Japanese encephalitis overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Japanese encephalitis (JE) virus is the leading cause of vaccine-preventable encephalitis in Asia and the western Pacific. For most travelers to Asia, the risk for JE is very low but varies based on destination, duration of travel, season, and activities. JE virus is maintained in a cycle involving mosquitoes and vertebrate hosts, mainly pigs and wading birds. Humans can be infected when bitten by an infected mosquito. Most human infections are asymptomatic or result in only mild symptoms. However, a small percentage of infected persons develop inflammation of the brain (encephalitis), with symptoms including sudden onset of headache, high fever, disorientation, coma, tremors and convulsions. About 1 in 4 cases are fatal. There is no specific treatment for JE. Patient management focuses on supportive care and management of complications. Steps to prevent JE include using personal protective measures to prevent mosquito bites and vaccination.

Diagnosis

Symptoms

Mild infections occur without apparent symptoms other than fever with headache. More severe infection is marked by quick onset, headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional convulsions (especially in infants) and spastic (but rarely flaccid) paralysis.

Laboratory Findings

Diagnosis is based on a combination of clinical signs and symptoms and specialized laboratory tests of blood or cerebrospinal fluid. These tests typically detect antibodies that the immune system makes against the viral infection.