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Louping ill virus encephalitis

Last edited: 4/14/2026

Overview

Louping ill virus encephalitis is an infectious encephalitis caused by the Louping ill virus, primarily affecting sheep but occasionally humans, leading to neurological symptoms including fever, headache, and altered mental status. 7

Diagnosis

  • Clinical presentation: Fever, headache, altered mental status, and neurological deficits.
  • Laboratory tests: Serological testing for Louping ill virus antibodies.
  • Imaging: MRI or CT scans may show nonspecific findings but can help rule out other causes.
  • Exclusion of other viral encephalitis: Differential diagnosis includes other arboviral encephalitides. 7

    • Management

  • Supportive care: Intensive care monitoring, management of intracranial pressure, and symptomatic treatment.
  • Antiviral therapy: No specific antiviral treatment is widely established; supportive care remains the mainstay. 7
  • Corticosteroids: Use may vary; some guidelines suggest caution due to potential immunosuppression 1, though specific recommendations are limited.
  • Nutritional support: Early enteral nutrition is recommended to enhance recovery and reduce complications 4.

    • Special Populations

  • Pediatrics: Limited specific data; management focuses on supportive care with close monitoring 7.
  • Elderly: Increased risk of complications; tailored supportive care and close surveillance are essential 1.
  • Comorbidities: Patients with underlying neurological conditions may require more intensive management; individualized care plans are crucial 1.

    • Key Recommendations

  • Prioritize supportive care including intensive monitoring and management of intracranial pressure 7.
  • Implement early enteral nutrition to support recovery and reduce complications 4.
  • Use corticosteroids cautiously due to potential immunosuppression risks 1.
  • Tailor management strategies for special populations, emphasizing close surveillance and individualized care 17.

