Abstract
Background: Acute encephalitis syndrome (AES) is defined as the acute-onset of fever and a change in mental status, these can include signs and symptoms such as confusion, disorientation, delirium or coma and/or new-onset of seizures. (Simple febrile seizures are not included) in a person of any age at any time of the year. AES is reported mainly from states like Assam, Bihar, Tamil Nadu, Karnataka, Uttar Pradesh attribute to major percentage of cases with over all case fatality rate of 20-25%. The objective of present work was to study the occurrence and outcome of AES cases admitted in PICU
Methods: This study was conducted in children admitted in PICU, Silchar medical college and hospital over a period of 1 year (July 2019 to June 2020).92 AES cases were admitted over this period. History, clinical features, demography, immunization status and outcome were recorded. Results of blood investigation, CSF analysis and IgM ELISA for HSV, JE, CMV, Dengue, scrub typhus were recorded and analysed.
Results: The percentage of AES in PICU was 7.47% (92/1230). Mean age of the cases was 4.3+-3.2 years. Male to female ratio was 2.06:1.The percentage of children who presented as AES and were not immunized fully was 91.3%.Most common presentation was seizure. Dysglycemia was present in 15.2% of cases. 6.5% of AES cases were JE positive. Hyponatremia (p value 0.007747) and shock (p value 0.00001) at presentation were associated with increased mortality. Mortality rate of infants were found to be higher than non infants. Behavioual disturbances were found in 20% of follow up cases.
Conclusions: 6.5% of AES cases were JE positive. Hyponatremia at presentation of AES cases are associated with increased risk of mortality, so it need priority care. Prompt identification and treatment of dysglycemia and shock are important in AES cases. General awareness and proper education amoung people about the immunization and hygienic practices will be beneficial.
References
- Solomon T, Thao TT, Lewthwaite P, Ooi MH, Kneen R, Dung NM, et al. A cohort study to assess the new WHO Japanese encephalitis surveillance standards. Bull World Health Organ. 2008;86(3):178-86.
- Joshi R, Kalantri SP, Reingold A, Colford JM Jr: Changing landscape of acute encephalitis syndrome in India: a systematic review. Natl Med J India 2012; 25: 212–220
- Joshi R, Kalantri SP, Reingold A, Colford JM Jr. Changing landscape of acute encephalitis syndrome in India: a systematic review. Natl Med J India. 2012;25(4)212-20.
- Vaughn DW, Hoke Jr CH. The epidemiology of Japanese encephalitis: prospects for prevention. Epidemiol Rev. 1992;14:197-221.
- Geevarghese G, Kanogia PC, Mishra AC (2004) Japanese encephalitis-Vector Biology. NIV Pune Year Book. Orient Longman Publication, Himayatnagar 335- 356.
- Guidelines clinical management of acute encephalitis syndrome Including japanese encephalitis Government of India Directorate of national vector borne disease control programme.
- Dutta K, Rangarajan PN, Vrati S, Basu A. Japanese encephalitis: pathogenesis, prophylactics and therapeutics. Current Science. 2010; 98(3):326-334.
- Dhillon GP, Raina VK. Epidemiology of Japanese encephalitis in context with Indian scenario. Journal of the Indian Medical Association. 2008; 106(10):660-663.
- Webb JKG, Pereira SM. Clinical diagnosis of arthropod borne type viral encephalitis in children in North Arcot district, Madras state, India. Indian Journal of Medical Science. 1956; 10:572
- Banerjee K, Sengupta SN, Dandawate CN, Tongaonkar SS, Gupta NP. Virological and serological investigations of an epidemic of encephalitis which occurred at Bankura district, West Bengal. Indian Journal of Medical Research. 1976; 64:121-130.
- Kabilan L, Rajendran R, Arunachalam N, Ramesh S, Srinivasan S, Samuel PP et al. Japanese encephalitis in India: an overview. Indian Journal of Pediatrics. 2004; 71:609-615.
- Phukan AC, Borah PK, Mahanta J. Japanese encephalitis in Assam, North East India. Southeast Asian Journal of Tropical Medical Public Health. 2004; 35:618-622.
- Khan SA, Narian K, Handique R, Dutta P, Mahanta J, Satyanarayana K et al. Role of some environmental factors in modulating seasonal abundance of potential Japanese encephalitis vectors in Assam, India. Southeast Asian Journal of Tropical Medicine and Public Health. 1996; 27:382-391.
- Chattopadhyay UK. A study on the status of Japanese encephalitis infection in Arunachal Pradesh. Journal of Communicable Diseases. 2001; 33:261-265.
- Khan SA, Dutta P, Khan AM, Topno R, Chowdhury P, Borah J et al. Japanese encephalitis epidemiology in Arunachal Pradesh, a hilly state in northeast India. Asian Pacific Journal of Tropical Disease. 2011, 119-122.
- Sambasivam E, Muthaiyan J, Mohan S, Ayyavoo AM, Jayachandran G. Clinical profile and predictors of outcome in children admitted to PICU with acute encephalitis syndrome. International Journal of Contemporary Pediatrics. 2017 Jun 21;4(4):1214-7.
- Thapa LJ, Twayana RS, Shilpakar R, Ghimire MR, Shrestha A, Sapkota S et al. Clinical profile and outcome of acute encephalitis syndrome (AES) patients treated in College of Medical Sciences-Teaching Hospital. Journal of College of Medical Sciences-Nepal. 2013; 9(2):31-37.
- Borah J, Dutta P, Khan SA, Mahanta J. A comparison of clinical features of Japanese encephalitis virus infection in the adult and pediatric age group with Acute Encephalitis Syndrome. Journal of Clinical Virology. 2011; 52(1):45-9.
- Gogoi A, Panyang R, Baro L. Acute encephalitis syndrome in children with special reference to Japanese encephalitis: a retrospective analysis. J Evolution Med. Dent. Sci. 2016; 5(51):3289-3294.
- Misra UK, Kalita J, Singh RK, Bhoi SK. A study of hyponatremia in acute encephalitis syndrome: a prospective study from a tertiary care center in India. Journal of Intensive Care Medicine. 2017 Jan 1:0885066617701422.
Corresponding Author
Anupama Deka
Professor and HOD, Department of Pediatrics, Silchar Medical College, Silchar, India
DOI: https://dx.doi.org/10.18535/jmscr/v9i6.23
