Acute Encephalitis Syndrome Cases Research Articles

Aetiological profile of acute encephalitis syndrome in Assam, India, during a 4-year period from 2019 to 2022.

Acute encephalitis syndrome (AES) is a major public health concern in India as the aetiology remains unknown in the majority of cases with the current testing algorithm. We aimed to study the incidence of Japanese encephalitis (JE) and determine the aetiology of non-JE AES cases to develop an evidence-based testing algorithm. Cerebrospinal fluid (CSF) samples were tested for Japanese encephalitis virus by ELISA and polymerase chain reaction (PCR). Multiplex real-time PCR was done for Dengue, Chikungunya, West Nile, Zika, Enterovirus, Epstein Barr Virus, Herpes Simplex Virus, Adenovirus, Cytomegalovirus, Herpesvirus 6, Parechovirus, Parvovirus B19, Varicella Zoster Virus, Scrub typhus, Rickettsia species, Leptospira, Salmonella species, Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Plasmodium species and by ELISA for Mumps and Measles virus. Of the 3173 CSF samples, 461 (14.5%) were positive for JE. Of the 334 non-JE AES cases, 66.2% viz. Scrub typhus (25.7%), Mumps (19.5%), Measles (4.2%), Parvovirus B19 (3.9%) Plasmodium (2.7%), HSV 1 and 2 (2.4%), EBV and Streptococcus pneumoniae (2.1% each), Salmonella and HHV 6 (1.2% each) were predominant. Hence, an improved surveillance system and our suggested expanded testing algorithm can improve the diagnosis of potentially treatable infectious agents of AES in India.

Thrombocytopenia in children with acute encephalitis syndrome: a prospective observational study

Background: The objective of this study is to find out the proportion of children with thrombocytopenia in acute encephalitis syndrome (AES); second, to compare the aetiology of AES in thrombocytopenic cases with non-thrombocytopenic cases; and finally, to find out clinical and laboratory predictors of thrombocytopenia in AES, as well as to study platelet aggregation and compare it in both scrub positive and scrub negative AES cases. Methods: This prospective observational study was conducted on 176 children with presumed viral aetiology were investigated to find out the cause of AES. Results: The majority of patients presented with thrombocytopenia. The most common aetiologies are Japanese encephalitis (JE). No significant difference was observed in the aetiology of AES between the thrombocytopenic and non-thrombocytopenic groups. Rash, bleeding, swelling, hepatomegaly, and splenomegaly were significantly more common in thrombocytopenic AES cases. Among the laboratory parameters, haemoglobin, PCV, and serum protein were found to be significantly low in the thrombocytopenic group. Liver enzymes, serum AST, and serum ALT were significantly high in the thrombocytopenic group. Platelet aggregation percentage was found to be significantly high in AES children who were positive for scrub typhus in comparison to other AES cases. Eighty-seven patients were discharged from the hospital. The mortality rate was 18%. There was no significant difference in the outcome of AES cases in relation to thrombocytopenia. Conclusions: This approach may help clinicians in the diagnosis of AES due to the scrub along with other tests available. There was no significant difference in the short-term outcome of AES cases in relation to thrombocytopenia.

Epidemiology of Japanese Encephalitis in Central India after Implementing Immunization

Abstract Objective We report the epidemiology of Japanese encephalitis (JE) disease after the implementation of routine immunization in medium-endemic districts in the states of Maharashtra and Telangana in Central India. Methods We investigated acute encephalitis syndrome (AES) patients hospitalized from October 2018 to September 2020. Field visits were also made to the residences of 262 AES cases, including 54 JE cases. Results The overall case fatality ratio was 31%. Maharashtra state contributed 72% of JE and 67% of AES cases. The rural localities had a significantly higher number of JE cases than the urban areas. The occurrence of JE was reported year round, with most JE cases reported during the rainy season. Both AES and JE cases were reported mostly among children, with JE in 66% and non-JE AES in 70% of children. Conclusion The JE disease continues to affect the population after routine immunization. Surveillance, prevention, and control need to be enhanced to achieve accelerated control.

