Encephalitis

What is encephalitis?

Encephalitis is inflammation (swelling) of the brain. It can happen when an infection or medical condition that affects the brain activates your immune system. The inflammation can cause a wide range of symptoms. In extreme cases, it can lead to brain damage, stroke, or even death.

What causes encephalitis?

There are different types of encephalitis, based on what the cause is. The two main types are infectious encephalitis and autoimmune encephalitis.

Infectious encephalitis is usually caused by a virus. In fact, viruses are the most common cause of encephalitis. Some of the different viruses that cause it include:

• Herpes viruses, including herpes simplex (HSV), the Epstein-Barr virus (which causes infectious mononucleosis) and the varicella-zoster virus (which causes chickenpox).
• Viruses you can get if you are bitten by an infected tick, such as tick-borne encephalitis (TBE virus) and Powassan virus.
• Viruses you can get if you are bitten by an infected mosquito, such as eastern equine encephalitis virus, West Nile virus, and La Crosse virus.
• Enteroviruses, which are a common group of viruses that mostly cause mild illness or respiratory infection. These infections usually happen in the summer and fall.

Bacteria, fungi, and parasites can also cause infectious encephalitis. But this is not common.

Autoimmune encephalitis happens when your immune system mistakenly attacks healthy brain cells. It can be triggered by conditions such as certain cancers, benign tumors, and infections. Sometimes the cause is not known.

Who is more likely to get encephalitis?

Anyone can get encephalitis, but you are more likely to get it if you:

• Have a weakened immune system, for example from having HIV or taking certain medicines. These could include medicines taken after an organ transplant, certain chemotherapy medicines, and specialized treatments for certain autoimmune diseases.
• Are a young child or older adult.
• Live in areas where there are ticks and mosquitoes that carry viruses that can cause encephalitis.

What are the symptoms of encephalitis?

The symptoms of encephalitis can vary a lot, depending on how severe it is. Many people do not have any symptoms. Others may have mild flu-like symptoms such as fever, fatigue, headache, or body aches. If encephalitis becomes more serious, it can cause:

• Severe headache
• Stiff neck
• Vomiting
• Seizures
• Behavior changes
• Drowsiness
• Muscle weakness
• Partial paralysis in your arms and legs
• Coma

Encephalitis can be dangerous in infants. Their symptoms may include:

• Fever
• Lethargy (weakness or drowsiness)
• Poor feeding
• Vomiting
• Body stiffness
• Unusual irritability or crying
• A full or bulging fontanel (the soft spot on the top of the head)

If you or your child is having symptoms of encephalitis, it's important to get medical care right away.

How is encephalitis diagnosed?

To find out if you have encephalitis, your health care provider:

• Will do a physical exam
• Will take your medical history, which includes asking about your symptoms
• May do a neurologic exam
• May order imaging tests, such as a brain CT scan or MRI
• May order an EEG (electroencephalography), which use small electric sensors to measure your brain activity
• May order blood and cerebrospinal fluid (CSF) tests

What are the treatments for encephalitis?

Most people with encephalitis will need treatment in the hospital. Depending on the cause, treatments may include antiviral medicines, antibiotics, corticosteroids, and other medicines.

For some types of encephalitis, there is no medicine to treat it. But rest, nutrition, and fluids can help your body fight the infection and relieve symptoms.

Some people may need physical, speech, and occupational therapy once the illness is under control.

Can encephalitis be prevented?

There are steps you can take to help prevent encephalitis that is caused by infections:

• Use good hygiene, including washing your hands often with soap and water.
• Don't share food, drinks, utensils, and glasses with other people.
• Get vaccines for viruses that can cause encephalitis.
• Avoid mosquito and tick bites, for example by:
  • Wearing insect repellent with DEET or another U.S. Environmental Protection Agency (EPA)-registered insect repellent. Make sure to follow the instructions for using the repellant.
  • Wearing clothes that cover your arms, legs and feet.
  • Treating your clothing and gear with products containing 0.5% permethrin before you go in grassy or woody areas.

