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Encephalitis, also known as Chamki fever has claimed a lot of lives in Bihar and hence the topic has become hotter today. A lot of people are now wondering what causes this fever and how to prevent it. Here is an account of the causes of Chamki fever, its symptoms, and prevention methods. The cases reported Encephalitis or Acute Encephalitis Syndrome (AES) or Chamki fever can be explained to an extent as the inflammatory condition in the brain. The most common targets of Chamki fever are children and young adults. Chamki fever is noted to cause a huge amount of mortality and morbidity. The recent outbreak of Chamki fever in Bihar has resulted in over a hundred deaths in the districts of Muzaffarpur and the surrounding districts. More than 200 children have been admitted in hospitals in the state of Bihar diagnosed with high fever and a number of severe viral infection symptoms. Earlier during a similar outbreak of chamki fever in 2014, as many as 700 deaths were reported. Investigations into the causes of chamki fever Few of the terms that describe chamki fever are Litchi Havoc, Killer Encephalitis, Chamki Bhukar, and Deadly Litchi Toxin. Mangal Pandey, the health minister of Bihar had set up a team of medical industry professionals to investigate into the causes of chamki fever. The list of causes identified by this team includes consuming lychee on an empty stomach, going to bed with an empty stomach, and humid conditions resulting in dehydration in addition to some others. The recent reports have confirmed that the highest number of mortality on account of chamki fever is noted in the age group of 1 to 10. The number of cases diagnosed with chamki fever has peaked in the months of April, May and June with the disease-focused mainly in the regions in and around Muzaffarpur in Bihar. The predominant cases of chamki fever are noted in the children who were undernourished and visited the litchi farms as observed by a report published in the National Health Portal of India. Do litchi fruits cause chamki fever? Two commissions set up by the government to investigate into the causes of chamki fever had concluded that malnourished children who consumed litchis and slept without food were affected with chamki fever in the pre-monsoon season in the early mornings. Their studies tried to establish a relationship between low blood glucose levels noticed in poor and malnourished children who slept with an empty stomach and a toxic chemical known as methylene cyclopropyl-glycine (MCPG) found in litchis that affects the brain during undernourished conditions. However, this theory has been discredited recently and the recent claims point out to the environmental factors like heat waves and the poor rainfall in these regions as the causes for chamki fever. During earlier outbreaks of chamki fever in 2005, 2011, 2013, and 2014, the temperature was more than 38 degrees and humidity was more than 50 percent. In Muzaffarpur, the sharp rise of humidity in nights make the condition worse for young children. Understanding Acute Encephalitis Syndrome (AES)? CDC describes acute encephalitis syndrome as a clinical condition predominantly caused due to infection by Japanese encephalitis virus (JEV) or due to some other infectious and non-infectious reasons. Symptoms of chamki fever (Encephalitis or Acute Encephalitis) The symptoms and signs of AES are an acute beginning of fever associated with headache. This will be accompanied by a range of clinical neurological symptoms like mental confusion, delirium, disorientation, and even coma. Who are at the highest risk of chamki fever? The chamki fever causing virus is very commonly present in the rural areas. Hence the children living in these regions are noted with the highest risk of chamki fever. The incidence of chamki fever was the highest among the children between 0 to 6 years with the other possible ager group targeted by this illness being 7 to 10 years. The most common targets of chamki fever are people with a weak immune system who already have HIV/AIDS, those that take immunity suppressing drugs and those that are undernourished. The spread of Encephalitis or Chamki fever While viruses are said to be the most common causes for chamki fever (AES) in India, some other sources like bacteria, fungus, spirochetes, parasites, some toxins and chemicals were also said to cause this condition. Severe kinds of leptospirosis and toxoplasmosis are also found to be causing AES. Scientists have a notion that the toxin known as methylene cyclopropyl-glycine (MCPG) present in litchi fruit could be related to the inflammation of the brain. AES and chamki fever Any brain disease or AES cannot be termed as chamki fever. AES can be of different types including brain inflammation due to virus known as encephalitis, swelling of the protective membranes of the spinal cord and brain known as meningitis, any brain disease that can alter the brain structure and function like encephalopathy, and many kinds of neurological complications or malarial infections like cerebral malaria. The two important theories connected to the causes of chamki fever include the heat wave stroke and the toxins found in the locally grown litchi fruits. However, the recent views state that the main causes of chamki fever is the lack of acclimatization in children, heat wave and poor rainfall. Treating Encephalitis or Chamki fever The subjects reporting encephalitis must be treated urgently. The treatment plan for chamki fever will include antiviral medication, and steroid injections besides many others in order to support the body and relieve the subjects of the symptoms. During recent days, the PHCs have been instructed to provide an intravenous glucose infusion during the attacks of chamki fever. The subjects are also given a lot of rest, fruits and anti-inflammatory medicines to relieve the headache and fever. Though there is no cure noted for this disease, there are safer and effective vaccines available today to prevent chamki fever. How to prevent chamki fever or encephalitis Vaccination is advised as the most dependable preventive measure for encephalitis. In addition, using repellants, wearing long-sleeved clothes, maintaining hygienic conditions, washing hands with soap and water after using the toilet and before taking meals can help prevent the encephalitis that is caused due to the virus.

