CLINICAL ASPECTS, THERAPY, AND PROPHYLAXIS OF ENCEPHALITIS

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP80-00809A000700040450-6
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 8
• Document Creation Date: December 22, 2016
• Document Release Date: October 31, 2011
• Sequence Number: 450
• Publication Date: March 4, 1952
• Content Type: REPORT

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SECtTTyvl'tVFOR1'1rI0N
CENTRAL INTELLIGENCE AGENCY
INFORMATION FROM
CLASSIPICATIdN
COUNTRY USSR
SUBJECT Scientific - Medicine, virus diseases
HOW
PUBLISHED Monthly periodical
WHERE
PUBLISHED Moscow
DATE
PUBLISHED Mar 1951
LANGUAGE Russian
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REPORT
CD NO.
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DATE DIST. 4 /V)alt 1952
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NO. OF PAGES 8
SUPPLEMENT TO
REPORT NO.
CLINICAL ASPECTS, THERAPY AND PROPHYLAXIS OF ENCEPL '?rrIS
Inflammation of the bras is called encephalitis. It may be primary or
secondary. In primary encephalitis, the inflammatory changes in the brain are
of primary origin. To this group of encephalitic diseases belong epidemic
encephalitis (Economo's~disease jncephalitis lethargica7), tick-borne (spring-
summer) encephalitis, Jnronese encephalitis, American ZS_t Louie7 encephalitis,
and others. Secondary encephalites originate as complications after a basic
infection in various common diseases; in this ca-gory of diseases belong
influenza, malaria, measles, and others.
In this report, we shall deal only with some basic forms of primary
encephalitis which are encountered most frequently.
The first cases of epidemic encephalitis were described in 1915. Since
that time, several epidemic outbreaks and sporadic cases of this type of ence-
phalitis in various countries have been described in literature.
The causative agent of epidemic encephalitic has not yet been discovered.
It apparently belongs to the group of filtrable viruses. It is assumed that the
virus of epidemic encephalitis is found in the nasopharynx. Under certain con-
ditions, the virulence (infectiousness) of the virus increases; it assumes neuro-
tropic properties and penetrates into the central nervous system. During the
cold season, the infectiousness of the virus increases and the resistance of the
organism is lowered, causing a predisposition to this disease during the fall and
winter.
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CLASSIFICATION N~ Qf-_~_ _
STATE
ARMY
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In anatomic investigations of the brains of fatalities due to epidemic ence-
phalitis, hyperemia and edema of the soft brain membranes, as well as of the brain
matter, and small point hemorrhages were found. The pathological process is loc-
alized mainly in gray matter of the brain, and the inflammation manifestations
are most sharply expressed in the basal ganglia in the midbrain, the pone, and in
the upper section of the medulla oblongata.
In the USSR, the first cases of this disease were observed in 1918. Epidemic
encephalitis affects people of any age, but the 20-30 year group is most suscep-
tible.
The manner of infection with epidemic encephalitis has not been definitely
established, but there are indications of the possibility that the infection is
transmitted directly or th"nuoh inte"mediate carriers. Cases of intrafamily or
intrahospital infection are very rare. The length of the incubation period is not
known.
Epidemic encephalitis is characterized by its highly variegated clinical pic-
ture and great diversity of symptoms. Clinically, two stages of development e!
epidemic encephalitis can be distinguished: the acute stage and the chronic age.
The disease usually starts slowly. In these cases, the patients suffer for several
days from malaise, rheumatic pains in the whole body, headacte, dizziness, noises
in the ears, lack of appetite, and lowered working capacity. During this period,
catarrhal manifestations in the upper respiratory tract are observed occasionally,
frequently suggesting grippe. The temperature is slightly raised but generall" re-
mains subfebrile. In some cases, the onset of the disease is acute, with the
temperature rising to
39 C from a state of perfect health. There is no character-
istic temperature curve for epidemic encephalitis. The basic complex of symptoms
in the acute period of the disease amounts to disturbed sleep and disturbance of the
oculomotor functions.
