Therefore, the main auxiliary examinations for encephalitis include MRI, EEG, and lumbar puncture.

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Written by Zhang Hui
Neurology
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What tests are conducted for encephalitis?

First, it is generally necessary to conduct an EEG test. This test is very convenient and non-invasive for patients. If significant slow waves are detected, encephalitis cannot be ruled out. Secondly, an MRI of the brain should be performed. If the viral encephalitis is severe, abnormal signals can be observed in areas such as the frontal lobe, temporal lobe, and hippocampus on the MRI, which are of great diagnostic reference value. Thirdly, lumbar puncture is also very important. It allows for a direct observation of the color of the cerebrospinal fluid, to monitor the pressure of the brain fluid, and to test the cerebrospinal fluid for cell count, protein, sugar, and chloride levels. These tests are very important for the diagnosis and differential diagnosis of encephalitis.

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Written by Tang Bo
Neurology
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How is a brain encephalitis puncture performed?

The encephalitis you mentioned is considered a central nervous system infection. In this case, a definitive diagnosis requires a lumbar puncture, which you referred to as a puncture. The lumbar puncture requires the patient to be in the lateral recumbent position, then the puncture is performed in the interspaces between L1-L3 or L4-L5 on the back to collect cerebrospinal fluid and conduct tests. This also allows for the examination of pathogens and pressure measurements. After the lumbar puncture, the patient needs to lie flat for six hours with a pillow removed to prevent headaches due to low cranial pressure.

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Written by Zhang Hui
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Pediatric Encephalitis Examination Items

Encephalitis in children is primarily due to a lowered immune resistance, which leads to infection by certain viruses. These viruses invade the nervous system, causing damage to neurons, resulting in symptoms such as fever, headache, nausea, and vomiting. Generally, the main tests for pediatric encephalitis include hematological tests related to bleeding, primarily involving routine blood tests, C-reactive protein, and erythrocyte sedimentation rate. These indices can reflect the inflammatory conditions inside the patient's body, helping to distinguish between viral and bacterial infections. Another very important auxiliary examination is the electroencephalogram (EEG), where pediatric encephalitis can show mild to moderate abnormalities, which is helpful for accurate diagnosis. The third examination involves performing a lumbar puncture to test the cerebrospinal fluid (CSF) for the levels of white cells, glucose, and chloride, which are crucial for diagnosing encephalitis and differentiating it from other types of encephalitis.