Viral Encephalitis

A recent news on 16 April 2015 shocking the community in Malaysia as a standard 5 student died with suspected H1N1 infection. However, State Education, Science, Technology, Green Technology, and Innovations committee chairman Datuk Md Yunos Husin said this was confirmed by a report issued by the Pantai Hospital that the student died of viral encephalitis, not H1N1.

Students wearing mask

What is Viral encephalitis?

Encephalitis is a general term that means inflammation of the brain. Encephalitis can occur two different ways: From direct infection of the brain, or from a previous infection that causes your immune system to attack your brain. Direct infection can be caused by many different agents, including bacteria, fungi, and viruses. 

This article will explore only viral causes of encephalitis. There are many encephalitis-causing viruses, so only causes, symptoms, and treatment related to the most common viruses will be discussed.

Encephalitis - inflammation of the brain

The symptoms of viral encephalitis include:

• High temperature
• Headache
• Sensitivity to light (photophobia)
• General malaise
• Stiff neck
• Stiff back
• Vomiting
• Changes to personality
• Confusion
• Memory loss (amnesia)
• Seizures
• Paralysis
• Coma.

General Causes

Encephalitis can result from certain viral infections passed between humans, or from contact with infected animals or insects.

Encephalitis can develop 5 to 10 days after some childhood illnesses (for example, chickenpox, measles, mumps, rubella, and polio). Fortunately, it is not common to get encephalitis after a viral illness. On rare occasions, encephalitis can occur weeks, months, or years after the initial viral infection. Vaccine programs have markedly reduced some of these diseases in the developed world.

Chickenpox

There are many viruses transmitted between humans that can lead to encephalitis. Viruses from the herpes group are familiar examples. Chickenpox, cytomegalovirus, and Epstein-Barr virus (the cause of infectious mononucleosis) are herpes viruses. All herpes viruses may cause encephalitis occasionally, but herpes simplex virus 1 is the most common culprit.

The herpes simplex virus 1 causes herpes simplex encephalitis.

Herpes simplex viruses occur throughout the world. About 90% of adults age 50 or older have been exposed to herpes simplex virus 1 at some time during their lifetime. Herpes simplex virus 1 is most commonly known for causing cold sores (fever blisters) on the lips or around the mouth area. The most common cause of non-epidemic (not affecting a large number of people at once) encephalitis in developed countries is the herpes simplex virus. About 30% of herpes encephalitis infections result from initial contact with the virus. However, 70% of encephalitis cases occur years after the first infection. This happens when virus particles that have been dormant in the brain since the initial infection become active. While it is not known what causes the herpes simplex virus to reactivate, it is thought that a weakened or suppressed immune system may play a role.

Ticks or mosquitoes spread certain encephalitis-causing viruses to people.

Insect-transmitted viruses are the most common cause of epidemic viral encephalitis in the world. Viruses that can be transmitted to humans from mosquitoes or ticks are called arboviruses. Mosquitoes and ticks acquire these viruses from feeding on an infected host. Depending on the specific virus, birds, horses, small animals, or rodents can act as hosts. After the mosquito bites an infected host, the virus multiplies inside the mosquito. When it feeds or bites again, the mosquito can transmit the virus to the person or animal it bites. 

Tick borne encephalitis

Infection and the immune system response

Once the viruses have gained access to the bloodstream, they multiply and head to the spinal cord and brain (central nervous system). Access to the brain is by blood or nerves. After breaching the blood–brain barrier, the viruses slip inside brain cells. This disrupts, damages and ultimately ruptures the infected brain cells. 

Certain viruses have a preference for different areas of the brain. For example, the herpes simplex virus likes to target the temporal lobes located over each ear. The cells of the immune system rush to the brain and start attacking the viruses. This causes the characteristic brain swelling (cerebral oedema). Both the infection and the attempts of the body to fight the infection are responsible for the symptoms of viral encephalitis.

Mosquito plays a role in spreading encephalitis

Complications

Babies, older people and people with reduced immunity are at increased risk of developing complications of viral encephalitis. Some of these complications include:

• Low blood pressure (hypotension)
• Low oxygen levels in the blood (hypoxaemia)
• Bleeding inside the brain (intracerebral haemorrhage)
• Brain damage
• Death.