The disturbance of sleep shows itself by extreme sleepiness for aevcat~' weeks
or longer. In this period, the patient feels a great need for sleep. Sometimes
this excessive amount of sleep alternates with persistent insomnia. Occasionally,
a reversed rhythm of sleep is ob?A-ved, with the patients sleeping the whole day
through and being unable to fall asleen at night. One characteristic feature is
that the patients can sleep in any position and under any condition. The effect
on the oculomotor mechanism is most frequently expressed by disturbance of the
function of the muscles raising the upper eyelid. Drooping of one or both eyelids
is one of the most frequent symptoms of the acute period of the disease. The mal-
function of one of the external eye muscles leads to double vision. Double vision,
as well as disturbed sleep, are characteristic indications of the acute period of
epidemic encephalitis. In same cases, coordination of the eyes is interfered with:
disturbances of convergence and paralyses of fixation occur.
Vestibular disorder (vertigo) is among the frequent symptoms of the acute per-
iod. In some cases, involuntary spasms and compulsive movements are noted even in
the initial period of the diseas:. ('eses of encephalitis with extremely severe and
persistent pains in various parts of the body, neck, trunk, and extremities have
also been described. In children, in addition to disturbed sleep and oculomotor
functions, various d.vperkin-tic and spasti:: states are observe" In such eases,
there is also disturbance of the rhythm of breathing, myoclonia of the respiratory
muscles, and breathing tic_ expressed in compulsive coughing, sneezing and yawning.
In early childhood cases, a meningeal complex of symptoms often occurs. The spinal
fluid, both in children and in adults, is clear, flows out under somewhat increased
pressure, and in some cases contains an increased quantity of cellular elements.
In the blood, moderate leucocytosis and a decreased number of neutrophils are
observed.
The duration of the acute period varies within wide limits. Some symptoms con-
tinue for a few days, others last several months and longer.
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The course of the disease is frequently characterized by periods of improve.-
ment and aggravation. Lethal outcomes occur during the first daye or weeks of the
disease, but in a number of cases death may take place at a much later stage of the
disease. Full recovery without aftereffects is rare (up to 10 percent of all cases).
Some of the cases turn into chronic forms.
In addition to sharply expressed clinical symptoms, abortive or ambulatory
cases are frequently observed. In these cases, one or several weakly expressed
symptoms are noted, connected mainly with disturbances of the oculomotor and vesti-
bulary apparatus.
The course of the disease in these abortive forms is r-re favorable, but oc-
casionaliy it later turns into the chronic form. According to the findings of most
investigators, there is no direct relation between the gravity of manifestations in
the acute stage and further development of the disease. Very grave cases, with
strong manifestations of the failure of a number of functions during the acute per-
iod, may end in recovery, and, conversely, light and previously almost unnoticed
cases may develop into parkinsonism after a certain period of time (from 6 months
to several years). The basic features of parkinsonism are: disturbed sleep ex-
pressed in the form of sleepiness, insomnia, or inversion (sleepiness during the
day, insomnia during the night), sparse and slowed motions, rigidity of the muscula-
ture, absence of expressive coordinated movements, tremor, oculomotor malfunction,
increased salivation, and repression of mental processes. The above picture of
such patients is typical.
In p~t.ients suffering from parkinsonism, the head is usually bent low and the
face is sallow, amimic, and mask-like, with an unflickering, frozen gaze. The eyes
are involuntarily directed upward and become fixed in this position for a while.
The patient frequently stares fixedly straight ahead; there is copious flow of
saliva from the mouth. The trunk is inclined slightly forward, the arms znd hands
are bent at the elbow and at the radial wrist joints, the wrists and fingers tremble,
and the fingers perform peculiar motions suggesting pill rolling. Muscle tone is
increased; voluntary movements are slowed down, rigid, and monotonous; initial
movements are not carried out to completion. Thus, for instance, the patient takes
hold' of a spoon in order to carry it to his mouth, but fails to complete the motioq.
A new effort is required to finish the initial motion, and frequently his hand starts
to tremble just as he has lifted the spoon to his mouth, Sc' that the food is spilled.
Changing from one position to another is accomplished with difficulty.
The patient will lie for hours without moving and without changing position.
Special and often repeated commands are necessary to make the patient get up, walk,
and take nourishment. The patients walk with small steps. without swinging their
arms. Their speech is expressionless, monotonous, and irdistinct; they have dif-
ficulty pronouncing words Emotional experiences are not reflected in facial ex-
pressions. The psychic productivity is lowered; thought processes are dull and
slowed down; the mood is changeable, and a dull and depressed statc predominates. The
character and personality of the patient frequently change. The patient becomes
irritable and hard to get along with, and flies into a rage for no good reason.