Acute Encephalitis Syndrome (Chamki Fever) causes, symptoms and prevention

What Is Chamki Fever/Acute Encephalitis Syndrome Chamki fever or encephalitis is an inflammatory condition of the brain resulting in a variety of associated symptoms. Acute Encephalitis Syndrome (AES) causes an acute-onset of fever associated with headache and most commonly reported in children and young adults. This illness brings about an alarming rate of morbidity and mortality. The recent outbreak of chamki fever in Bihar resulted in over 100 deaths in Muzaffarpur and its adjoining regions in the state of Bihar, India. Most notably, the similar outbreak of chamki fever resulted in about 700 deaths in 2014. Predominantly, chamki fever affects children and young adults in the age group of 1 to 10. The name chamki bukhar means fever condition associated with a seizure. Reports say that chamki fever or AES has spread in over 12 districts of Bihar including Muzaffarpur, Vaishali and East Champaran with Muzaffarpur declared as the worst hit zone. What is Chamki Fever or Acute Encephalitis Syndrome Acute encephalitis syndrome (AES) or chamki fever is a highly serious public health problem in India. It manifests as an acute onset of fever and a seriously affected mental condition resulting in confusion, disorientation, delirium, or coma. The affected individual may experience seizures. Chamki fever can happen in any age and at any time of the year. Muzaffarpur, Bihar and adjoining areas in Bihar are litchi producing districts. This disease mostly spreads far and wide in the months between April and June especially in children who are undernourished with a history of consuming litchis from the neighboring orchards. Causes of Chamki fever or Acute Encephalitis Syndrome Viruses are said to be the main agents causing AES. However, other sources like bacteria, fungus, chemicals, parasites, spirochetes, toxins, and some noninfectious agents have also been noted to cause chamki fever as studied over the past few decades. Japanese encephalitis virus (JEV) is identified as the major cause of AES in India. The percentage of this agent ranges from 5-35 percent. Nipah virus and Zika virus are also said to be AES causing agents. In some cases. The other agents causing chamki fever include Influenza A virus, simplex virus, mumps, dengue, West Parvovirus B4, Nile virus, Epstein-Barr virus Chandipura virus, measles, enteroviruses, scrub typhus, and S pneumonia. Symptoms of chamki fever or Encephalitis Some of the prominent and most common symptoms of chamki fever include High temperature, Headache, extreme sensitivity to light, stiff neck and back, nausea, and mental confusion. In severe cases of chamki fever, seizures and paralysis can result. Japanese encephalitis virus (JEV) As discussed so far, JEV is identified as the major cause of AES in India. This virus is spread by mosquitos and it is a kind of flavivirus. This virus belongs to the same genus like dengue, yellow fever, and West Nile viruses. So far no cure has been discovered for chamki fever. The treatment available now focuses mainly on relieving the severe clinical symptoms found in the affected persons and supporting the patients to overcome the infective condition. Treatment for chamki fever or Encephalitis The affected persons must be treated immediately to avoid severe complications. The patients must be admitted to the Intensive Care unit or ICU to prevent any kinds of major mishaps. Chamki fever can be treated with anti-inflammatory drugs including Acetaminophen, Ibuprofen and Naproxen Sodium which can bring down the temperature and headache. Majority of cases reported with chamki fever can get resolved in a matter of a few days. However, some severe cases can take about a few weeks to recover.

What Is Acute Encephalitis Syndrome (Chamki Fever) - All you need to know

<ul><li>Encephalitis syndrome death toll crossed 100 in Muzaffarpur, Bihar, on Monday.</li><li>CM <keyword id="6358190" type="PERSON" weightage="20" keywordseo="Nitish-Kumar">Nitish Kumar</keyword> has called an emergency meeting with senior health officers.</li><li>₹400,000 Ex-gratia announced for the families.</li></ul> Bihar is witnessing an outbreak of Acute Encephalitis Syndrome (AES) as the death toll crossed 100 on Monday. Ten more children died due the syndrome on Monday in <keyword id="527716" type="PERSON" weightage="20" keywordseo="Muzaffarpur-district">Muzaffarpur district</keyword>’s Sri Krishna Medical College and Hospital (SKMCH) in Bihar, medical superintendent of the hospital, Sunil Shahi, <a href="https://www.indiatoday.in/mail-today/story/encephalitis-deaths-lapses-behind-bihar-brain-fever-horror-1550908-2019-06-18">informed</a> media on Monday. Bihar Chief Minister Nitish Kumar has called in an urgent internal meeting to take stock of the situation. Senior officers of the Health ministry are expected to attend the meeting. Earlier, on Saturday, Bihar Health Minister Mangal Pandey had said that the state government is doing its best to save the children, <a href="https://www.thequint.com/news/india/muzaffarpur-deaths-hypogylcemia-bihar-brain-fever-outbreak?utm_campaign=fullarticle&amp;utm_medium=referral&amp;utm_source=inshorts">reported ANI</a>. “Everything is being made available, from medicines to doctors. We have even called doctors and nurses from AIIMS in Patna,” Pandey said, adding that protocol is being adhered to while monitoring things, <a href="https://www.thequint.com/news/india/muzaffarpur-deaths-hypogylcemia-bihar-brain-fever-outbreak?utm_campaign=fullarticle&amp;utm_medium=referral&amp;utm_source=inshorts">as per The Quint</a>. The minister also said that six ambulances will be operational at the hospital from Friday and a new ward with 100-bed capacity will be made operational soon, after holding a meeting with SKMCH staff. CM Kumar expressed grief over the unfortunate deaths and announced an ex-gratia of ₹400 ,000 for the families who have lost their children. Encephalitis and Bihar Bihar has been affected by the disease before. In 2014, encephalitis, caused 379 deaths in Bihar. It was said to be due to the delay in implementation of centre’s ambitious project to curb the disease. The then Health Minister, Dr Harsha Vardhan had then visited SKMCH and announced a 100-bed super-speciality facility which is still incomplete. On Sunday, Vardhan said it will be operational in six months. A 10-bed facility for treatment of children also awaits completion. Encephalitis deaths in Muzaffarpur, and adjoining places such as, Sitamarthi, Motihari, Sheohar and Vaishali have been an annual feature for the last three decades. Another lapse in this prevailing problem was a weak awareness campaign by the government. Director-in-Chief, Disease Control, Bihar, RD Ranjan, after his visit to Muzaffarpur on Friday, 14 June, said, “We can confirm the data as of 10 June.” Till then, 34 deaths had taken place and 109 cases of brain fever were reported. He reiterated that none of the deaths, till then, have been caused by AES. “The casualties were result of hypoglycaemia,” Ranjan <a href="https://www.thequint.com/news/india/encephalitis-bihar-muzzaffarpur-brain-fever-outbreak">told Quint</a>.

