Abstract
Encephalitis is a major cause of morbidity and mortality worldwide. The clinical syndrome of encephalitis consists of altered mental status, seizures, neurologic signs, and is often accompanied by fever, headache, nausea, and vomiting. The encephalitis in children has been known that more common than in adult, with the incidence rate of infants was 3.9 times higher than that of people 20-44 years of age. The reported incidence of hospitalization attributed to paediatric encephalitis ranged from 3 to 13 admissions per 100,000 children per year with the overall mortality ranging from 0 to 7%. There are however more than 100 pathogens that can cause encephalitis and accurate diagnosis is challenging. Over 50% of patients with encephalitis are left undiagnosed despite extensive laboratory investigations. Furthermore, recent studies in high-income settings have suggested autoimmune encephalitis has now surpassed infectious aetiologies, mainly due to increased awareness and diagnostic capacity, which further challenges routine diagnosis and clinical management, especially in developing countries. There are limited contemporary data on the causes of encephalitis in children in Vietnam. Improving our knowledge of the causative agents of encephalitis in this resource-constrained setting remains critical to informing case management, resource distribution and vaccination strategy. Therefore, we conduct a prospective observational study to characterise the clinical, microbiological, and epidemiological features of encephalitis in a major children's hospital in southern Vietnam. Admission clinical samples will be collected alongside meta clinical data and from each study participants. A combination of classical assays (serology and PCR) and metagenomic next-generation sequencing will used to identify the causative agents. Undiagnosed patients with clinical presentations compatible with autoimmune encephalitis will then be tested for common forms of the disease. Finally, using direct- and indirect costs, we will estimate the economic burden of hospitalization and seven days post hospital discharge of paediatric encephalitis in our setting.
Highlights
Encephalitis is a major cause of morbidity and mortality worldwide
In Vietnam we have recently described the diagnosis, clinical management, and long-term outcome of the first case series of anti-NMDAR encephalitis admitted to the Hospital for Tropical Disease (HTD) between 2015 and 201620
This study aims to improve our knowledge about the causes of paediatric encephalitis in southern Vietnam
Summary
The clinical syndrome of encephalitis consists of altered mental status, seizures, neurologic signs, and is often accompanied by fever, headache, nausea, and vomiting. The reported incidence of hospitalization attributed to paediatric encephalitis ranged from 3 to 13 admissions per 100,000 children per year with the overall mortality ranging from 0 to 7%. In the California Encephalitis Project, 1570 patients who were at least six months of age (median age 23 years) were enrolled in the study between 1998 and 2005, and despite extensive microbiologic investigations, no aetiology was identified in 63% of cases. Of the patients with an aetiology identified, a confirmed or probable infectious aetiology was identified in 16%, with viruses (enteroviruses and herpes simplex virus) being the most common causes, accounting for 69% of the detected pathogens. An unfavourable outcome was recorded in 54% of the patients, including 57 (29%) fatal cases
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