Predictors of mortality in acute encephalitis syndrome in children

Encephalitis is an important cause of morbidity, mortality and neurological sequelae in children globally. Causes are diverse and include viral and non-viral etiology as well as autoimmune processes. In the west autoimmune encephalitis are now most common than any single infectious cause, but in India infectious causes are still most common. It is critical to evaluate the immediately to reduce mortality and sequalae in Acute Encephalitis Syndrome (AES) patients. This study has been done to find out different predictors of mortality in outcome of AES at the end of hospital stay. To find out the predictors of mortality in children with acute encephalitis syndrome between age group of 1 month to 14 years. This was a cross sectional analytical study conducted over a period of two years. A total of 310 subjects were included in the study. Different clinical and laboratory parameters were taken to know the different significant predictors of mortality. A total of 310 cases were taken for the study from the age group of 1 month to 14 years. Out of these AES cases 22.5% cases died and 77.5% patients were discharged. Higher mortality was seen in 11-14 years of age group and females had higher mortality as compared to males. Only 5 variables that is refractory seizure, GCS<8, features of raised ICT, shock and requirement of ventilatory support were found to be significant (p<0.05) in predictors of mortality. Other variables like age, sex, socioeconomic status, fever altered sensorium, seizure, meningeal sign, laboratory investigations like serum sodium, total leucocyte count, serum creatinine, duration of hospitalisation were not found to be significant(p>0.05). AES is a disorder of multiple and varying etiology with significant mortality and morbidity. Early diagnosis, appropriate investigation, prompt management go a long way in reducing mortality and sequalae in AES. Refractory seizure, Glasgow Coma Score<8, features of raised Intracranial Tension, Shock and requirement of ventilatory support prognosticate the outcome of Acute Encephalitis Syndrome.

Correlation between clinical-laboratory profile and outcome of AES cases in children: A hospital-based study

Objective: This study aims to determine the correlation between clinical as well as laboratory profile changes with the outcome of acute encephalitis syndrome (AES) cases. Materials and Methods: This prospective observational study was conducted in the Department of Pediatrics at Jorhat Medical College and Hospital, Assam over a period of 1 year where 49 diagnosed cases of AES in children aged between 1 month and 12 years were enrolled. Results: The study found that fever (100%) and altered sensorium (100%) were the most common clinical presentations in AES cases, followed by seizure (63%), headache (34.7%), vomiting (26.5%), diarrhea (22.4%), etc. Japanese encephalitis (JE) was the most common cause of AES (28.6%), followed by herpes simplex virus (4.1%), pyogenic meningitis (4.1%), and tubercular meningitis (2%), etc. However, the majority of cases (61.2%) were found to have an unknown etiology. Among the 49 cases, 27 (55.1%) recovered without neurological sequelae, 8 (16.8%) had neurological sequelae, and 14 (28.6%) died during the course of treatment. The most common neurological sequelae observed were motor deficit (37.5%), behavioral disorders, aphasia (25% each), and cranial nerve palsy. Glasgow coma scale (GCS) at the time of admission and during the time of hospital stay was found to have a significant (p<0.05) correlation with outcome in AES patients. Conclusion: The study concludes that AES cases commonly present with fever, altered sensorium, seizure, headache, vomiting, and signs of meningeal irritation. JE remains a major known cause of AES in children in this region of India. GCS at the time of admission and during the time of hospital stay were found to have a significant correlation with outcome. The neurological sequelae highlight the need for global attention to combat them save the lives of children.

Evidence on the prevalence of emerging and re-emerging tick- and flea-borne rickettsial agents in acute encephalitis syndrome endemic areas of northeast Uttar Pradesh, India.