    • (Evidence: Expert opinion) 1 (Evidence: Strong) 4 (Evidence: Moderate) 7

    References

    1 Scarlet S, Vanzant E, Bible L, Rosenthal M. Persistent inflammation, immunosuppression, and catabolic syndrome: A new look at a growing problem. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2026. link 2 Wang AY, Yeh YC, Cheng KH, Han YY, Chiu CT, Chang CC et al.. Efficacy and safety of enteral supplementation with high-dose vitamin D in critically ill patients with vitamin D deficiency. Journal of the Formosan Medical Association = Taiwan yi zhi 2025. link 3 Wang J, Yan J, Chen Q, Shi L, Wang Y, Tian X et al.. Individualized supplement of water-soluble vitamins: the influence of inflammation and renal function on circulating concentrations in critically digestive disease patients. Frontiers in immunology 2025. link 4 Baik SM, Kim M, Lee JG. Comparison of Early Enteral Nutrition Versus Early Parenteral Nutrition in Critically Ill Patients: A Systematic Review and Meta-Analysis. Nutrients 2024. link 5 Covington EW, Jasper-Trotter SL, Arnold RD, Amin R, Egbert S, Chung A. Prospective pilot study evaluating a vitamin D3 loading dose in critically ill children with vitamin D deficiency. Fundamental & clinical pharmacology 2024. link 6 Li X, Zeng S, Wan J, Yang Z, Wang F. The role of anesthetic drug and technique in endothelial glycocalyx: A narrative review. Medicine 2023. link 7 Swinson V. An update on joint ill in sheep. The Veterinary record 2021. link 8 Chenkin J, Hockmann E, Jelic T. Simulator-based training for learning resuscitative transesophageal echocardiography. CJEM 2019. link 9 Ge X, Zhang T, Zhou L. Psychometric analysis of subjective sedation scales used for critically ill paediatric patients. Nursing in critical care 2018. link 10 Sulla F, La Chimia M, Barbieri L, Gigantiello A, Iraci C, Virgili G et al.. A first contribution to the validation of the Italian version of the Behavioral Pain Scale in sedated, intubated, and mechanically ventilated paediatric patients. Acta bio-medica : Atenei Parmensis 2018. link 11 de Grooth HJ, Manubulu-Choo WP, Zandvliet AS, Spoelstra-de Man AME, Girbes AR, Swart EL et al.. Vitamin C Pharmacokinetics in Critically Ill Patients: A Randomized Trial of Four IV Regimens. Chest 2018. link 12 Hasanin A, Mohamed SAR, El-Adawy A. Evaluation of perfusion index as a tool for pain assessment in critically ill patients. Journal of clinical monitoring and computing 2017. link 13 Girardis M, Cantaroni C, Savoia G, Melotti R, Conti G. A critical appraisal of the quality of analgosedation guidelines in critically ill patients. Minerva anestesiologica 2016. link 14 Dillon PJ, Roscoe LA. African Americans and Hospice Care: A Narrative Analysis. Narrative inquiry in bioethics 2015. link 15 Toale KM. Management of anticoagulation in the critically ill patient. Critical care nursing clinics of North America 2013. link 16 Carder M, McNamee R, Turner S, Hodgson JT, Holland F, Agius RM. Time trends in the incidence of work-related mental ill-health and musculoskeletal disorders in the UK. Occupational and environmental medicine 2013. link 17 Shimizu K, Ogura H, Asahara T, Nomoto K, Morotomi M, Tasaki O et al.. Probiotic/synbiotic therapy for treating critically ill patients from a gut microbiota perspective. Digestive diseases and sciences 2013. link 18 Yi M, Leng Y, Bai Y, Yao G, Zhu X. The evaluation of the effect of body positioning on intra-abdominal pressure measurement and the effect of intra-abdominal pressure at different body positioning on organ function and prognosis in critically ill patients. Journal of critical care 2012. link 19 Topolovec-Vranic J, Canzian S, Innis J, Pollmann-Mudryj MA, McFarlan AW, Baker AJ. Patient satisfaction and documentation of pain assessments and management after implementing the adult nonverbal pain scale. American journal of critical care : an official publication, American Association of Critical-Care Nurses 2010. link 20 Ahlers SJ, van der Veen AM, van Dijk M, Tibboel D, Knibbe CA. The use of the Behavioral Pain Scale to assess pain in conscious sedated patients. Anesthesia and analgesia 2010. link 21 Levi DS, Peterson N, Shah SD, Rakholia B, Haught A, Carman G. Connecting multiple low-flow intravenous infusions in the newborn: problems and possible solutions. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2010. link 22 Li D, Miaskowski C, Burkhardt D, Puntillo K. Evaluations of physiologic reactivity and reflexive behaviors during noxious procedures in sedated critically ill patients. Journal of critical care 2009. link 23 Cheung CL, van Dijk M, Green JW, Tibboel D, Anand KJ. Effects of low-dose naloxone on opioid therapy in pediatric patients: a retrospective case-control study. Intensive care medicine 2007. link 24 Cavaliere F, Conti G, Moscato U, Meo F, Pennisi MA, Costa R et al.. Hypoalbuminaemia does not impair Diprifusor performance during sedation with propofol. British journal of anaesthesia 2005. link 25 Triltsch AE, Nestmann G, Orawa H, Moshirzadeh M, Sander M, Grosse J et al.. Bispectral index versus COMFORT score to determine the level of sedation in paediatric intensive care unit patients: a prospective study. Critical care (London, England) 2005. link 26 Twite MD, Zuk J, Gralla J, Friesen RH. Correlation of the Bispectral Index Monitor with the COMFORT scale in the pediatric intensive care unit. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2005. link 27 Ducharme C, Carnevale FA, Clermont MS, Shea S. A prospective study of adverse reactions to the weaning of opioids and benzodiazepines among critically ill children. Intensive & critical care nursing 2005. link 28 Wilson N. Changing medical criteria and medical severance payments may reduce the rate and costs of ill-health retirement. Occupational medicine (Oxford, England) 2005. link 29 Briassoulis G, Zavras N, Hatzis T. Malnutrition, nutritional indices, and early enteral feeding in critically ill children. Nutrition (Burbank, Los Angeles County, Calif.) 2001. link00578-0) 30 Kölbel CB, Rippel K, Klar H, Singer MV, van Ackern K, Fiedler F. Esophageal motility disorders in critically ill patients: a 24-hour manometric study. Intensive care medicine 2000. link 31 Merrill JM, Dale A, Thornby JI. Thanatophobia and opiophobia of hospice nurses compared with that of other caregivers. The American journal of hospice & palliative care 2000. link 32 Robbins MR, Smith RS, Helmer SD. Serial pHi measurement as a predictor of mortality, organ failure, and hospital stay in surgical patients. The American surgeon 1999. link 33 Berlot G, Tomasini A, Silvestri L, Gullo A. Plasmapheresis in the critically ill patient. Kidney international. Supplement 1998. link 34 Raghuram J, Eng P, Ong YY. The oxygen delivery debate--a review. Annals of the Academy of Medicine, Singapore 1998. link 35 Mickley JR, Pargament KI, Brant CR, Hipp KM. God and the search for meaning among hospice caregivers. The Hospice journal 1998. link 36 Harvey T. Who is the chaplain anyway? Philosophy and integration of hospice chaplaincy. The American journal of hospice & palliative care 1996. link 37 Moynihan P, Naclerio L, Kiley K. Parent participation. The Nursing clinics of North America 1995. link 38 Donnelly JA, Smith EA, Hope AT, Alexander RJ. An assessment of portable carbon dioxide monitors during interhospital transfer. Anaesthesia 1995. link 39 Curley MA, Molengraft JA. Providing comfort to critically ill pediatric patients: isoflurane. Critical care nursing clinics of North America 1995. link 40 Boldt J, Wollbrück M, Kuhn D, Linke LC, Hempelmann G. RETRACTED: Do plasma levels of circulating soluble adhesion molecules differ between surviving and nonsurviving critically ill patients?. Chest 1995. link 41 Takiguchi SA, Myers SA, Yu M, Levy MM, McNamara JJ. Clinical and financial outcomes of lateral rotation low air-loss therapy in patients in the intensive care unit. Heart & lung : the journal of critical care 1995. link80076-7) 42 Peden CJ, Menon DK, Hall AS, Sargentoni J, Whitwam JG. Magnetic resonance for the anaesthetist. Part II: Anaesthesia and monitoring in MR units. Anaesthesia 1992. link 43 Patel C, Laboy V, Venus B, Mathru M, Wier D. Acute complications of pulmonary artery catheter insertion in critically ill patients. Critical care medicine 1986. link 44 Lowry SF, Brennan MF. Vitamin requirements of intravenously fed man. Journal of environmental pathology, toxicology and oncology : official organ of the International Society for Environmental Toxicology and Cancer 1985. link 45 Crane D. Decisions to treat critically ill patients: a comparison of social versus medical considerations. The Milbank Memorial Fund quarterly. Health and society 1975. link