Obstinacy, tenacity, and pesters-q., people with one and the same question or idea
are most characteristic indications if parkinsonism.
The change of the psyche is noted particularly in children who have gone
through epidemic encephalitis. In such cases, extraordinary mobility and restless-
pess are noted. The child bcco?nes ompletely incapable of taking part in organized
activities. His attention is attracted by all surrounding objecte, but is not held
by any of them; the child runs aimlessly around the room, is capable of striking and
spitting at people, pinches and bites, and is rude and impertinent to adults.
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The child frequently wakes up at night, and suffers from insomnia and fits
of unmotivated excitement. Sharp increase in sexual desire is also a frequent
symptom; school children and teen-agers masturbate. openly, not tathered by any-
one's presence. For such patients, disturbance of the emotional-volitional sphere
with relative retention of intellect and memory is characteristic. The psychic
change takes place in various degrees and intensities, beginning with slight
changes of behavior and ending, in rare cases, with a complete change of the
child's personality as a whole. Such children are frequently patients in psychi-
atric institutions.
The course of encephalitic parkinsonism is chronically progressive. The
prognosis, as regards recovery, is poor. There are no specific means of curing
epidemic encephalitis.
In the acute stages, as well as in case of other infections of the nervous
system, intravenous injection of a 40-percent solution of urotropin with a 40 per-
cent-solution of glucose is recommended. The intravenous injection of urotropin is
also combined with the infusion of 1-percent collargol and of 0.5-percent trypa-
flavine solution.
In a number of cases in the acute stage, a 10-percent aqueous sodium iodide
solr-ior is introduced intravenously. Such patients are also given convalescent
serum (50 cu cm intramuscularly) and autohemotherapy is applied. During the acute
period, the patients must be kept in bed
Great attention must be given to the care of these patients. In the acute per-
iod, when the patient is a bed case in the hospital, and it is essential, as in all
cases of serious illness, to maintain an atmosphere of quiet and rest around him;
loud talking, slamming of doors, rumbling noises, bustling activity, and great haste
are inadmissible. The wards should be aired several times per day. In making the
bed, care should be taken that the mattress is beaten flat, and that the sheet is
dry and not wrinkled. In the morning, thorough toilet of the mouth, nose, and ears
is essential. Once a day, the perineal region, the inguinol fold, and the sex organs
should be washed. Special attention must be given to skin care and to the preven-
tion of bedsores. The skin of the patient must be rubbed with spirits of camphor
or vodka at least twice every 24 hours. He must be placed on the bedpan and the
position changed. To prevent festering, the groin and armpits must be sprinkled
with talcum powder or smeared with vaseline.
Proper performance of the functions of the intestine and the bladder are very
important for the general condition of the patient.
Food should preferably consist of dairy and vegetable products, with sufficient
calories and a high vitamin content. It should be soft, easy to swallow, and easily
digestible. Weak patients must be fed with great care, and, to prevent exhaustion,
food must be administered to them in Small portions, with sufficient intervals
during the process of feeding. Patients who suffer from increased saliva flow, and
particularly those who soil themselves, must be given especially careful treatment.
Patients with tremor of the hands or other motor disturbances, who cannot dress
and undress themselves, must be helped in making their toilet. If the patient's
walk is impaired, care must be taken that they do not fall down. They should be
supported under the arms, especially when they walk on stairs.
In caring for patients afflicted with encephalitis, nurses should bear in mind
that the patients are badly bothered by their helplessness and worry about the
outcome of their disease. For that reason, nurses should be particularly tolerant
of them, try to divert them from their gloomy state of mind, and give them faith
in their recovery. One sho"+ld never speak of the patients' affliction in their
presence.
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In the chronic stages pf the disease, the use of a decoction of belladonna
roots, and also of scopolamine solution, gives food but not lasting results.
Subjective impro'"ement is noted in treatment by means of warm bath, showers,
ultraviolet radiation, and diathermy of the head, as well as injertions of mas-
sive doses (up to 3 cu cm at one time) of vitamin Bl. A very bereficial effect
on these patients results from general massage, therapeutic gymnastics, and
occupational therapy.
For purposes of prophylaxis persons who have become afflicted with epi-
demic encephalitis must be hospitalized. Their residence and all objects sur-
rounding them must be disinfected. During the acute period, it is also desira-
ble to disinfect the urine, feces, and other excretions of the patients with a
10-percent calcium hypochloride solution. The patient should be in isolation
until the acute period has passed. In all cases of epidemic encephalitis, an
emergency report (on a special form) should be submitted to the local health
authorities.