Outbreaks of acute encephalitis syndrome (AES) with unknown aetiology are reported every year in Gorakhpur district, Uttar Pradesh, India, and Orientia tsutsugamushi, the rickettsial pathogen, responsible for scrub typhus has been attributed as the primary cause of AES problem. However, information on the prevalence of other rickettsial infections is lacking. Hence, this study was carried out to assess any occurrence of tick- and flea-borne rickettsial agents in villages reporting AES cases in this district. In total, 825 peridomestic small mammals were trapped, by setting 9254 Sherman traps in four villages with a trap success rate of 8.9%. The Asian house shrew, Suncus murinus, constituted the predominant animal species (56.2%) and contributed to the maximum number (87.37%) of ectoparasites. In total, 1552 ectoparasites comprising two species of ticks and one species each of flea and louse were retrieved from the trapped rodents/shrews. Rhipicephalus sanguineus, the brown dog tick, was the predominant species retrieved from the trapped rodents/shrews, and the overall infestation rate was 1.75 per animal. In total, 4428 ectoparasites comprising five tick species, three louse species and one flea species were collected from 1798 domestic animals screened. Rhipicephalus microplus was the predominant tick species collected from the domestic animals. The cat flea, Ctenocephalides felis, constituted 1.5% of the total ectoparasites. Of all the ectoparasite samples (5980) from domestic animals and rodents, tested as 1211 pools through real-time PCR assays, 64 pools were positive for 23S rRNA gene of rickettsial agents. The PCR-positive samples were subjected to multi-locus sequence typing (MLST). In BLAST and phylogenetic analysis, the ectoparasites were found to harbour Rickettsia asembonensis (n = 9), Rickettsia conorii (n = 3), Rickettsia massiliae (n = 29) and Candidatus Rickettsia senegalensis (n = 1). A total of 22 pools were detected to have multiple rickettsial agents. The prevalence of fleas and high abundance of tick vectors with natural infections of rickettsial agents indicates the risk of transmission of tick- and flea-borne rickettsial diseases in rural villages of Gorakhpur. Further epidemiological studies are required to confirm the transmission of these agents to humans.

Molecular detection of spotted fever group of Rickettsiae in acute encephalitis syndrome cases from eastern Uttar Pradesh region of India.

The Eastern Uttar Pradesh region of India is known for its endemicity of acute encephalitis syndrome (AES). Decades of research have established that Orientia tsutsugamushi, a causative of scrub typhus, is a substantial contributor (>60%) for the AES cases besides other aetiology, but additional factors in the remaining proportion are still unidentified. Rickettsial infections are challenging to diagnose in clinical settings due to overlapping clinical symptoms, the absence of definitive indicators, a low index of suspicion, and the lack of low-cost, rapid diagnostic tools. Hence, the present study was designed to determine the load of rickettsial infections among AES cases. Furthermore, we aim to find out the prevalent rickettsial species in AES cases as well as in the vector population at this location. The study included the whole blood/cerebrospinal fluid of AES patients and arthropod specimens from rodents. The molecular identification was performed using the 23S-5S intergenic spacer region and ompB gene with genomic DNA obtained from studied specimens. We detected 5.34% (62/1160) of rickettsial infection in AES cases. Among these, phylogenetic analysis confirmed the presence of 54.8% Rickettsia conorii (n = 34) and 16.1% of Rickettsia felis (n = 10), while the rest proportion of the isolates was unidentified at the species level. Furthermore, R. felis was identified in one CSF sample from AES patients and three flea samples from Xenopsylla cheopis. Rickettsia spp. was also confirmed in one Ornithonyssus bacoti mite sample. The results of this investigation concluded the presence of spotted fever group Rickettsia spp. among AES identified cases as well as in the mite and flea vectors that infest rodents.

Phylogenetic and immunological investigations of complete TSA56 ORF of Orientia tsutsugamushi present in acute encephalitis syndrome cases from eastern Uttar Pradesh, India.