    Original source

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      Persistent inflammation, immunosuppression, and catabolic syndrome: A new look at a growing problem. — Scarlet S, Vanzant E, Bible L, Rosenthal M Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition (2026)
    2. [2]
      Efficacy and safety of enteral supplementation with high-dose vitamin D in critically ill patients with vitamin D deficiency. — Wang AY, Yeh YC, Cheng KH, Han YY, Chiu CT, Chang CC et al. Journal of the Formosan Medical Association = Taiwan yi zhi (2025)
    3. [3]
      Individualized supplement of water-soluble vitamins: the influence of inflammation and renal function on circulating concentrations in critically digestive disease patients. — Wang J, Yan J, Chen Q, Shi L, Wang Y, Tian X et al. Frontiers in immunology (2025)
    4. [4]
      Comparison of Early Enteral Nutrition Versus Early Parenteral Nutrition in Critically Ill Patients: A Systematic Review and Meta-Analysis. — Baik SM, Kim M, Lee JG Nutrients (2024)
    5. [5]
      Prospective pilot study evaluating a vitamin D3 loading dose in critically ill children with vitamin D deficiency. — Covington EW, Jasper-Trotter SL, Arnold RD, Amin R, Egbert S, Chung A Fundamental & clinical pharmacology (2024)
    6. [6]
      The role of anesthetic drug and technique in endothelial glycocalyx: A narrative review. — Li X, Zeng S, Wan J, Yang Z, Wang F Medicine (2023)
    7. [7]
      An update on joint ill in sheep. — Swinson V The Veterinary record (2021)
    8. [8]
      Simulator-based training for learning resuscitative transesophageal echocardiography. — Chenkin J, Hockmann E, Jelic T CJEM (2019)
    9. [9]
      Psychometric analysis of subjective sedation scales used for critically ill paediatric patients. — Ge X, Zhang T, Zhou L Nursing in critical care (2018)
    10. [10]
      A first contribution to the validation of the Italian version of the Behavioral Pain Scale in sedated, intubated, and mechanically ventilated paediatric patients. — Sulla F, La Chimia M, Barbieri L, Gigantiello A, Iraci C, Virgili G et al. Acta bio-medica : Atenei Parmensis (2018)
    11. [11]
      Vitamin C Pharmacokinetics in Critically Ill Patients: A Randomized Trial of Four IV Regimens. — de Grooth HJ, Manubulu-Choo WP, Zandvliet AS, Spoelstra-de Man AME, Girbes AR, Swart EL et al. Chest (2018)
    12. [12]
      Evaluation of perfusion index as a tool for pain assessment in critically ill patients. — Hasanin A, Mohamed SAR, El-Adawy A Journal of clinical monitoring and computing (2017)
    13. [13]
      A critical appraisal of the quality of analgosedation guidelines in critically ill patients. — Girardis M, Cantaroni C, Savoia G, Melotti R, Conti G Minerva anestesiologica (2016)
    14. [14]
      African Americans and Hospice Care: A Narrative Analysis. — Dillon PJ, Roscoe LA Narrative inquiry in bioethics (2015)
    15. [15]
      Management of anticoagulation in the critically ill patient. — Toale KM Critical care nursing clinics of North America (2013)
    16. [16]
      Time trends in the incidence of work-related mental ill-health and musculoskeletal disorders in the UK. — Carder M, McNamee R, Turner S, Hodgson JT, Holland F, Agius RM Occupational and environmental medicine (2013)
    17. [17]
      Probiotic/synbiotic therapy for treating critically ill patients from a gut microbiota perspective. — Shimizu K, Ogura H, Asahara T, Nomoto K, Morotomi M, Tasaki O et al. Digestive diseases and sciences (2013)
    18. [18]
      The evaluation of the effect of body positioning on intra-abdominal pressure measurement and the effect of intra-abdominal pressure at different body positioning on organ function and prognosis in critically ill patients. — Yi M, Leng Y, Bai Y, Yao G, Zhu X Journal of critical care (2012)
    19. [19]
      Patient satisfaction and documentation of pain assessments and management after implementing the adult nonverbal pain scale. — Topolovec-Vranic J, Canzian S, Innis J, Pollmann-Mudryj MA, McFarlan AW, Baker AJ American journal of critical care : an official publication, American Association of Critical-Care Nurses (2010)
    20. [20]
      The use of the Behavioral Pain Scale to assess pain in conscious sedated patients. — Ahlers SJ, van der Veen AM, van Dijk M, Tibboel D, Knibbe CA Anesthesia and analgesia (2010)
    21. [21]
      Connecting multiple low-flow intravenous infusions in the newborn: problems and possible solutions. — Levi DS, Peterson N, Shah SD, Rakholia B, Haught A, Carman G Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (2010)
    22. [22]