NIH: National Institute of Neurological Disorders and Stroke

Fatty Liver Disease

What is fatty liver disease?

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Fatty liver disease is a condition in which fat builds up in your liver. There are two main types:

• Nonalcoholic fatty liver disease (NAFLD)
• Alcoholic fatty liver disease, also called alcoholic steatohepatitis

What is nonalcoholic fatty liver disease (NAFLD)?

NAFLD is a type of fatty liver disease that is not related to heavy alcohol use. There are two kinds:

• Simple fatty liver, in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not get bad enough to cause liver damage or complications.
• Nonalcoholic steatohepatitis (NASH), in which you have inflammation and liver cell damage, as well as fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer.

What is alcoholic fatty liver disease?

Alcoholic fatty liver disease is due to heavy alcohol use. Your liver breaks down most of the alcohol you drink, so it can be removed from your body. But the process of breaking it down can generate harmful substances. These substances can damage liver cells, promote inflammation, and weaken your body's natural defenses. The more alcohol that you drink, the more you damage your liver. Alcoholic fatty liver disease is the earliest stage of alcohol-related liver disease. The next stages are alcoholic hepatitis and cirrhosis.

Who is at risk for fatty liver disease?

The cause of nonalcoholic fatty liver disease (NAFLD) is unknown. Researchers do know that it is more common in people who:

• Have type 2 diabetes and prediabetes
• Have obesity
• Are middle aged or older (although children can also get it)
• Are Hispanic, followed by non-Hispanic whites. It is less common in African Americans.
• Have high levels of fats in the blood, such as cholesterol and triglycerides
• Have high blood pressure
• Take certain drugs, such as corticosteroids and some cancer drugs
• Have certain metabolic disorders, including metabolic syndrome
• Have rapid weight loss
• Have certain infections, such as hepatitis C
• Have been exposed to some toxins

NAFLD affects about 25% of people in the world. As the rates of obesity, type 2 diabetes, and high cholesterol are rising in the United States, so is the rate of NAFLD. NAFLD is the most common chronic liver disorder in the United States.

Alcoholic fatty liver disease only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time. The risk is higher for heavy drinkers who are women, have obesity, or have certain genetic mutations.

What are the symptoms of fatty liver disease?

Both NAFLD and alcoholic fatty liver disease are usually silent diseases with few or no symptoms. If you do have symptoms, you may feel tired or have discomfort in the upper right side of your abdomen.

How is fatty liver disease diagnosed?

Because there are often no symptoms, it is not easy to find fatty liver disease. Your doctor may suspect that you have it if you get abnormal results on liver tests that you had for other reasons. To make a diagnosis, your doctor will use:

• Your medical history
• A physical exam
• Various tests, including blood and imaging tests, and sometimes a biopsy

As part of the medical history, your doctor will ask about your alcohol use, to find out whether fat in your liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver (NAFLD). He or she will also ask which medicines you take, to try to determine whether a medicine is causing your NAFLD.

During the physical exam, your doctor will examine your body and check your weight and height. Your doctor will look for signs of fatty liver disease, such as:

• An enlarged liver
• Signs of cirrhosis, such as jaundice, a condition that causes your skin and whites of your eyes to turn yellow

You will likely have blood tests, including liver function tests and blood count tests. In some cases you may also have imaging tests, like those that check for fat in the liver and the stiffness of your liver. Liver stiffness can mean fibrosis, which is scarring of the liver. In some cases you may also need a liver biopsy to confirm the diagnosis, and to check how bad the liver damage is.

What are the treatments for fatty liver disease?

Doctors recommend weight loss for nonalcoholic fatty liver. Weight loss can reduce fat in the liver, inflammation, and fibrosis. If your doctor thinks that a certain medicine is the cause of your NAFLD, you should stop taking that medicine. But check with your doctor before stopping the medicine. You may need to get off the medicine gradually, and you might need to switch to another medicine instead.