CM Nitish Kumar to hold internal meeting as Encephalitis death toll crosses 100

8 reasons you're hallucinating and what to do about it

By Yoshita Singh United Nations, Jul 7 () Global outbreaks like COVID-19 will become more common and increasingly prevalent if countries do not take effective steps to curb zoonotic diseases that pass from animals to humans, a report by the UN has said. The UN Environment Programme (UNEP) and the International Livestock Research Institute (ILRI) on Monday launched the report- 'Preventing the next pandemic: Zoonotic diseases and how to break the chain of transmission'. "People look back to the influenza pandemic of 1918–1919 and think that such disease outbreaks only happen once in a century," head of scientific assessments at UNEP Maarten Kappelle said. "But that's no longer true. If we don't restore the balance between the natural world and the human one, these outbreaks will become increasingly prevalent," he said. UNEP Executive Director Inger Andersen said that as nations seek to build back better after COVID-19, "we need to fully understand the transmission of zoonoses, the threats they pose to human health and how to minimise the risk of further devastating outbreaks. "COVID-19 is one of the worst zoonotic diseases, but it is not the first. Ebola, SARS, MERS, HIV, Lyme disease, Rift Valley fever and Lassa fever preceded it. In the last century we have seen at least six major outbreaks of novel coronaviruses," she said. Zoonotic diseases are infections that jump between animals and humans, some of which have led to severe illnesses and deaths. The coronavirus outbreak has so far claimed 500,000 lives globally. It originated from a wildlife food market in China's Wuhan city. The Highly pathogenic avian influenza (HPAI) or bird flu in 1996, Nipah virus infection in 1998, Severe acute respiratory syndrome (SARS) in 2003 and the Swine acute diarrhoea syndrome (SADS) in 2016 all emerged in Guangdong, China, the report's data said. She said nations need to invest in ending the over-exploitation of wildlife and other natural resources, farming sustainably, reversing land degradation and protecting ecosystem health. "We were warned that the current pandemic was a matter of if, not when. It is a human failing that we predict but not prepare. Now we must become more proactive to avoid another pandemic and address endemic zoonotic diseases. This means recognising that human health, animal health and planetary health cannot be separated, and planning our responses accordingly," she said. The report said that 60 per cent of the 1,400 microbes known to infect humans originated in animals. It also noted that apart from contagions like COVID-19, neglected zoonotic diseases such as anthrax, bovine tuberculosis, rabies and Japanese encephalitis kill at least two million people every year, mostly in developing countries, which have communities with complex development problems, high dependence on livestock and proximity to wildlife. Zoonotic diseases have plagued societies since Neolithic times and were responsible for some of history's deadliest pandemics, including the bubonic plague of the late Middle Ages and the influenza pandemic of the early twentieth century. UNEP noted that as the world's population edges towards 8 billion, rampant development is putting humans and animals in increasingly close quarters, making it easier for diseases to vault between species. Andersen added that growth in humanity and its activity is largely to blame for increasing frequency of zoonotic diseases. She said meat production has increased by 260 per cent in 50 years, agriculture has intensified, infrastructure expanded and resources extracted at the expense of wild spaces. Dams, irrigation and factory farms are linked to 25 per cent of infectious diseases in humans. Travel, transport and food supply chains have erased borders and distances. Climate change has contributed to the spread of pathogens. "The end result is that people and animals, with the diseases they carry, are closer than ever," she said. Eric Fèvre, a professor of veterinary infectious diseases at the University of Liverpool and a jointly appointed ILRI researcher said, "as we exploit more marginal areas, we are creating opportunities for transmission. There is an increasing risk of seeing bigger epidemics and, eventually, a pandemic of the COVID-19 type as our footprint on the world expands." The report also noted that cost of zoonotic epidemics is steep. The International Monetary Fund has predicted that COVID-19 alone will cause the global economy to contract by 3 per cent this year, wiping out USD 9 trillion in productivity through 2021. But even in the two decades before the pandemic, the World Bank estimated that zoonotic diseases had direct costs of more than USD 100 billion. In order to prevent future outbreaks, countries need a coordinated, science-backed response to emerging zoonotic diseases, says Delia Grace, lead author of the report as well as a veterinary epidemiologist at ILRI and professor of food safety at the UK's Natural Resources Institute. UNEP and ILRI are urging governments to embrace an inter-sectoral and interdisciplinary approach called One Health. It calls on states not only to buttress their animal as well as human healthcare systems, but also to address factors - like environmental degradation and increased demand for meat – that make it easier for diseases to jump species. Co-author of the assessment and UNEP's Chief of Wildlife Doreen Robinson says it's also important for governments to better understand how zoonotic diseases work. That could help the world avoid another pandemic on the scale of COVID-19. YAS RS AKJ RS RS

Zoonotic diseases need to be curbed to prevent outbreaks like COVID-19: UN

<div class="KonaFilter image-container display-table"><div><div class="image on-image">Caroline Walsh</div></div></div><ul><li>When she was 24 years old, Caroline Walsh started having disturbing symptoms, like forgetfulness and sudden behavior changes.</li><li>Doctors incorrectly diagnosed her several times before she was properly diagnosed with autoimmune encephalitis, a disease in which the body attacks itself and targets the brain.</li><li>New research suggests the disease may affect up to 90,000 people each year.</li></ul> There's a blank year in 26-year-old Caroline Walsh's once-spotless memory.She's pieced parts together from stories her friends have told her and a collection of photos on Facebook. But she cannot remember the day it all began - when her father found her in the middle of a seizure, her body writhing on the floor. She also can't remember waking up with her hands tied to a hospital bed, begging her sister to help her escape, or the next day when she proclaimed she was the Zac Brown Band.Instead, Walsh's first recollection of that time is of a recovery room filled with family and flowers. By then, her doctors had diagnosed her with a mysterious disease called autoimmune encephalitis, or AE. While there's lot we still don't know about the condition, experts believe it's part of a larger class of illnesses in which the body turns on itself. A <a href="http://onlinelibrary.wiley.com/doi/10.1002/ana.25131/full">new study from Mayo Clinic researchers</a> suggests it's a lot more common that previously thought. In fact, AE may occur just as frequently as cases of regular encephalitis, the brain swelling caused by viral infections. If that's the case, it could be impacting roughly 90,000 people around the world every year.In Walsh's case, the disease attacked her brain, setting off a chain reaction of symptoms that mimicked those of other mental illnesses like depression and schizophrenia. If treated properly and early enough, people with AE can make a near-complete recovery. But if they go undiagnosed or land in a psychiatric ward, they can die.