Far Eastern (tick-borne) encephalitis was first described in the USSR and
has been thoroughly studied by Soviet researchers (ZIl'ber, Levkovich, Chumakov,
Shubladze, Solov'yev). The ca,.sative agent of the disease belongs to the virus
group and is transmitted by ticks.
The pathological process is localized in the brain and the spinal cord.
In autopsies, definite inflammatory changes and point hemorrhages are found in
various sections of the brain and the spinal cord The rrocess is locale^ed pre-
dominantly in the anterior horns of the upper sections of the spinal cord, in the
medulla oblongata, and occasionally in the gray and white matter of the brain cor-
tex. Most. cases of the disease occur from May to August (spring-summer encepha-
litis, Tick-borne encephalitis most frequently strikes persons from 20 to 40 years old.
The incubation period lasts 12-14 drys. The acute onset is characteristic
for the disease. The temperature curve is characterized by a rapid rise, reaching
a maximum on the second day. For 2-3 days, the temperature stays high, and then
gradually goes down. Early symptoms of the disease are general malaise, severe
headache, nausea, and vomitiu5. Oh-n examination (rigidity of the back of the neck)
Kernig's and Brudzinski's symptoms are found.
The most prominent place in the clinical picture of the disease is occupied
by motor disturbances, convulsions, epilepsy-like fits, paresis, and paralysis.
One of the frequent symptoms of the acute period is disturbance of the psyche.
which is most frequently expressed by daze and sleepiness, sometimes by complete
loss of consciousness; less frequently, fits of excitement are observed. The di-
versity of the clinical manifestations depends to a large extent on the localiza-
tion of the process in the nervous system.
The fever period varies between 3-10 days in length. The motor disturbances
persist after the fever pertua; the upper humeral region is particularly affected.
In these cases, the patient cannot bold his head in a vertical position (it hangs
down passively) and the upper ext.remitiec are paretic. Sometimes, in addition to
the limp, paralyzed condition of t`.:e upper extremities, there are spastic mani-
festations in the lower extremities.
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As far as the seriousness of the disease is concerned, the following dis-
tinctions can be made:
1. Light cases, in which the fever period lasts 3-5 days, with subsequent
rapid recovery.
2. Medium serious cases, with longer duration if the acute period, and
good recovery within 1-2 months.
3. Serious cases, with a considerable percentage of fatalities; recovery is
delayed, incomplete, and persiste:it invalidism follows.
There are also galloping forms, in which death occurs within t'ie first few
days of the illness.
Tick-borne encephalitis attacks children more rarely than adults. No cases
of this disease in children less than 5 years of age have been described.
The clinical picture in children differs little from that in adults. In
children. meningeal symptoms predominate, and sometimes Kozhevnikov's epilepsy is
observed (between heavyfits there are permanent spasms of some muscle group).
In children, the course of tick-borne encephalitis is more rapid than in
adults. The temperature drops on the seventh or eighth day of illness. Just as
in the case of adults, the most frequent and permanent aftereffects are limp
paralyses of the neck and shoulder muscles.
Cases of tick-borne encephalitis have lately been reported in East and West
Siberia, in the Urals, in the Volga region, in the Karelo-Finnish SSR, in Belo-
russia, and in other places. In these regions, tick-borne encephalitis has a
much lighter aspect.
There is no specific remedy for tick-borne encephalitis. The introduction of
convalescents' serum, and also intravenous injection of 40-percent urotropin with
glucose, are recommended. Intramuscular introduction of vitamin B1 has also met
with some success. Patients must be kept in bed not only during the acute per-
iod, but for several weeks afterward.
The general ru''i of hospitalization, feeding, care of patients, and report-
ing the disease are the same as in epidemic encephalitis.
A number of authors are of the opinion that special vaccination against tick-
borne encephalitis is extremely effective, and recommend prophylactic vaccination
of that group of the population which live under conditions involving danger of ex-
posure to tick bites.
