G440(P) Validation of world health organization definition of acute encephalitis syndrome with central nervous system infection in nepali children

Abstract

Aims World Health Organisation(WHO) defines acute encephalitis syndrome(AES) as a person of any age, at any time of year, with the acute onset of fever and a change in mental status and/or new onset of seizures in order to identify patients with possible acute encephalitis(AE). We aimed to compare and validate WHO definition of AES with the diagnosis of all central nervous system(CNS) infections, bacterial meningitis (BM), viral encephalitis and Japanese Encephalitis(JE). We also aimed to validate positive cerebrospinal fluid(CSF) cytology and biochemistry result with the diagnosis of BM and JE. Methods We conducted a prospective cross-sectional study recruiting children aged between 1 month to 14 years attending Kanti Children’s Hospital, Kathmandu, Nepal with altered sensorium and two of the following: fever, seizure, focal neurological deficit, CSF pleocytosis, electroencephalogram and computer tomography suggestive of encephalitis, over one year. In these patients, VE was if CSF cell count was 1000 cells/mm3(polymorph predominance) and CSF protein >0.45 g/L and CSF/plasma glucose 4/mm3. Results Out of 38, bacterial meningitis was found in 47%, JE 21% and other causes in 32%. Although WHO definition of AES was not significantly associated with all CNS infections (p-value= 0.069), it was significantly associated with VE (p-value≤0.001, sensitivity 74%, specificity 93%, PPV 94%, NPV 70%) and BM (p-value≤0.001, sensitivity 30%, specificity 7%, PPV 33%, NPV 6%). Likewise, CSF criteria(cytology and biochemistry) for diagnosing JE was significantly associated with confirmed diagnosis of JE(p-value= 0.001). Conclusion We validate WHO AES definition of BM and VE and CSF cytology and biochemistry analysis for the diagnosis of JE, as a significantly useful screening tool for children with these diseases specially in resource poor settings, endemic areas and confirmatory tests were not easily available.