Clinical profile and prognostic markers of acute febrile encephalopathy (AFE) in adult patients presenting to a North Indian tertiary care hospital

Abstract

Background: Acute febrile encephalopathy (AFE) is a clinical term used to an altered mental state that either accompanies or follows a short febrile illness and is characterized by a diffuse and nonspecific brain insult manifested by a combination of coma, seizures, and decerebration. Objective: To identify the clinical and etiological profile of acute febrile encephalopathy in adult patients presenting to JNMCH, Aligarh from January-December, 2014. Patients and Methods: 238 adults (>14 yrs.) presenting to the emergency with complains of fever (>38΀C) of less than 2 weeks duration with altered sensorium with/or without seizure were prospectively investigated for etiological cause. The investigations included routine blood investigations, chest X-rays, cerebrospinal fluid (CSF) microscopy, bacterial and fungal cultures, CSF serology, peripheral smear and serology for malarial parasite. Other investigations included were CT or MRI wherever indicated. Non-infectious causes were ruled out by various investigations mentioned above. Outcome was evaluated by the report of investigations and response to treatment over during the period of inpatient treatment. Results: Out of all the patients admitted, acute pyogenic meningitis was the most common cause accounting for 34.5% of cases followed by cerebral malaria 20.2%, sepsis associated encephalopathy 14.3%, acute meningoencephalitis 9.2%, tubercular meningitis 6.7%, enteric encephalopathy 2.5% and fungal meningitis in 1.3% cases. Conclusion: Acute pyogenic meningitis is the most common cause of AFE in the patients who reported to JNMCH in the past one year. Prompt and specific treatment can mimimise morbidity and mortality in many cases presenting with AFE.