What to know about encephalitis, Sen. Feinstein's shingles complication

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Shingles, the infection that sent Sen. Dianne Feinstein to the hospital in February, affects a third of Americans. But the related complications the 89-year-old senator faced - encephalitis and Ramsay Hunt syndrome - are less common and can be severe.

Feinstein (D-Calif.) returned to Washington last week after a months-long absence and has recovered from the encephalitis, an inflammation of the brain, her spokesman said.

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Here's what to know about shingles and its potential complications.

- What is shingles and how can it cause encephalitis?

Shingles is a painful rash that forms on one side of the face or body and consists of blisters, according to the Centers for Disease Control and Prevention. The rash usually forms in a single stripe on the body. Other symptoms can include fever, headache, chills and upset stomach, and 10 to 18 percent of people develop long-lasting nerve pain, the most common shingles complication.

A third of Americans will develop shingles during their lives, the CDC says. It results from the same virus that causes chickenpox, the varicella zoster virus, and the risk grows with age. "If you've ever had chickenpox, you can get shingles," the CDC says, adding that over 99 percent of Americans born before 1980 have had chickenpox, even if they don't remember it.

After a person recovers from chickenpox, the virus that caused it "hides in groups of nerve cells close to the spinal cord, controlled by our immune systems," says Tony Cunningham, an infectious-disease physician at Australia's Westmead Institute for Medical Research. Shingles occurs when "these controlling immune cells" decrease, he said.

Shingles is generally not life-threatening, says Michael Wilson, a doctor who specializes in encephalitis at the University of California at San Francisco. But in rare instances, the varicella zoster virus "can attack the brain cells."

That is when patients may suffer from shingles-related encephalitis, a swelling of the brain, Wilson said - a much more serious complication.

- How common is post-shingles encephalitis?

Very uncommon. The risk for post-shingles encephalitis rises with age, and in people with weaker immune systems. But "we're still talking about one in a thousand or something. The numbers vary because it's so rare," Wilson said.

Even among senior citizens, encephalitis is rare in people with normal immune systems, says Cunningham, the infectious-disease expert in Australia. Less than 2 percent of those with shingles will experience encephalitis, he said.

- What are the symptoms of encephalitis?

Encephalitis symptoms tend to get worse over the course of days to weeks and can include fever, headache, sensitivity to light or sound, neck stiffness, or even seizures and loss of consciousness.

More severe cases may involve partial paralysis of the arms or legs, double vision, impairment of speech or hearing and coma, according to Johns Hopkins Medicine, which recommends "prompt treatment to lower the risk of lasting complications or death."

"The outcome is quite variable," says Lance Turtle, a consultant physician in infectious diseases at the University of Liverpool in Britain. "Some patients recover well" while others can have lasting brain damage or die, he said. Early treatment usually gives the best chance of recovery, he added.

It is not known what Feinstein's symptoms were, or how severe they were.

- Can shingles lead to Ramsay Hunt syndrome?

Yes, though it's also quite rare. Ramsay Hunt syndrome is caused by the same virus that causes chickenpox and shingles, and refers to facial paralysis accompanied by a rash. Last year the singer Justin Bieber, who also had shingles, announced he was suffering from Ramsay Hunt syndrome, which paralyzed one side of his face and cut his tour short.

The rare condition can result in hearing loss, while symptoms include blisters in the ears or the roof of the mouth.

Ramsay Hunt syndrome occurs when a shingles case "affects the facial nerve near one of your ears," according to the Mayo Clinic, a nonprofit health-care group in the United States. The two main symptoms are a "painful red rash with fluid-filled blisters" near, in, or on one ear, and "facial weakness or paralysis on the same side as the affected ear." Both occur at the same time, but sometimes the rash never occurs, according to the Mayo Clinic. Ear pain and hearing loss may accompany the symptoms.

- Is there a shingles vaccine?

Yes, and Feinstein has received it, The Post has reported.

The vaccine Shingrix was licensed by the Food and Drug Administration in 2017 as a more effective replacement for an earlier vaccine.

The CDC recommends adults ages 50 and older get two doses of Shingrix, separated by two to six months. Adults 19 or older should also get the vaccine if they have weakened immune systems due to disease or treatment. This latter group of adults may also get the second shot one or two months after their initial dose, the CDC says.


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Video: Sen. Dianne Feinstein (D-Calif.), 89, returned to the U.S. Capitol May 11 after a health-related absence that lasted more than two months.(REF:tuckerw/The Washington Post)

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