<h2>Something brewing</h2>A stroll down a real street called Memory Lane in London leads you to the London Institute of Psychiatry, where J.A.N. "Nick" Corsellis sliced into the brains of three corpses and found the first evidence of AE.Deep in the dense part of the brain called the limbic system, the normally lithe network of rubbery-smooth tissue had become puffy and inflamed. It was as if something had attacked it from within.Most of the people these brains once belonged to had been diagnosed with cancer, then seemed to make a full recovery. But their personalities <a href="https://academic.oup.com/brain/article-abstract/91/3/481/258399/LIMBIC-ENCEPHALITIS-AND-ITS-ASSOCIATION-WITH?redirectedFrom=fulltext">began to change</a>. A partner or friend was usually the first to notice an odd shift in their behavior - usually a progressive increase in forgetfulness, though others experienced a sudden bout of mania or depression. A 58-year old bus driver found himself waking up most days not knowing where he was.Corsellis saw inflammation in parts of the brain linked with memory and mood, but he couldn't explain what had caused the swelling that triggered the symptoms."The first question to arise ... is whether the assertion of a connection between carcinoma [cancer] and 'limbic encephalitis' is now justified, even if it cannot be explained," he wrote in a 1968 paper in the journal Brain. It was first time the condition was mentioned in a scientific journal.Walsh's symptoms became noticeable one day at work when she started repeating herself. She joked with a co-worker that she was coming down with early-onset Alzheimer's."I was just getting very confused all the time," Walsh said.The next week, more mysterious problems cropped up - Walsh had a knack for remembering names, but one day when she met up with some new friends, she introduced herself half a dozen times and struggled to commit anyone's name to memory."They'd say it and then a couple minutes later I'd have no clue what their name was or what we were even talking about," she said.At the office the next day, things got worse. "My personality was just off. I thought it was work. I pulled my boss aside into a conference room and I started to cry, which was just not me," she said. When she wasn't feeling stressed and anxious, she felt depressed."Something was just brewing, I could feel it," she said.<h2>When the body attacks itself</h2>Our immune system is our body's defense against the outside world.Most of the action is coordinated by white blood cells, which direct the lines of attack like football coaches, churning out antibodies that target the opponent for destruction.<div class="KonaFilter image-container display-table float_right"><div><div class="image on-image">ShutterstockA new way of boosting white blood cells.</div></div></div>But sometimes the process can go awry. In generating an immune response against a virus or other disease, the body can wind up up attacking itself - such issues are known as autoimmune diseases.It's as if "some wires get crossed," <a href="https://www.researchgate.net/profile/Brendan_Kelley">Brenden Kelley</a>, a neuroradiologist at Henry Ford hospital in Detroit who's part of the small community researching autoimmune encephalitis, told Business Insider last year.Sometimes, this abnormal response can be caused by a virus like the flu or a bacterial infection. Other times, certain types of cancer appear to be the source."In picking targets that match the cancer, the body may also pick targets that match places in your body that don't have cancer," Kelley said.The Mayo Clinic's new <a href="http://onlinelibrary.wiley.com/doi/10.1002/ana.25131/full">study, published in February in the journal Annals of Neurology,</a> suggests that cases of autoimmune encephalitis aren't nearly as rare as researchers once believed. By drawing on data from the Rochester Epidemiology Project, a medical records database in Olmsted County, Minnesota, the researchers were able to estimate that roughly 1 million people across the globe had autoimmune encephalitis at some point in their life. Each year, roughly 90,000 people may develop AE, they estimated."No prior studies evaluated this," Eoin Flanagan, the lead author on the paper and an autoimmune neurology specialist at the Mayo Clinic, <a href="https://newsnetwork.mayoclinic.org/discussion/when-the-body-attacks-the-brain-immune-system-often-to-blame-for-encephalitis-study-finds/">said in a statement</a>.Kelley, who is working on his own forthcoming study of the frequency of AE in young people, said his work echoes Flanagan's findings."You can't diagnose something you don't know about, or that you don't recognize," Kelley told Business Insider.Last summer, he <a href="http://www.ajnr.org/content/38/6/1070">published a study in the American Journal of Radiology</a> to help radiologists like himself better diagnose and understand diseases like AE.<h2>Knee deep in the water</h2>Three months after Walsh first started noticing changes in her personality, she relocated to her childhood home outside of Boston, and saw two doctors who both incorrectly diagnosed her with the flu.Then one morning around 4 a.m., as her dad got ready for work, he heard a loud crash. He found his daughter on the ground, her limbs thrashing. He screamed her name, but she didn't respond.The most common cause of the type of seizure that Walsh had - known as a grand mal seizure (literally "great sickness" in French) - is epilepsy. Other causes can include extremely low blood sugar, high fever, and stroke.At the hospital, Walsh's doctors tested her extensively. But even lumbar punctures or "spinal taps" - how doctors first spot autoimmune encephalitis in many cases - didn't show enough characteristic markers of inflammation to draw a definite conclusion.