A clinico-epidemiological study of acute encephalitis syndrome with multi organ dysfunction

Abstract

Background: Acute Encephalitis Syndrome (AES) is a pressing public health problem in Eastern Uttar Pradesh, India. Japanese Encephalitis (JE), which has been endemic in this region, has shown a declining trend. AES not due to JE (Non JE) constitutes more than 75% of all cases and is associated with non-neurological clinical manifestations also. The etiology of Non JE AES is still unknown. We studied the clinic-epidemiological profile of AES, and compared Non JE AES to JE.Methods: This study was done in a tertiary care hospital in children 1-15 years. Clinical features, CSF analysis, biochemical tests, radiological features and outcome were studied in AES cases.Results: Out of 505 patients, 27 had an identifiable non-viral etiology. JE was a cause in 31/478(6.48%) patients. The remaining 447 patients were labeled as Non JE AES. Headache at presentation (25.8% vs. 10.7%) and hypertonia (22.6% vs. 9.8%) were significantly higher in JE patients. Swelling over the body (21.25%vs 3.2%) and hypotonia (25.7% vs. 3.2%) were significantly more common in Non JE AES. Although cardiac involvement and multi-organ involvement was more in Non JE AES, the difference was not statistically significant. Overall mortality was 32.42%.Conclusions: JE is no longer an important cause of AES in this region. Swelling over the body, floppiness and multi organ involvement are predominant features of Non JE AES. Although many infectious diseases can present with similar features, a viral etiology seems most likely. Further efforts are needed to identify etiology.