Epidemic encephalitis

Arboviruses cause epidemic encephalitis in various parts of the world.11 They are not an important cause of encephalitis in Britain, but with the increasing ease of intercontinental travel, cases are now being recognised here and the frequency is likely to increase. It is imperative therefore that a full travel and recreational history be taken from anyone suspected of neurological infection and arbovirus encephalitis should be suspected if there has been exposure to insect bites in countries known to harbour these viruses.

All these arboviruses are perpetuated by zoonoses of pathologically insignificant infection in birds and smaller vertebrates. Transmission is by an arthropod vector, such as the mosquito or tick. Replication and viraemia develop after a bite. Most people suffer only a mild systemic illness but some go on to develop encephalitis, the severity of which depends upon the strain of the virus. Clinical features are common to all, with some variation in incubation, progression, and severity. They cannot be distinguished on clinical grounds alone. There are no specific features on imaging, EEG, or in the CSF. Diagnosis is by demonstration of antibody titre rise in paired serum samples. Treatment is largely symptomatic.

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