Prophylaxis against.ick-borne encephalitis should be based on a fight against
the ticks. Just before and during the season in which the d ease occurs (March to
August), widespread sanitary instruction should be given on the role of the tick
in the disease and on prophylactic measures. To prevent the ticks from penetra-
ting the body, various authors recommend wearing clothes with fasteLars on the
collar, sleeves, and legs, coating the body with 1 percent camphor or thymol oint-
ment, and impregr-ting the clothing with a water-soap emulsion containing up to
5 percent of Preparation K and with an emulsion of turpentine and lysol. A piece
of material impregnated with 15-20 percent creolip solution and worn as a scarf
is recommended. All those working in the Tayga Northern forest country should
examine their bodies, underwear, and clothes for ticks twice a day (in the middle
of the working period and after work). Ticks which have been discovered must not
be squashed with the hand; they should rather be thrown into kerosene or burned.
When a tick bite has been found, intramuscular injections of 30 to 50 cu cm of
hyperimmune serum must be made two or three times, at intervals of 5-6 days.
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Japanese (summer) encephalitis derives its name from the country where it
was first discovered. In the USSR, a disease similar to Japanese encephalitis was
first discovered in the Far East and described in 1938-39. The causative agent
of the disease also is a neurotropic virus. Japanese encephalitis is transmitted
by several kinds of mosquitoes and is a seasonal disease. It is observed in
Northern Manchuria at the end of summer, and in Primorskiy Kray in the USSR at
the beginning of fall.
The pathological process is localized mainly in the brain. Small spot hemor-
rhages are noted in the gray _.id white matter of the brain, predominantly localized
in the basal ganglia, the pons varolii, and the medulla oblongata. On the other
hand, in the spinal cord there is only slight blurring of the general appearance.
The disease usually starts with a sudden rise of temperature, from perfect
health. In rare cases, general malaise precedes the violent onset of the illness.
The temperature curve is not constant. Mostly, a sudden rise is observed, reaching
40-41? C in the first 2 days. The h._gh temperature is accompanied by rapidly accumr'a-
ting manifestations involving the nervous system. Among the most frequent and con-
stant symptoms are headache with nausea and vomiting, rigidity of the back of the
neck, and change of muscle tone. At the beginning of the illness or at its height,
paresis and paralysis of the extremities occur. In the acute period, disturbance
of the psyche is often observed. The change in thepsyche is shown by general
stupor and sleepiness; sometimes there is comilete loss of consciousness. Fre-
quently, a very strongly expressed state of excitement is noted, which requires
keeping the patient in bed by the use of force. Twilight or hallucination states
are also observed during the acute period. In such cases, the patients are rest-
less, seize something with their hands, move their fingers, or hide themselves
in fright as though pursued by horrible apparitions.
During such fits, the belt, collar, and all other confining articles of cloth-
ing must be unfastened, a pillow must be laid carefully under the head, and a knot
made in the sheet or robe and placed between the patient's jaws to prevent him
from biting his tongue. During the fits, the patient must not be weft alone and
his movements must be observed, so that he will not injure his hands or arms;
pulse and breathing must be watched.
The course of the disease is characterized by its brevity: the fever period
lasts 3-12 days. Japanese encephalitis is frequently accompanied by a high death
rate and in s=_ay cases results in lasting impairment. Full recovery takes place
only in some cases. The aftereffects are persistent headaches, paresis, and
paralysis. Some patients (more frequently children) who have survived the disease
suffer fits similar to those occurring in epilepsy. There is no specific remedy for
Japanese encephalitis.
The same treatment is used in cases of this illness as in other acute infec-
tious liseases of the nervous system. In the acute period, special attention
should be given -) general treatment strengthening the patient (%'ministration of
cardiac stimulants). Liberal drinking of liquids, subcutaneous Injection of large
quantities of glucose or physiological solution, nourishment, and thorough care
comprise the measures which should be applied and which differ in no way from those
employed in other forms of encephalitis. Prophylaxis consists of hospitalization
of the patient, disinfection of the surrounding objects, and above all, fighting
the mosquitoes and preventing their bites in infested localities, staying in the
open air on warm summer nights must be avoided. As in the case of tick-borne
encephalitis, sanitary instruction on the role of the mosquito in the disease and
on methods of fighting "'= mosquitoes should be given before the start of the
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season se. at its height (July - October). Special attention should be paid to
the destruction of larvae and winged mosquitoes, and also to individual protective
measures (use of mosquito netting, installation of canopies and special nets,
spraying of repellant solutions). Acute cases of Japanese encephalitis are
also subject to registration with the local health authorities.
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