<div class="KonaFilter image-container display-table"><div><div class="image on-image">Caroline Walsh</div></div></div>When Walsh's sister Alana arrived at the hospital, Caroline was lying motionless on her hospital bed under the harsh lighting. Her hands had been encased in heavily padded mitts that looked like boxing gloves, and were fastened to the railings on her bed to keep her from pulling out the IV tubes keeping her hydrated. She asked Alana to come closer so she could whisper something into her ear."You have to fight 'em, you have to get me out of here," Caroline said, motioning her head towards the nurses as she eyed them suspiciously.When Alana asked her sister what she was talking about, Caroline explained that she'd been abducted while she was asleep and was now being held hostage at the hospital.A few hours later, after drifting into the sleepy, dazed state she was in for much of her hospital stay, she woke with a jolt and proclaimed she was the country singer the Zac Brown Band. She started belting out her favorite song of his, a catchy tune about taking a break from reality called "Knee Deep.""Gonna put the world away for a minute," she sang, getting louder with every verse. "Pretend I don't live in it."When her family couldn't stop Caroline's crooning, Alana got up and closed the doors to her room in an attempt to keep her from waking up everyone on the ward. Caroline continued."Mind on a permanent vacation, the ocean is my only medication, wishin' my condition ain't ever gonna go away."Over the next week, Walsh proceeded to seize more than a hundred times. Alana recalls that nearly every time she sat down to talk with her, Caroline would seize half a dozen times. They weren't massive seizures like the one that had landed her in the hospital, but small, barely perceptible ones."You'd know because her eyes would drift away and she'd stare in one spot, she was having little ones almost every minute," Alana said. "She was very shaky and confused; her heart rate was extremely high, and the doctors just seemed so confused by everything every time we talked to them."Eventually, the doctors decided to put Walsh in a medically-induced coma.<h2>Smoke from the fire</h2>In children, infections like strep throat appear to be a trigger of AE. <a href="http://nyulangone.org/doctors/1962593632/susan-schulman">Susan Schulman</a>, a pediatrician in New York, told Business Insider last year that she had seen hundreds of cases of a related condition, called PANS (pediatric acute-onset neuropsychiatric syndrome), in her patients. Her first case, in 1998, was a five-year old girl from Brooklyn who flew into a panic about keeping special holiday clothes separate from her regular clothes."She was driving her mother crazy," Schulman said last year. At first, she believed the girl had <a href="http://pedsinreview.aappublications.org/content/34/1/19">childhood obsessive-compulsive disorder</a>, but medication made the child's symptoms worse. She later returned to Schulman's office with a nasty case of strep throat and strangely, after Schulman treated the strep with antibiotics, the OCD symptoms vanished."I said you know what, that's odd," Schulman said.<div class="KonaFilter image-container display-table float_right"><div><div class="image on-image">Caroline Walsh</div></div></div>Around the same time, an NIH pediatrician named Susan Swedo published an <a href="http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.155.2.264">article in the American Journal of Psychiatry</a> describing 50 cases of a phenomenon she called "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections." Schulman realized that the sudden psychiatric symptoms she had observed in her young patients - which ranged from OCD to rage and paranoia - were likely connected to their infections."I see infection as the match that lights the autoimmune reaction. The inflammation is the fire; the symptoms you see is the smoke coming out of the fire," Schulman said.Autoimmune conditions that affect the brain only represent a fraction of all autoimmune diseases. Scientists have identified as many as <a href="https://www.niams.nih.gov/Health_info/Autoimmune/default.asp#2">80 others</a>, which range from type 1 diabetes, which develops when the body attacks its insulin-producing cells, to multiple sclerosis, psoriasis, and rheumatoid arthritis. More are being recognized each year.Through his research, Kelley hopes to find out what autoimmune diseases that affect the brain have in common so the team can figure out what causes them."A lot of these conditions are variants on the same theme," he said.In Walsh's case, "these are people who tend to not have a lot of other medical problems and then all of a sudden they feel like they're going crazy, they're losing themselves," Kelley said. "It tends to be very clear that something's not right, but precisely what's going on can be difficult to piece together."<h2>Putting the pieces together</h2>When Walsh woke up in her hospital room, she wasn't sure why she was there."I was like why are all these people in my room? Why is it decorated with all of these flowers?," she recalled.A day or so before, a specialist had diagnosed Walsh with autoimmune encephalitis and started her on a regimen of powerful steroids, now considered one of the best treatments for the disease. The drugs began to reduce the inflammation in her brain. The affected area was Walsh's hippocampus, the region responsible for making and storing memories."I just remember I kept asking, 'What?' you know, 'Wait, why am I here?' and they would tell me, but I kept forgetting," she said.<div class="KonaFilter image-container display-table float_right"><div><div class="image on-image">Caroline Walsh</div></div></div>The treatment for autoimmune encephalitis can vary based on the trigger, but timing is always key. If doctors treat whatever is triggering the condition, many people with the disease can go on to lead fairly normal, full lives."It's a race against time in a way," Kelley said.In patients whose autoimmune encephalitis seems to be triggered by cancer (as opposed to Walsh's, which may have been set off by the flu), the treatment focuses on treating or removing the cancer first. "When you remove the cancer, you remove the stimulus," Kelley said.As Walsh began to regain her ability to remember, she realized she'd have to re-learn a lot of basic things."I remember going to get up to use the bathroom, and one of the nurses went to bring me a wheelchair and I was like, 'Oh no I don't need that,'" Walsh said. "So then I just thought about standing and suddenly I just had no idea, I couldn't function to walk."She regained those skills over the next 10 days at Spaulding Rehabilitation Center, the same place the survivors of the Boston Marathon bombing were brought after the attack. There, Walsh re-learned how to put one foot in front of the other and how to hold a spoon.She now works part-time as a nanny and volunteers with Spaulding and the Boston Boys and Girls Club. Instead of going back to sales, she plans to work with children in some capacity. She recently attended a Spaulding fundraising event with her sister, Alana, where she bumped into the physical therapist who helped her walk in a straight line for the first time."We were in our dresses and we were both dancing together," Walsh said, "and Alana was like, 'You know she taught you to walk again?'" This story was originally published in May 2017, and has been updated to include recent findings on the prevalence of autoimmune encephalitis. <div class="margin-top"> <h3>NOW WATCH: <a href="http://www.businessinsider.com/how-to-tell-you-have-cold-flu-just-allergies-symptoms-2016-10">How to tell if you have a cold, flu, or just allergies</a></h3> <div> </div> </div>

A 24-year old got a mysterious disease where her body attacked her brain - and scientists are learning it's more common than they thought

