Encephalitis in Hyderabad: When the Brain Itself Is Under Attack — The Speed of Diagnosis Determines the Outcome

It could be. Fever with altered behaviour, confusion, unusual aggression or agitation, or unusual drowsiness requires immediate neurological assessment — not reassurance and paracetamol. Encephalitis — inflammation of the brain itself — can begin with psychiatric-type symptoms before the person’s consciousness level clearly deteriorates. Some autoimmune encephalitis types (particularly NMDA-R encephalitis) begin with what looks like acute psychiatric illness. If the behaviour change is new and accompanied by fever, or if the person develops a seizure, call 040-46324365 immediately. Do not take them to a psychiatric clinic until a neurological cause has been excluded.

Japanese encephalitis is a viral brain inflammation caused by Japanese encephalitis virus (JEV), transmitted by Culex mosquitoes that breed in rice paddies and irrigated fields. It is endemic in Telangana, Andhra Pradesh, and many other Indian states, with outbreaks typically July–November during and after the monsoon. Children and older adults are most severely affected. Symptoms: fever, headache, vomiting, then rapidly progressive confusion, seizures, movement abnormalities, and coma. Case fatality is 20–30%. The most important preventive measure: JEV vaccination is now in India’s national immunisation schedule for endemic areas. Two doses of JEV vaccine provide long-lasting protection. If your child lives in an endemic area and has not been vaccinated, please call 040-44885000 for vaccination guidance.

Anti-NMDA receptor encephalitis is an autoimmune condition — the immune system produces antibodies that attack NMDA receptors in the brain, causing encephalitis without any infectious organism. It is the most common autoimmune encephalitis. It typically affects young women (though men and children can be affected) and begins with psychiatric features (psychosis, agitation, paranoia) followed by seizures, abnormal movements, autonomic instability, and decreased consciousness. In young women, it is often triggered by an ovarian teratoma (a benign tumour). This is an important diagnosis because it is completely treatable: immunotherapy (steroids, IVIg, plasma exchange) and, when present, removal of the teratoma produce complete recovery in most patients. Without diagnosis and treatment, it is progressive and can be fatal. At KIMS, we test for anti-NMDAR antibodies in any young woman with unexplained psychiatric features and seizures. Call 040-44885000.

The essential investigations at KIMS for encephalitis: MRI brain with gadolinium (typically within hours of admission, to identify patterns — temporal lobe changes for HSV, thalamic changes for JEV, widespread cortical changes for autoimmune); lumbar puncture for CSF analysis including viral PCR panel, autoimmune antibodies, bacterial and fungal tests; blood tests including dengue, scrub typhus, and JEV serology; EEG for seizure identification; and blood for autoimmune antibody panel. In young women, pelvic MRI for teratoma. These investigations are arranged simultaneously, not sequentially, to make the diagnosis as quickly as possible. IV acyclovir is started before the results return. Call 040-46324365 urgently if the person is deteriorating.

Recovery from encephalitis depends on the cause, the severity of the acute illness, and the speed with which treatment was started. For HSV encephalitis: those treated early often achieve substantial recovery, though memory impairment (particularly of episodic memory — from temporal lobe damage) and epilepsy frequently persist. For JEV: the Parkinsonian and movement features often improve partially with time and physiotherapy, but significant neurological deficits persist in the majority of survivors. For autoimmune encephalitis: recovery is often excellent — many patients achieve complete or near-complete recovery over 6–12 months with appropriate immunotherapy, even from severe illness. At KIMS, the neurorehabilitation programme for post-encephalitis recovery includes physiotherapy, speech-language therapy, occupational therapy, neuropsychological rehabilitation, and epilepsy management. Please call 040-44885000 for a post-encephalitis review.

It depends entirely on the cause. Japanese encephalitis is transmitted by mosquito bite — it cannot be passed from person to person. Herpes simplex encephalitis is caused by reactivation of HSV-1 from latency within the patient’s own nervous system — it is not typically transmitted between people during the encephalitis episode. Scrub typhus encephalitis is transmitted by mite bites, not from person to person. Enteroviral encephalitis (EV71) is transmitted faecal-orally, mainly in young children — hand hygiene reduces risk. Autoimmune encephalitis is not infectious at all. The only encephalitis with significant person-to-person transmission concern would be rabies (extremely rare after established encephalitis). For most encephalitis types, close contacts do not require post-exposure prophylaxis, though good hand hygiene is always appropriate. Please call KIMS on 040-44885000 if you have specific concerns.