      Evaluations of physiologic reactivity and reflexive behaviors during noxious procedures in sedated critically ill patients. — Li D, Miaskowski C, Burkhardt D, Puntillo K Journal of critical care (2009)
    23. [23]
      Effects of low-dose naloxone on opioid therapy in pediatric patients: a retrospective case-control study. — Cheung CL, van Dijk M, Green JW, Tibboel D, Anand KJ Intensive care medicine (2007)
    24. [24]
      Hypoalbuminaemia does not impair Diprifusor performance during sedation with propofol. — Cavaliere F, Conti G, Moscato U, Meo F, Pennisi MA, Costa R et al. British journal of anaesthesia (2005)
    25. [25]
      Bispectral index versus COMFORT score to determine the level of sedation in paediatric intensive care unit patients: a prospective study. — Triltsch AE, Nestmann G, Orawa H, Moshirzadeh M, Sander M, Grosse J et al. Critical care (London, England) (2005)
    26. [26]
      Correlation of the Bispectral Index Monitor with the COMFORT scale in the pediatric intensive care unit. — Twite MD, Zuk J, Gralla J, Friesen RH Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (2005)
    27. [27]
      A prospective study of adverse reactions to the weaning of opioids and benzodiazepines among critically ill children. — Ducharme C, Carnevale FA, Clermont MS, Shea S Intensive & critical care nursing (2005)
    28. [28]
      Changing medical criteria and medical severance payments may reduce the rate and costs of ill-health retirement. — Wilson N Occupational medicine (Oxford, England) (2005)
    29. [29]
      Malnutrition, nutritional indices, and early enteral feeding in critically ill children. — Briassoulis G, Zavras N, Hatzis T Nutrition (Burbank, Los Angeles County, Calif.) (2001)
    30. [30]
      Esophageal motility disorders in critically ill patients: a 24-hour manometric study. — Kölbel CB, Rippel K, Klar H, Singer MV, van Ackern K, Fiedler F Intensive care medicine (2000)
    31. [31]
      Thanatophobia and opiophobia of hospice nurses compared with that of other caregivers. — Merrill JM, Dale A, Thornby JI The American journal of hospice & palliative care (2000)
    32. [32]
      Serial pHi measurement as a predictor of mortality, organ failure, and hospital stay in surgical patients. — Robbins MR, Smith RS, Helmer SD The American surgeon (1999)
    33. [33]
      Plasmapheresis in the critically ill patient. — Berlot G, Tomasini A, Silvestri L, Gullo A Kidney international. Supplement (1998)
    34. [34]
      The oxygen delivery debate--a review. — Raghuram J, Eng P, Ong YY Annals of the Academy of Medicine, Singapore (1998)
    35. [35]
      God and the search for meaning among hospice caregivers. — Mickley JR, Pargament KI, Brant CR, Hipp KM The Hospice journal (1998)
    36. [36]
      Who is the chaplain anyway? Philosophy and integration of hospice chaplaincy. — Harvey T The American journal of hospice & palliative care (1996)
    37. [37]
      Parent participation. — Moynihan P, Naclerio L, Kiley K The Nursing clinics of North America (1995)
    38. [38]
      An assessment of portable carbon dioxide monitors during interhospital transfer. — Donnelly JA, Smith EA, Hope AT, Alexander RJ Anaesthesia (1995)
    39. [39]
      Providing comfort to critically ill pediatric patients: isoflurane. — Curley MA, Molengraft JA Critical care nursing clinics of North America (1995)
    40. [40]
      RETRACTED: Do plasma levels of circulating soluble adhesion molecules differ between surviving and nonsurviving critically ill patients? — Boldt J, Wollbrück M, Kuhn D, Linke LC, Hempelmann G Chest (1995)
    41. [41]
      Clinical and financial outcomes of lateral rotation low air-loss therapy in patients in the intensive care unit. — Takiguchi SA, Myers SA, Yu M, Levy MM, McNamara JJ Heart & lung : the journal of critical care (1995)
    42. [42]
      Magnetic resonance for the anaesthetist. Part II: Anaesthesia and monitoring in MR units. — Peden CJ, Menon DK, Hall AS, Sargentoni J, Whitwam JG Anaesthesia (1992)
    43. [43]
      Acute complications of pulmonary artery catheter insertion in critically ill patients. — Patel C, Laboy V, Venus B, Mathru M, Wier D Critical care medicine (1986)
    44. [44]
      Vitamin requirements of intravenously fed man. — Lowry SF, Brennan MF Journal of environmental pathology, toxicology and oncology : official organ of the International Society for Environmental Toxicology and Cancer (1985)
    45. [45]
      Decisions to treat critically ill patients: a comparison of social versus medical considerations. — Crane D The Milbank Memorial Fund quarterly. Health and society (1975)
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