Caroline WalshCaroline, in the middle, with her family.There's a blank year in 25-year-old Caroline Walsh's once-spotless memory.She's pieced parts together from stories her friends have told her and a collection of photos on Facebook. But she cannot remember the day it all began - when her father found her in the middle of a seizure, her body writhing on the floor. She also can't remember waking up with her hands tied to a hospital bed, begging her sister to help her escape, or the next day when she proclaimed she was the Zac Brown Band.Instead, Walsh's first recollection of that time is of a recovery room filled with family and flowers. By then, her doctors had diagnosed her with a mysterious disease called autoimmune encephalitis, or AE for short. While there's lot we still don't know about the condition, experts believe it's part of a larger class of illnesses in which the body turns on itself.In Walsh's case, the disease attacked her brain, setting off a chain reaction of symptoms that mimicked those of other mental illnesses like depression and schizophrenia. If treated properly and early enough, people with AE can make a near-complete recovery. But if they go undiagnosed or land in a psychiatric ward, they can die.<h2>Something brewing</h2>A stroll down a real street called Memory Lane in London leads you to the London Institute of Psychiatry, where J.A.N. "Nick" Corsellis sliced into the brains of three corpses and found the first evidence of AE.Deep in the dense part of the brain called the limbic system, the normally lithe network of rubbery-smooth tissue had become puffy and inflamed. It was as if something had attacked it from within.Most of the people these brains once belonged to had been diagnosed with cancer, then seemed to make a full recovery. But their personalities <a href="https://academic.oup.com/brain/article-abstract/91/3/481/258399/LIMBIC-ENCEPHALITIS-AND-ITS-ASSOCIATION-WITH?redirectedFrom=fulltext">began to change</a>. A partner or friend was usually the first to notice an odd shift in their behavior - usually a progressive increase in forgetfulness, though others experienced a sudden bout of mania or depression. A 58-year old bus driver found himself waking up most days not knowing where he was.Corsellis saw inflammation in parts of the brain linked with memory and mood, but he couldn't explain what had caused the swelling that triggered the symptoms."The first question to arise ... is whether the assertion of a connection between carcinoma [cancer] and 'limbic encephalitis' is now justified, even if it cannot be explained," he wrote in a 1968 paper in the journal Brain. It was first time the condition was mentioned in a scientific journal.Walsh's symptoms became noticeable one day at work when she started repeating herself. She joked with a co-worker that she was coming down with early-onset Alzheimer's."I was just getting very confused all the time," Walsh says.The next week, more mysterious problems cropped up - Walsh had a knack for remembering names, but one day when she met up with some new friends, she introduced herself half a dozen times and struggled to commit anyone's name to memory."They'd say it and then a couple minutes later I'd have no clue what their name was or what we were even talking about," she says.At the office the next day, things got worse. "My personality was just off. I thought it was work. I pulled my boss aside into a conference room and I started to cry, which was just not me," she says. When she wasn't feeling stressed and anxious, she felt depressed."Something was just brewing, I could feel it," she says.<h2>When the body attacks itself</h2>Our immune system is our body's defense against the outside world.Most of the action is coordinated by white blood cells, which direct the lines of attack like football coaches, churning out antibodies that target the opponent for destruction.ShutterstockA white blood cell.But sometimes the process can go awry. In generating an immune response against a virus or other disease, the body can wind up up attacking itself - a larger class of illnesses known as autoimmune diseases.It's as if "some wires get crossed," says <a href="https://www.researchgate.net/profile/Brendan_Kelley">Brenden Kelley</a>, a neuroradiologist at Henry Ford hospital in Detroit who's part of the small community researching autoimmune encephalitis.Sometimes, this abnormal response can be caused by a virus like the flu or a bacterial infection. Other times, certain types of cancer appear to be the source."In picking targets that match the cancer, the body may also pick targets that match places in your body that don't have cancer," says Kelley.<h2>Knee deep in the water</h2>Three months later, Walsh relocated to her childhood home outside of Boston, and saw two doctors who both incorrectly diagnosed her with the flu.Then one morning around 4 a.m., as her dad, a Boston police officer, got ready for work, he heard a loud crash. He found his daughter on the ground, her limbs thrashing. He screamed her name, but she didn't respond.The most common cause of the type of seizure that Walsh had that day - known as a grand mal seizure (literally "great sickness" in French) - is epilepsy. Other causes can include extremely low blood sugar, high fever, and stroke.At the hospital, Walsh's doctors tested her extensively, doing multiple lumbar punctures or "spinal taps," a painful, dangerous procedure that involves collecting and analyzing the protective fluid surrounding her brain and spinal cord. In most cases, this is where doctors will first spot autoimmune encephalitis, Kelley says.But sometimes, as in Walsh's case, the characteristic markers of inflammation are too subtle to draw a definite conclusion.Caroline WalshCaroline at the hospital.When Caroline's sister Alana arrived at the hospital, Caroline was lying motionless on her hospital bed under the harsh lighting. Her hands had been encased in heavily padded mitts that looked like boxing gloves, and were fastened to the railings on her bed to keep her from pulling out the IV tubes keeping her hydrated. She asked Alana to come closer so she could whisper something into her ear."You have to fight 'em, you have to get me out of here," said Caroline, motioning her head towards the nurses as she eyed them suspiciously.When Alana asked her sister what she was talking about, Caroline explained that she'd been abducted while she was asleep and was now being held hostage at the hospital.A few hours later, after drifting into the sleepy, dazed state she was in for much of her hospital stay, she woke with a jolt and proclaimed she was the country singer the Zac Brown Band. She started belting out her favorite song of his, a catchy tune about taking a break from reality called "Knee Deep.""Gonna put the world away for a minute," she sang, getting louder with every verse. "Pretend I don't live in it."When her family couldn't stop Caroline's crooning, Alana got up and closed the doors to her room in an attempt to keep her from waking up everyone on the ward. Caroline continued."Mind on a permanent vacation, the ocean is my only medication, wishin' my condition ain't ever gonna go away."Over the next week, Walsh proceeded to seize more than a hundred times. Alana recalls that nearly every time she sat down to talk with her, Caroline would seize half a dozen times. They weren't massive seizures like the one that had landed her in the hospital, but small, barely perceptible ones."You'd know because her eyes would drift away and she'd stare in one spot, she was having little ones almost every minute," says Alana. "She was very shaky and confused; her heart rate was extremely high, and the doctors just seemed so confused by everything every time we talked to them, they were like she can't be going into these seizures all the time, it's just too much."Eventually, the doctors decided to put her in a medically-induced coma.