There are no medicines that have been approved to treat NAFLD. Studies are investigating whether a certain diabetes medicine or Vitamin E can help, but more studies are needed.

The most important part of treating alcohol-related fatty liver disease is to stop drinking alcohol. If you need help doing that, you may want to see a therapist or participate in an alcohol recovery program. There are also medicines that can help, either by reducing your cravings or making you feel sick if you drink alcohol.

Both alcoholic fatty liver disease and one type of nonalcoholic fatty liver disease (nonalcoholic steatohepatitis) can lead to cirrhosis. Doctors can treat the health problems caused by cirrhosis with medicines, operations, and other medical procedures. If the cirrhosis leads to liver failure, you may need a liver transplant.

What are some lifestyle changes that can help with fatty liver disease?

If you have any of the types of fatty liver disease, there are some lifestyle changes that can help:

• Eat a healthy diet, limiting salt and sugar, plus eating lots of fruits, vegetables, and whole grains
• Get vaccinations for hepatitis A and B, the flu and pneumococcal disease. If you get hepatitis A or B along with fatty liver, it is more likely to lead to liver failure. People with chronic liver disease are more likely to get infections, so the other two vaccinations are also important.
• Get regular exercise, which can help you lose weight and reduce fat in the liver
• Talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices. Some herbal remedies can damage your liver.

Giant Cell Arteritis

Giant cell arteritis is a disorder that causes inflammation of your arteries, usually in the scalp, neck, and arms. It narrows the arteries, which keeps blood from flowing well. Giant cell arteritis often occurs with another disorder called polymyalgia rheumatica. Both are more common in women than in men. They almost always affect people over the age of 50.

Early symptoms of giant cell arteritis resemble the flu: fatigue, loss of appetite, and fever. Other symptoms include:

• Headaches
• Pain and tenderness over the temples
• Double vision or visual loss, dizziness
• Problems with coordination and balance
• Pain in your jaw and tongue

Your doctor will make the diagnosis based on your medical history, symptoms, and a physical exam. There is no specific test for giant cell arteritis, but you may have tests that measure inflammation.

Treatment is usually with corticosteroids. Early treatment is important; otherwise there is a risk of permanent vision loss or stroke. However, when properly treated, giant cell arteritis rarely comes back.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Health Fraud

Health fraud scams involve selling medicines, supplements, devices, foods, or cosmetics that have not been proven effective. At best, these scams don't work. At worst, they're dangerous. They also waste money and might keep you from getting the treatment you really need.

Some of the possible dangers of scam products are that they could:

• Be contaminated from being made in unclean facilities or without proper quality control
• Contain harmful ingredients that are not listed on the label
• Trigger a harmful interaction with medicines you are taking
• Cause serious, even life-threatening, injuries

Health fraud scams can be found everywhere, promising help for many common health issues, including weight loss, memory loss, sexual performance, and joint pain. They target people with serious conditions such as cancer, diabetes, heart disease, HIV, and Alzheimer's disease.

Just remember - if it sounds too good to be true, it's probably a scam. Some red flags to watch for are product claims that:

• Have personal testimonials by "real" people or "doctors" played by actors claiming amazing results.
• Say that the product can treat or cure a wide range of unrelated diseases. No one product can treat or cure many different illnesses.
• Mention conspiracy theories like "This is the cure our government and Big Pharma don't want you to know about."
• Include phrases such as:
  • Ancient remedy
  • Miracle cure
  • No-risk money back guarantee
  • Natural cure
  • Quick fix
  • Secret ingredient
  • Scientific breakthrough
• Use scientific-sounding terms that don't make sense for the products, such as "molecule multiplicity."
• Refer to prestigious prizes, for example "Nobel Prize winning technology."