Swelling of brain cause brain damage

Treatments

Unlike bacteria, viruses are difficult to treat. Antiviral medications only work on a limited number of viruses. Treatment aims to reduce the severity of the symptoms and can include:

• Hospitalization
• Antiviral medication, given intravenously, if the virus is known to be drug-sensitive (such as the herpes simplex virus)
• Intravenous administration of carbohydrate solutions to help reduce brain swelling
• Drugs, including cortico-steroids to reduce brain swelling
• Pain-killing drugs
• Drugs to prevent vomiting
• Anti-convulsive drugs
• Drugs to reduce fever, such as paracetamol
• Fluids to prevent dehydration, but not too much as this can worsen cerebral oedema (swelling of the brain).

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10 Easy Steps to Reduce Computer Vision Syndrome

With so many of us using computers at work, computer eye strain has become a major job-related complaint. Studies show that eye strain and other bothersome visual symptoms occur in 50 to 90 percent of computer workers.

Computer eye strain

These problems can range from physical fatigue, decreased productivity and increased numbers of work errors, to minor annoyances like eye twitching and red eyes.

Computer vision syndrome

Here are 10 easy steps you can take to reduce your risk of computer eye strain and other common symptoms of computer vision syndrome (CVS):

1. Get a comprehensive eye exam.

Having a routine comprehensive eye exam is the most important thing you can do to prevent or treat computer vision problems.

According to the National Institute of Occupational Safety and Health (NIOSH), computer users should have an eye exam before they start working on a computer and once a year thereafter.

Get a routine eye check-up

During your exam, be sure to tell your eye doctor how often you use a computer at work and at home. Measure how far your eyes are from your screen when you sit at your computer, and bring this measurement to your exam so your eye doctor can test your eyes at that specific working distance.

2. Use proper lighting.

Eye strain often is caused by excessively bright light either from outdoor sunlight coming in through a window or from harsh interior lighting. When you use a computer, your ambient lighting should be about half as bright as that typically found in most offices.

Proper lighting in office

Eliminate exterior light by closing drapes, shades or blinds. Reduce interior lighting by using fewer light bulbs or fluorescent tubes, or use lower intensity bulbs and tubes. If possible, position your computer monitor or screen so windows are to the side, instead of in front or behind it.

Many computer users find their eyes feel better if they can avoid working under overhead fluorescent lights. If possible, turn off the overhead fluorescent lights in your office and use floor lamps that provide indirect incandescent or halogen lighting instead.

Sometimes switching to "full spectrum" fluorescent lighting that more closely approximates the light spectrum emitted by sunlight can be more comforting for computer work than regular fluorescent tubes. But even full spectrum lighting can cause discomfort if it's too bright. Try reducing the number of fluorescent tubes installed above your computer workspace if you are bothered by overhead lighting.

3. Minimize glare.

Glare on walls and finished surfaces, as well as reflections on your computer screen also can cause computer eye strain. Consider installing an anti-glare screen on your monitor and, if possible, paint bright white walls a darker color with a matte finish.

Again, cover the windows. When outside light cannot be reduced, consider using a computer hood.

Use a computer hood to reduce glare

If you wear glasses, purchase lenses with anti-reflective (AR) coating. AR coating reduces glare by minimizing the amount of light reflecting off the front and back surfaces of your eyeglass lenses.

4. Upgrade your display.

If you have not already done so, replace your old tube-style monitor (called a cathode ray tube or CRT) with a flat-panel liquid crystal display (LCD), like those on laptop computers.

Change to LCD

LCD screens are easier on the eyes and usually have an anti-reflective surface. Old-fashioned CRT screens can cause a noticeable "flicker" of images, which is a major cause of computer eye strain. Even if this flicker is imperceptible, it still can contribute to eye strain and fatigue during computer work.

Finally, choose a relatively large display. For a desktop computer, select a display that has a diagonal screen size of at least 19 inches.

If your older monitor is causing computer eye strain, replace it with a flat-panel LCD screen that is easier on the eyes.

