Abstract
Background: The north eastern region of India is an endemic area for viral encephalitis that clinically presents as acute encephalitis syndrome (AES). The Japanese Encephalitis (JE) is an acute mosquito-borne viral disease and the most important causative agent of AES in this region, resulting in considerable morbidity and mortality every year. JE is endemic in Assam with outbreaks every year during the monsoons.
Aims: This study was conducted to study the clinical profile of pediatric Acute Encephalitic Syndrome with special reference to Japanese Encephalitis admitted to the department of Pediatrics, Jorhat Medical College and Hospital.
Study Design: Retrospective record-based hospital study in the Department of Pediatrics, Jorhat Medical College and Hospital, Jorhat for 2 years (1st January 2014 to 31st December 2015).
Methods And Materials: All admitted cases age between 2months to 12 years fulfilling WHO clinical criteria of AES admitted in Pediatric Ward during study period were included in the study. Other cause of fever, altered sensorium with or without seizure and febrile seizure cases were excluded from the study. Clinical & pathological profile, outcome were analyzed from patient bed head tickets.
Results: The mean age at presentation of AES in children was 6.5 years (range 2 month-12 years) with a male: female ratio of 1:1.2. The maximum number of cases presented during the monsoon months of July and August. JE virus was the commonest causative agent accounting for 34.56% of all cases. Case fatality rate for JE was 51.78% and the majority of deaths were observed in the age group of 5 to 12 years.
Conclusion: Acute Encephalitic Syndrome is a major public health problem in Assam. The yearly seasonal occurrence of both Japanese and Non – JE encephalitic diseases is associated with significant mortality and morbidity in terms of long term neurological sequeale. Japanese Encephalitis accounts for a majority of cases of AES in this region. Though JE vaccine has been introduced in the National Immunization Schedule (NIS), effective vaccination combined with improved vector control strategies and public awareness will be helpful in reducing the disease burden of Japanese Encephalitis.
Keywords: Encephalitis, Japanese; Encephalitis, Viral; Japanese Encephalitis Vaccines.
References
1. Forbes BA, Sahm DF, Weissfeld AS, editors. Bailey & Scott’s Diagnostic Microbiology, 12th ed.Missouri: Mosby Elsevier; 2007. p. 826.
2. Solomon T, Thao TT, Lewthwaite P, et al. A cohort study to assess the new WHO Japanese encephalitis surveillance stand-ards. Bull World Health Organ 2008;86 (3):178-86.
3. Mishra UK, Tan CT, Jayanti K. Seizures in encephalitis. Neurol Asia 2008;13:1-13.
4. Reuben R, Gajanana A. Japanese encepha-litis in India. Indian J Pediatr 1997;64:243-51.
5. Japanese Encephalitis: A manual for Medical Officers of Health, Epidemiology Unit, Ministry of health, PATH. Available at: http://www.epid.gov.lk/web/attachmen-ts/a rticle/141/JE%20book.pdf
6. Basumatary LJ, Raja D, Bhuyan D, Das M, Goswami M, KayalAK.Clinical and radiological spectrum of Japanese encephalitis. J Neurol Sci 2013;325:1521.
7. Ghosh D, Basu A. Japanese encephalitis-a pathological and clinical perspective. PLoS Negl Trop Dis 2009;3:e437.
8. Solomon T, Dung NM, Kneen R, Gainsborough M, Vaughn DW,Khanh VT. Japanese encephalitis. J Neurol Neurosurg Psychiatry 2000;68:405-15.
9. Cuzzubo AJ, Endy TP, Vaughn DW, Solemon T, Nisalak A, Kalayanarooj S, et al. Evaluation of a new commercially available immunoglobulin M capture enzyme- linked immunosarbent assay for diagnosis of Japanese Encephalitis infections. J Clin Microbiol. 1999;37:3738 41. [PMC free article] [PubMed)
10. Burke DS, Nisalak A, et al. Kinetics of IgM and IgG responses to Japanese encephalalitis virus in human serum and cerebrospinal fluid. J Infect Dis 1985.151(6): 1093-9
11. Revised Treatment Guidelines of AES including JE - NVBDCP, Available at:nvbdcp.gov.in/Doc/Revised%20guidelines%20on%20AES_JE.pdf
12. Guidelines for Surveillance of Acute Encephalitis Syndrome (with Special Reference to Japanese Encephalitis). Directorate of National Vector Borne Diseases Control Programme , Directorate General of Health Services, Ministry of Health and Family Welfare, November 2006. Available from: http://www.nvb-dcp.gov.in/Doc/AES%20guidelines. pdf (Last accessed on 15.05.2014).
13. Gitali Kakoti, Prafulla Dutta, Bishnu Ram Das, Jani Bora, Jagadish Mahanta. Clinical Profile and Outcome of Japanese Encephalitis in Children admitted with Acute Encephalitis Syndrome. Biomed Research International: Vol. 2013; p 1-5.
14. L Kabilan,S Ramesh, S Muthukumarvel, R Rajendran. Hospital and Laboratory investigation of hospitalized children with central nervous system related symptom to assess Japanese encephalitis virus etiology in Cuddalore district, Tamilnadu,India. “Journal of Clinical Microbiology, Vol 42,No.6 , p2813-2815;2004.
15. Mahima Mittal , K P Kushwaha. AES: Clinical Presentation and Dilemmas in Critical Care Management. J.Commun. Dis. 2014;46 (1):50-65.
16. Abhisekh Roy, Kalyanbrata Mandal, Sandip Sen, Toshibananda Bag. Study of acute viral meningoencephalitis in children in sub Himalayan Tarai region: Clinico-epidemiological, etiological and imaging profile.Indian J. Child Health; Vol 2,Issue 4, October-December 2015, p177-181.
17. Y R Khinchi, A Kumar, S Yadav. Study of acute encephalitic syndrome in children. Journal of College of Medical Sciences, Nepal; Vol. 6, No1,p7-13.
18. Saumen De, Sanjana Samanta, Sanjay Halder, Pronabesh Sarkar. Clinical Profile and Outcome of Children Admitted with Acute Encephalitic Syndrome in a Tertiary Care hospital in West Bengal, India. IOSR Journal of Dental and Medical Sciences: Volume 14, Issue 11, Nov 2015, p 08-12.
19. D G Mohan, N K Hazarika:A Clinico- pathological Study and Demographic Profile of Japanese Encephalitis from a Tertiary Care Hospital in Assam, India.International Journal of Current Microbiology and Applied Sciences: Volume 4, No 6, p 522-529.
20. Saurav Jyoti Patgiri, Achinta K. Borthakur, Biswajyoti Borkakoti, Lahori Saikia, Ridip Dutta, Sanjib Kr . Phukan. An appraisal of Clinico- pathological parameters in Japanese Encephalitis and Changing Epidemiological trends in Upper Assam, India.Indian Journal of Pathology and Microbiology; 57(3), July-Sep 2014, p 400-406.
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.61