Before taking an unproven or little-known product, talk to your health care provider, especially if you are taking any prescription medicines.

Food and Drug Administration

HIV

What is HIV?

HIV stands for human immunodeficiency virus. HIV harms your immune system by destroying a type of white blood cell that helps your body fight infection. This puts you at risk for other infections and diseases.

What is AIDS?

AIDS stands for acquired immunodeficiency syndrome. It is the final stage of infection with HIV. It happens when the body's immune system is badly damaged because of the virus. Not everyone with HIV develops AIDS.

How does HIV spread?

HIV is spread through certain body fluids from a person who has HIV. This can happen:

• By having unprotected vaginal or anal sex with a person who has HIV. "Unprotected" means not using condoms or medicine to treat or prevent HIV. This is the most common way that it spreads.
• By sharing drug needles.
• Through contact with the blood of a person with HIV.
• From mother to baby during pregnancy, childbirth, or breastfeeding.

Who is at risk for HIV infection?

Anyone can get HIV, but certain groups have a higher risk of getting it:

• People who have another sexually transmitted infection (STI). Having an STI can increase your risk of getting or spreading HIV.
• People who inject drugs with shared needles.
• Gay and bisexual men.
• Black/African Americans and Hispanic/Latino Americans. They make up a higher proportion of new HIV diagnoses and people with HIV, compared to other races and ethnicities.
• People who engage in risky sexual behaviors, such as not using condoms or medicine to prevent or treat HIV.

Factors such as stigma, discrimination, income, education, and geographic region can also affect people's risk for HIV.

What are the symptoms of HIV?

The first signs of HIV infection may be flu-like symptoms:

• Fever
• Chills
• Rash
• Night sweats (heavy sweating during sleep)
• Muscle aches
• Sore throat
• Fatigue
• Swollen lymph nodes
• Mouth ulcers

These symptoms may come and go within two to four weeks. This stage is called acute HIV infection.

If the infection is not treated, it becomes chronic HIV infection. Often, there are no symptoms during this stage. If it is not treated, eventually the virus will weaken your body's immune system. Then the infection will progress to AIDS. This is the late stage of HIV infection. Because your immune system is badly damaged, your body cannot fight off other infections, called opportunistic infections (OIs). OIs are infections that happen more frequently or are more severe in people who have weakened immune systems.

Some people may not feel sick during the earlier stages of HIV infection. So the only way to know for sure whether you have HIV is to get tested.

How do I know if I have HIV?

A blood test can tell if you have HIV infection. Your health care provider can do the test, or you can use a home testing kit. You can also use the CDC Testing Locator to find free testing sites.

What are the treatments for HIV?

There is no cure for HIV infection, but it can be treated with medicines. This is called antiretroviral therapy (ART). ART can make HIV infection a manageable chronic condition. It also reduces the risk of spreading the virus to others.

Most people with HIV live long and healthy lives if they get ART as soon as possible and stay on it. It's also important to take care of yourself. Making sure that you have the support you need, living a healthy lifestyle, and getting regular medical care can help you enjoy a better quality of life.

Can HIV infection be prevented?

You can reduce the risk of getting or spreading HIV by:

• Getting tested for HIV.
• Choosing less risky sexual behaviors. This includes limiting the number of sexual partners you have and using latex condoms every time you have sex. If your or your partner is allergic to latex, you can use polyurethane condoms.
• Getting tested and treated for sexually transmitted infections (STIs).
• Not injecting drugs.
• Talking to your health care provider about medicines to prevent HIV:
  • PrEP (pre-exposure prophylaxis) is for people who don't already have HIV but are at very high risk of getting it. PrEP is daily medicine that can reduce this risk.
  • PEP (post-exposure prophylaxis) is for people who have possibly been exposed to HIV. It is only for emergency situations. PEP must be started within 72 hours after a possible exposure to HIV.

NIH: National Institutes of Health