Once JE is suspected, case should be referred to big Hospitals. Following Precautions & care must be taken while transporting the patient.
- Make the patient to lie down on the side.
- Keep the mouth cavity and nose clean. If available, use a mucous sucker to clear secretions.
- Discourage bending of Neck.
- In case of high fever, do rapid sponging of the body to reduce the temperature.
- Loud noises and bright light should be avoided.
Investigations are required to exclude pyogenic meningitis, Tuberculous meningitis, Cerebral Malaria, Hypoglycemia, dyselectrolytemia, Reye’s syndrome and other metabolic condition.
Cerebro Spinal Fluid (CSF) changes in JE
CSF is usually clear and show mild pleocytosis (100 – 1000/cmm) initially polymorphonuclear but in few days predominantly lumphocytosis. The CSF protein levels shows mild elevation. CSF sugar and chlorides remain within normal limits.
Routine investigations like CBP, ESR & CSF do not help much except to exclude pyogenic, tuberculous meningitis and cerebral malaria.
Aetiological diagnosis of JE is established by testing
Management of JE
- Acute phase serum collected early in the illness for the virus specific IgM antibodies (IgM captured Elisa) in CSF or in blood within 4–7 days.
- Demonstrating the four fold rise IgG. Antibody titres by paired, acute and convalescent sera.
- If facilities are available, the virus can be identified by PCR (Polymerase chain reaction).
The patient with JE needs early recognition of symptoms and treatment at various settings with acute neurological deterioration in patient. JE may be a life threatening event associated with diverse clinical presentation. Patients with progressive neurological signs must be quickly stabilised to avoid further injury to the brain by early recognition of the condition.
For JE, no specific therapy is available. Proper supportive and adequate nursing care are of prime importance.
Case Management Protocol of Chandipura Viral Encephalitis
A) At PHC level – Basic supportive protocol
1. Assessment of vital signs
- Airway maintenance.
- Breathing – Respiratory rate, abnormal / irregular.
- Circulation – Pulse, BP, Capillary refill time.
: HB %, Total Leucocyte Count (TLC) / Differrential Leucocyte Count (DLC), Peripheral Smear (PS) for MP.
3. Basic support
- Maintain Air way (Suction, Position – supine with head elevated by 300, Oxygen therapy by nasal catheter, by face mask, oxygen tent with flow rate of oxygen 3–5 lt. per minute.
- Ambu bag and face mask for manual resuscitation.
- Maintain nutrition – IV fluid maintenance.
- Adequate nursing care – care of eyes, mouth, skin, bladder, bowel & back.
- Paracetamol – per rectal suppository, inj. 10 mg/kg / dose or oral dose at the interval of 8 hrs.
- I.V. fluid maintenance – 100 ml/Kg. in 24 hrs.
- Anti malarial – I.V. Quinine 10 mg/kg in 10% dextrose 10 ml/kg. drip over a period of 2 hrs and repeat 8 hrly. or
- Inj. I. V. Artisunate 3 mg/kg state followed by 1.5 mg/kg OD for 3 days.
- I.V. Mannitol – 5 ml/kg single dose bolus stat. in 20 minutes and can be repeated 6 hourly for 48 hours.
- I.V. Dizepam (Only if seizure present) – 0.3 mg/kg over a period of 5 to 10 minutes if seizure recurs.
- Inj. Ampicillin – 100 mg/kg/day in 8 hrly divided doses.
- Inj Gentamycin – 5 to 7.5 mg/kg/day twice daily.
- Inj. Cirpofloxacine – 10 mg/kg/dose BD.
If necessarym early referral to nearest hospital after giving basic supportive care and while referring a referral slip with details of medication should be given with the patient.