Viral Etiology of Encephalitis in Children in Southern Vietnam: Results of a One-Year Prospective Descriptive Study

Le Van Tan,Tran Vu Thieu Nga,Menno D De Jong,Tran Tinh Hien,Constance Schultsz,Truong Huu Khanh,Jeremy Farrar,Lam Quoi Bao,Bach Van Cam,Tran Tan Tram,Vo Minh Hien,Nguyen Van Vinh Chau,H Rogier Van Doorn,Phan Tu Qui,Do Quang Ha,Nguyen Bach Hue,Sunit Kumar Singh

doi:10.1371/journal.pntd.0000854

Abstract

BackgroundAcute encephalitis is an important and severe disease in children in Vietnam. However, little is known about the etiology while such knowledge is essential for optimal prevention and treatment. To identify viral causes of encephalitis, in 2004 we conducted a one-year descriptive study at Children's Hospital Number One, a referral hospital for children in southern Vietnam including Ho Chi Minh City.Methodology/Principal FindingsChildren less than 16 years of age presenting with acute encephalitis of presumed viral etiology were enrolled. Diagnostic efforts included viral culture, serology and real time (RT)-PCRs. A confirmed or probable viral causative agent was established in 41% of 194 enrolled patients. The most commonly diagnosed causative agent was Japanese encephalitis virus (n = 50, 26%), followed by enteroviruses (n = 18, 9.3%), dengue virus (n = 9, 4.6%), herpes simplex virus (n = 1), cytomegalovirus (n = 1) and influenza A virus (n = 1). Fifty-seven (29%) children died acutely. Fatal outcome was independently associated with patient age and Glasgow Coma Scale (GCS) on admission.Conclusions/SignificanceAcute encephalitis in children in southern Vietnam is associated with high mortality. Although the etiology remains unknown in a majority of the patients, the result from the present study may be useful for future design of treatment and prevention strategies of the disease. The recognition of GCS and age as predictive factors may be helpful for clinicians in managing the patient.

Highlights

Acute encephalitis is associated with high morbidity and mortality and affects both children and adults
Viral encephalitis is associated with high morbidity and mortality in Vietnam
Knowledge about the etiologies and clinical outcome of viral encephalitis is necessary for future design of intervention studies targeted at improvement of clinical management, treatment and prevention of the disease

Summary

Introduction

Acute encephalitis is associated with high morbidity and mortality and affects both children and adults. There have been few population-based studies, reporting incidences ranging between 3.5 and 7.4 cases per 100.000 patient-years [1]. In a population-based study in the United Kingdom, herpes simplex virus (HSV) was the most common virus diagnosed, and the proportion of cases with an identified etiology was significantly lower in children (33%) than in adults (45%) [2]. In the California Encephalitis Project, a confirmed or probable infectious etiology was found in only 16% of cases, with HSV-1 most commonly found in adult patients and enteroviruses in children [3]. In Southeast Asian countries like Cambodia and Vietnam, Japanese encephalitis virus (JEV) has been the leading reported cause of acute encephalitis in children, accounting for 31% to 45% of cases [4,5]. We conducted a one-year prospective descriptive study of children with acute encephalitis who were admitted to a pediatric referral hospital in Ho Chi Minh City, Vietnam

Author Summary

Results

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