5. Adjust your computer display settings.

Adjusting the display settings of your computer can help reduce eye strain and fatigue. Generally, these adjustments are beneficial:

Brightness. Adjust the brightness of the display so it's approximately the same as the brightness of your surrounding workstation. As a test, look at the white background of this Web page. If it looks like a light source, it's too bright. If it seems dull and gray, it may be too dark.

LED light behind a Computer screen

Text size and contrast. Adjust the text size and contrast for comfort, especially when reading or composing long documents. Usually, black print on a white background is the best combination for comfort.

Color temperature. This is a technical term used to describe the spectrum of visible light emitted by a color display. Blue light is short-wavelength visible light that is associated with more eye strain than longer wavelength hues, such as orange and red. Reducing the color temperature of your display lowers the amount of blue light emitted by a color display for better long-term viewing comfort.

6. Blink more often.

Blinking is very important when working at a computer; blinking moistens your eyes to prevent dryness and irritation.

When working at a computer, people blink less frequently — about one-third as often as they normally do — and many blinks performed during computer work are only partial lid closures, according to studies.

Blink your eyes

Tears coating the eye evaporate more rapidly during long non-blinking phases and this can cause dry eyes. Also, the air in many office environments is dry, which can increase how quickly your tears evaporate, placing you at greater risk for dry eye problems.

If you experience dry eye symptoms, ask your eye doctor about artificial tears for use during the day.

To reduce your risk of dry eyes during computer use, try this exercise: Every 20 minutes, blink 10 times by closing your eyes as if falling asleep (very slowly). This will help to moisturizes your eyes.

7. Exercise your eyes.

Another cause of computer eye strain is focusing fatigue. To reduce your risk of tiring your eyes by constantly focusing on your screen, look away from your computer at least every 20 minutes and gaze at a distant object (at least 20 feet away) for at least 20 seconds. Some eye doctors call this the "20-20-20 rule." Looking far away relaxes the focusing muscle inside the eye to reduce fatigue.

Eye Exercises

Another exercise is to look far away at an object for 10-15 seconds, then gaze at something up close for 10-15 seconds. Then look back at the distant object. Do this 10 times. This exercise reduces the risk of your eyes' focusing ability to "lock up" (a condition called accommodative spasm) after prolonged computer work.

Both of these exercises will reduce your risk of computer eye strain. Also, remember to blink frequently during the exercises to reduce your risk of computer-related dry eye.

8. Take frequent breaks.

To reduce your risk for computer vision syndrome and neck, back and shoulder pain, take frequent breaks during your computer work day.

Many workers take only two 15-minute breaks from their computer throughout their work day. According to a recent NIOSH study, discomfort and eye strain were significantly reduced when computer workers took four additional five-minute "mini-breaks" throughout their work day. And these supplementary breaks did not reduce the workers' productivity. Data entry speed was significantly faster as a result of the extra breaks, so work output was maintained even though the workers had 20 extra minutes of break time each day.

Take a break

During your computer breaks, stand up, move about and stretch your arms, legs, back, neck and shoulders to reduce tension and muscle fatigue. Check your local bookstore or consult your fitness club for suggestions on developing a quick sequence of exercises you can perform during your breaks and after work to reduce tension in your arms, neck, shoulders and back.

9. Modify your workstation.

• If you need to look back and forth between a printed page and your computer screen, this can cause eye strain. Place written pages on a copy stand adjacent to the monitor.



Appropriate distance for computer user

• Light the copy stand properly. You may want to use a desk lamp, but make sure it doesn't shine into your eyes or onto your computer screen.
• Improper posture during computer work also contributes to computer vision syndrome. Adjust your workstation and chair to the correct height.
• Purchase ergonomic furniture to enable you to position your computer screen 20 to 24 inches from your eyes. The center of your screen should be about 10 to 15 degrees below your eyes for comfortable positioning of your head and neck.

10. Consider computer eye wear.

For the greatest comfort at your computer, you might benefit from having your eye care professional modify your eyeglasses prescription to create customized computer glasses. This is especially true if you normally wear contact lenses, which may become dry and uncomfortable during sustained computer work.

Computer glasses also are a good choice if you wear bifocals or progressive lenses, because these lenses generally are not optimal for the distance to your computer screen

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