<h2>Smoke from the fire</h2>In children, infections like strep throat appear to be a trigger of AE. <a href="http://nyulangone.org/doctors/1962593632/susan-schulman">Susan Schulman</a>, a pediatrician in New York, says she's seen hundreds of cases of a related condition, called PANS (pediatric acute-onset neuropsychiatric syndrome), in her patients. Her first case, in 1998, was a five-year old girl from Brooklyn who flew into a panic about keeping the clothes she wore on the Jewish holiday of Shabbat separate from her regular clothes."She was driving her mother crazy," Schulman says. At first, she believed the girl had <a href="http://pedsinreview.aappublications.org/content/34/1/19">childhood obsessive-compulsive disorder</a>, but medication made the child's symptoms worse, and she returned to Schulman's office with more intense OCD symptoms and a nasty case of strep throat. Strangely, after Schulman treated the strep with antibiotics, the OCD symptoms vanished."I said you know what, that's odd," Schulman says.Caroline WalshAround the same time, an NIH pediatrician named Susan Swedo published an <a href="http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.155.2.264">article in the American Journal of Psychiatry</a> describing 50 cases of a phenomenon she called "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections." Schulman realized that the sudden psychiatric symptoms she had observed in her young patients - which ranged from OCD to rage and paranoia - were likely connected to their infections."I see infection as the match that lights the autoimmune reaction. The inflammation is the fire; the symptoms you see is the smoke coming out of the fire," Schulman says.Autoimmune conditions that affect the brain only represent a fraction of all autoimmune diseases. Scientists have identified as many as <a href="https://www.niams.nih.gov/Health_info/Autoimmune/default.asp#2">80 others</a>, which range from type 1 diabetes, which develops when the body attacks its insulin-producing cells, to multiple sclerosis, psoriasis, and rheumatoid arthritis. More are being recognized each year.Kelley and others at Henry Ford are currently researching autoimmune diseases that affect the brain. By working with scientists who specialize in the brain and the immune system, Kelley hopes to find out what these conditions have in common so the team can eventually figure out what causes them."A lot of these conditions are variants on the same theme," he says. In Walsh's case, "these are people who tend to not have a lot of other medical problems and then all of a sudden they feel like they're going crazy, they're losing themselves," Kelley says. "It tends to be very clear that something's not right, but precisely what's going on can be difficult to piece together."<h2>Putting the pieces together</h2>When Walsh woke up in her hospital room, she wasn't sure why she was there."I was like why are all these people in my room? Why is it decorated with all of these flowers?," she recalls.A day or so before, a specialist had diagnosed Walsh with autoimmune encephalitis and started her on a regimen of powerful steroids, now considered one of the best treatments for the disease. The drugs began to reduce the inflammation in her brain. In Walsh's case, the affected area was her hippocampus, the region responsible for making and storing memories."I just remember I kept asking, 'What?' you know, 'Wait, why am I here?' and they would tell me, but I kept forgetting," she says.Caroline WalshCaroline at Spaulding Rehabilitation Hospital.In patients whose autoimmune encephalitis seems to be triggered by cancer (as opposed to Walsh's, which may have been set off by the flu), the treatment focuses on treating or removing the cancer first. "When you remove the cancer, you remove the stimulus," Kelley says.The treatment for autoimmune encephalitis can vary based on the trigger, but timing is always key. If doctors treat whatever is triggering the condition, many people with the disease can go on to lead fairly normal, full lives."It's a race against time in a way," Kelley says.As Walsh began to regain her ability to remember, she realized she'd have to re-learn a lot of basic things."I remember going to get up to use the bathroom, and one of the nurses went to bring me a wheelchair and I was like, 'Oh no I don't need that,'" says Walsh. "So then I just thought about standing and suddenly I just had no idea, I couldn't function to walk."She regained those skills over the next 10 days at Spaulding Rehabilitation Center, the same place the survivors of the Boston Marathon bombing were brought after the attack. There, Walsh re-learned how to put one foot in front of the other and how to hold a spoon.Walsh now works part-time as a nanny and volunteers with Spaulding and the Boston Boys and Girls Club. Instead of going back to sales, she plans to work with children in some capacity. She recently attended a Spaulding fundraising event with her sister, Alana, where she bumped into the physical therapist who helped her walk in a straight line for the first time."We were in our dresses and we were both dancing together," Walsh says, "and Alana was like, 'You know she taught you to walk again?'" <h3>More from Erin Brodwin:</h3><ul><li><a href="http://www.businessinsider.com/rare-disease-body-attacks-brain-2017-5" rel="nofollow">A 24-year old got a mysterious disease where her body attacked her brain - and everyone thought it was in her mind</a></li><li><a href="http://www.businessinsider.com/shark-video-california-oc-hides-bigger-threat-2017-5" rel="nofollow">A video of 15 sharks circling near paddleboarders in California hides a bigger problem</a></li><li><a href="http://www.businessinsider.com/seaweed-tastes-like-bacon-review-2017-5" rel="nofollow">We tried the seaweed that 'tastes like bacon' and is healthier than kale - here's the verdict</a></li><li><a href="http://www.businessinsider.com/microdosing-lsd-effects-risks-science-2017-5" rel="nofollow">Scientists are about to find out how Silicon Valley's LSD habit really affects productivity</a></li><li><a href="http://www.businessinsider.com/healthiest-fast-food-chipotle-panera-shake-shack-2017-5" rel="nofollow">15 of the healthiest fast-food menu items</a></li></ul> <h3>NOW WATCH: <a href="http://www.businessinsider.com/nasa-cassini-saturn-dive-video-grand-finale-2017-5">NASA released its first incredible video of our closest look at Saturn yet</a></h3> Please enable Javascript to watch this video

A 24-year old got a mysterious disease where her body attacked her brain - and everyone thought it was in her mind

<div class="KonaFilter image-container display-table float_right"><div><div class="image">CDC</div></div></div>Since the West Nile virus arrived in the U.S. in 1999, at least 37,000 people have been sickened by mosquitoes carrying the disease. Far greater numbers have been infected unknowingly.
