Etiology of Acute Encephalitis Syndrome in Adults in a Tertiary Care Center in Eastern Uttar Pradesh

Abstract

Seasonal outbreaks of acute encephalitis syndrome (AES) with high case fatality rates have been commonly reported among adults in India. With an increase in Japanese encephalitis virus (JEV) vaccination, the etiology of AES is also changing. However, most studies on AES in India have focused only on children and on JEV. This study was conducted in the Department of Medicine, Institute of Medical Sciences, Banaras Hindu University between 2020 and 2022 to determine the etiology of AES in adults. Blood and cerebrospinal fluid (CSF) were collected from patients 18 years or older with fever and altered sensorium for ≤15 days. We did IgM ELISA for dengue, chikungunya, West Nile virus, scrub typhus, leptospirosis from serum, CSF-IgM for JEV, and CSF–polymerase chain reaction for herpes simplex virus 1 and 2, varicella-zoster virus, enterovirus, and cartridge-based nucleic acid amplification test (CBNAAT) for tuberculous meningitis (TBM). The most common cause of AES identified in our study was TBM (16.7%), followed by leptospirosis (15.1%) and scrub typhus (11.9%). The high occurrence of TBM in our study highlights the importance of CSF-CBNAAT for all AES patients. As leptospirosis and scrub typhus are easily treatable, early detection and treatment of these infections should be recommended.