Acute Febrile Encephalopathy in Children: Etiology, Clinical Presentation and Outcome

Abstract

Background: Fever and altered sensorium constitute a medical emergency in children. Early recognition, accurate diagnosis and timely management may help in reducing the morbidity and mortality in acute febrile encephalopathy (AFE). AIM: To study etiology, clinical presentation and outcome in children presenting with acute febrile encephalopathy. Methods: This prospective observational cohort study was conducted in a tertiary care center over the duration of one year (2016 to 2017).consecutive patients (age group of one month to 12 years) presenting with fever of ≤ 2 weeks duration and altered mental status were enrolled. The clinical features were noted and patients were followed up through the duration of hospital stay (wards & intensive care unit). Etiology and clinical features were listed as percentage of total cases. Risk factors for mortality were determined using chi-square test. Results: 120 children were enrolled. Besides fever and altered sensorium, convulsions (70%) and meningeal signs (38.3%) were common clinical features. Tubercular meningitis (33.3%) was the most common cause followed by viral encephalitis (24.2%), bacterial meningitis (9.2%) and cerebral malaria (5.8%). Mortality was 16.7% with neuro-morbidity seen in 45% of the cases. Longer duration of hospital stay (≥ 28 days), longer duration of PICU stay (> 14 days), longer duration of mechanical ventilation (≥ 7 days) and low Glasgow coma score (GCS< 8) were risk factors associated with higher mortality. Conclusion: Infectious causes were the commonest cause of AFE. AFE has a high rate of neuro-morbidity. Early identification of high risk factors may help to reduce the mortality. Corresponding Author : Milind S. Tullu, Professor Additional, Department of Pediatrics, Seth Gordhandas Sunderdas Medical College & King Edward Memorial Hospital, Mumbai 400012, Maharashtra, India.