In addition, a new report from the CDC estimates that the virus has cost the U.S. approximately $778 million, an average of $56 million a year.
"We knew that the impact of the disease was not just limited to the initial illness or even just the first couple of months," J. Erin Staples, a medical epidemiologist at the CDC, told Business Insider. "We wanted to get at the long-term effects."
The new study, published in the <a href="http://www.ajtmh.org/" target="_blank">American Journal of Tropical Medicine and Hygiene</a> Feb. 10, is the first to look at the costs of long-term medical care and long-term lost productivity associated with West Nile.
This data can help public health officials and policymakers decide if public health campaigns like vaccinations would be cost-effective.
An <a href="http://wwwnc.cdc.gov/eid/article/16/3/09-0667_article.htm" target="_blank">earlier CDC analysis</a> that did not factor in the costs of long-term care concluded that vaccination against WNV would not be cost-effective. The new study suggests the opposite: The long-term costs of West Nile may be higher than previously thought, and it might be worth developing vaccines and drugs to treat it.
<h3>What is West Nile virus?</h3>
For decades, West Nile virus infected people across large swaths of Africa, West Asia, and the Middle East. But it didn't become a threat in the Western Hemisphere until <a href="http://diseasemaps.usgs.gov/wnv_background.html" target="_blank">a 1999 outbreak in New York City</a> sickened at least <a href="http://www.cdc.gov/westnile/resources/pdfs/cummulative/99_2012_CasesAndDeathsClinicalPresentationHumanCases.pdf" target="_blank">62 people</a>.
Just four years later, the U.S. saw <a href="http://www.cdc.gov/westnile/resources/pdfs/cummulative/99_2012_CasesAndDeathsClinicalPresentationHumanCases.pdf" target="_blank">its largest outbreak so far</a>, with 9,862 falling ill and 264 dying. Spread by mosquitoes, the virus has returned every summer since, sometimes with fewer than 1,000 recorded cases. But 2012 was another big year: 5,674 were sickened from WNV and 286 died.
At first glance, West Nile doesn't seem so bad: 80% of infected people don't have any symptoms.
But when people do get sick - a greater risk in people over 50 or with conditions like cancer, diabetes, and high blood pressure - the virus can lead to long-term health complications and even death. From 1999 to 2012, the CDC confirmed more than 37,000 WNV infections and 1,500 deaths.
It's impossible to know exactly how high these numbers would climb if we include all of the people who never showed any symptoms, but one study estimated there could be <a href="http://www.ncbi.nlm.nih.gov/pubmed/22640592" target="_blank">more than 3 million</a> people in the U.S. who have been infected with West Nile.
Even in those who do get sick, the disease often doesn't get diagnosed. The most common symptoms resemble a flu: fever and sometimes aches, vomiting, and rash.
But about 1 in 150 infected people develop severe nervous system complications like encephalitis (inflammation of the brain), meningitis (inflammation of the brain and spinal cord's protective membranes), and <a href="http://www.cdc.gov/MMWR/PREVIEW/MMWRHTML/mm5137a1.htm" target="_blank">acute flaccid paralysis</a> (polio-like paralysis and muscle weakness).
The vast majority of people with symptomatic WNV recover, but <a href="http://www.cdc.gov/westnile/faq/genQuestions.html">10% of people</a> who develop severe neurological symptoms die. We don't have effective treatments or a vaccine against West Nile.
<h3>Where does $778 million come from?</h3>
Estimating the cost of the virus is no easy task, and the current analysis has some serious limitations. While the researchers made every effort to be conservative, the final number - $778 million - should be considered a ballpark estimate.
The researchers studied a cohort of 80 people hospitalized because of West Nile during a 2003 outbreak in Colorado, but only 38 completed the follow-up five years later. The researchers used these 38 cases to estimate the cost of the 37,000 cases confirmed by the CDC, about <a href="http://www.cdc.gov/westnile/resources/pdfs/cummulative/99_2012_CasesAndDeathsClinicalPresentationHumanCases.pdf" target="_blank">16,000 of which</a> involved severe symptoms.
"The authors make a major assumption that the 38 patients in the five-year follow-up period are representative of the entire United States," and that "data obtained in Colorado [can] be extrapolated to other states," cautions Alan Barrett of the University of Texas Medical Branch in an editorial accompanying the report.
Still, he goes on to note that an earlier study of encephalitis-associated hospitalizations arrived at a similar per-patient cost, suggesting that "the data in the present study may be indicative of the national situation."
<div class="KonaFilter image-container float_left click-to-enlarge"><div class="image"><a title_source="Journal of Tropical Medicine and Hygiene / Business Insider" title_caption="Here's what the break down in cost looked like - you can see how the cost in lost productivity caused by death dwarfs everything else." class="zoomin" href="http://static4.businessinsider.com/image/52f95cf0eab8eacd4cbea1e8-960/screen-shot-2014-02-10-at-42258-pm.png"></a>Journal of Tropical Medicine and Hygiene / Business InsiderHere's what the break down in cost looked like - you can see how the cost in lost productivity caused by death dwarfs everything else.</div></div>
The CDC authors also did not take into account the underreporting of WNV, the cost of non-hospitalized cases, or the cost of non-medical expenses like mosquito control. They found that the data collected from their admittedly small cohort "were not significantly different in terms of age and sex by clinical syndrome" than the full CDC data set, except that more of the Colorado patients had paralysis.
The majority - 58% - of the $778 million cost was actually a result of lifetime lost productivity from those people who died.
"For adults in their 20s and 30s, [lifetime productivity] is approximately $1.6 million and then it declines with increasing age," explains Scott Grosse in <a href="http://www.ncbi.nlm.nih.gov/pubmed/19536021" target="_blank">the paper</a> the CDC study used to calculate productivity.
The next-largest cost was for hospitalization when people first got sick. That accounted for another $252 million.

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