LISTEN: A new study warns the number of people at risk of developing encephalitis from an infection is growing and that can lead to mental health problems. GPB’s Ellen Eldridge has more.

A woman lies in a hospital bed

Michelle Bravo Cano lies in a hospital bed in 2018. Then 20 years old, she'd experienced nearly a year of symptoms of mental illness after developing encephalitis.

Credit: Family photo

Michelle Bravo Cano almost ended her life by suicide — twice.  

Now 25, Bravo Cano said she'd never experienced depression or mental health problems before developing encephalitis in 2017.  

She was abroad in Paris from January to May that year and started feeling manic, she said, describing a period of insomnia during which she couldn't sleep for days and she wasn't eating. She said she used alcohol to stop headaches, and felt depressed. 

Once time, she nearly jumped from her third-story room window, she said. 

“So, after I came back from Paris, there was another kind of like suicide attempt in the summer,” Bravo Cano said. “I remember that on that particular day I was, like, doing my makeup, getting ready to, like, go out or do something, and suddenly I just started crying; bawling. I got in my car and went to the park and I just kind of like sat there.” 

At the time, she had no idea what was going on with her. 

Brain inflammation — also known as encephalitis — leads some patients to suicidal thoughts and behaviors, a pair of new studies suggest.  

“We've got two papers that we're releasing for World Encephalitis Day,” said Dr. Eva Easton, one of the study authors.  

The first study included more than 400 patient respondents in more than 31 countries, and found that 37% of survivors of encephalitis thought about or attempted suicide. 

The relationship between brain inflammation and depression was uncovered in a peer-reviewed study published Feb. 22 in the Journal of Neuropsychiatry and Clinical Neurosciences.  

While anybody can develop an autoimmune or infectious encephalitis, some groups are more at risk than others, Easton said.  

“So, for example, if you're a traveler and you don't have an immunity to something that exists in other communities, then you might be more susceptible,” Easton said. “But, generally speaking, encephalitis can affect anyone of any sex, any age, any ethnicity.” 

Patients often report feeling unwell for days, weeks and even months in some cases before they become acutely unwell, Easton said. 

Their condition often gets misdiagnosed as psychiatric in nature, which Easton said is a problem because that means patients don't get the correct diagnosis or the right treatment that they need. 

That's what happened to Bravo Cano. 

When her mental health continued to deteriorate, her mother took her to an emergency room. 

“I apparently had taken off my clothes and just like, ran through the halls of the ER bum naked,” Bravo Cano said. “I do not remember any of this, by the way. This is just what my mom told me.” 

Patients without a proper diagnosis and treatment can have seizures, lose consciousness and possibly become comatose, Easton said. 

Bravo Cano, who spent January 2018 hospitalized, still has lesions on her brain from the condition. 

Infectious encephalitis is typically caused by a viral infection such as herpes simplex virus types 1 and 2, varicella zoster virus and enteroviruses, which cause gastrointestinal illness. Symptoms begin with flu-like symptoms, headaches and high temperatures. 

Some causes of encephalitis, such as measles, are vaccine preventable. 

“Travelers might be familiar with getting vaccines for Japanese encephalitis if they're traveling to Southeast Asia and the Pacific Islands, for example,” Easton said. “And, of course, COVID-19 now is vaccine preventable. So, the gold standard is prevention and the right treatment in some cases, but not in others.” 

Another way to protect against encephalitis is bug spray.  

Several mosquito-borne viruses circulate in Georgia yearly and can cause disease in humans and other animals, according to the state Department of Public Health.  

While the most reported mosquito-borne virus in Georgia is West Nile virus, epidemiologists have detected Eastern Equine encephalitis, La Crosse encephalitis, and Saint Louis encephalitis viruses. 

Bravo Cano wished she had known at the time of her acute encephalitis that everything that was happening wasn't all in her head.

“I would have much preferred the diagnosis to have been schizophrenia rather than encephalitis,” Bravo Cano said. “Because if it were schizophrenia, then, in a way, none of what happened would have happened at all." 

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