Scrub typhus (ST) caused by Orientia tsutsugamushi (OT), has long been known to cause acute encephalitis syndrome (AES) and acute febrile illness (AFI). The immunodominant 56kDa protein of OT, which is encoded by the 56kDa gene (1600bp encoding 516-541 amino acids) is a commonly studied antigen for genotype and serotype assignment. Previous studies from India have utilized partial type specific antigen (TSA) 56kDa sequences for OT strain characterisation. On the other hand, understanding the antigenic diversity of current OT strains, is critical for developing specific diagnostic tests and vaccines against ST. As a result, the current study analyses antigenic variants using the entire TSA56 ORF of OT from AES cases. Phylogenetic investigation using complete TSA56 ORF sequences revealed Karp and Gilliam were the circulating predominant strains of OT. Furthermore, Immuno-informatical analysis demonstrated that the majority of high-binding affinity CD4 TCEs against the most prevalent Indian human leukocyte antigen alleles were present in the S-VDIII/IV and S-VDIV spacer regions of TSA56 ORF. TSA56 conserved spacer is crucial for OT immunological response investigations. Further, the pathophysiological effects of spacer domains in ST require further investigation. Furthermore, the characterization of the TSA56 spacer region of the OT from different parts of India is critical for developing region-specific ST diagnostic assays and vaccines.

Comparison of Clinical Profile and Outcomes of Japanese Encephalitis and Acute Encephalitis Syndrome among Rural Children.

The study compared the clinical profile and outcomes of Japanese encephalitis (JE) and acute encephalitis syndrome (AES) in children. Fifty-six consecutive children with symptoms fulfilling the WHO clinical case definition of AES from June 2018 to June 2020 were included in the study. All patients who tested positive for either serum or cerebrospinal fluid (CSF) anti-JE-IgM antibodies were JE patients (n = 24) and compared with non-JE AES cases (n = 32). Fever, seizures, and altered sensorium were the most common presenting symptoms. Low GCS, status epilepticus, meningeal irritation, raised CSF protein, and INR > 1.5 of JE children showed significant association with mortality (p value < 0.05), whereas only low GCS showed significant association in non-JE AES cases. The JE-specific mortality rate was 29%, which was less than the mortality rate of non-JE AES children at 41%. Both JE and non-JE AES children had a similar clinical profile, but only the JE children's poor clinical and laboratory parameters were associated with adverse outcomes.

Outbreaks and sporadic cases of japanese encephalitis in the state of Odisha, India: Outcome of 7 years of laboratory surveillance.

Acute encephalitis syndrome (AES) is a major public health challenge in India. We report here the epidemiology of sporadics and outbreaks of Japanese Encephalitis (JE) in Odisha state during 2012-2018. A total of 4235 AES cases (sporadics - 3394, outbreak cases - 841) recorded including 42 outbreaks; majority (n = 18) of which were during 2016. Overall JE virus (JEV) positivity was 11.78% (outbreak cases - 24.5%, sporadic cases - 8.6%). Age ≤15 years were largely affected during outbreaks, while 16-60 years population was dominant among sporadics. The major outbreak (2016) involved 336 patients from a tribal dominated district, spread over 173 villages. JEV seropositivity was high (43.45%) with 28.57% mortality. Epidemiological linkage with pig rearing was documented through JEV neutralizing antibodies in 50% of pig serum samples. Although the postvaccination period (2017-18) showed increase in AES case reporting but low JE proportion. Ongoing surveillance and preparedness of the health system would be of importance, especially in tribal-dominated districts.

The Surveillance of Acute Encephalitis Syndrome in Thailand, 2003-2019: A Perspective for Prevention and Control.

Acute encephalitis syndrome (AES) is an infection of the central nervous system with high case-fatality rates. Japanese encephalitis virus (JEV) is the most common vaccine preventable cause of AES in Asia and part of the Western Pacific. In 2003, the JE vaccine was introduced into Thailand's National Immunization Program and expanded to all provinces. This study reviews data from the national surveillance system on the incidence of AES, including Japanese encephalitis in Thailand to guide surveillance, control, and prevention strategies. We collected data on all patients diagnosed with AES and reported to the Bureau of Epidemiology, Ministry of Public Health, Thailand, from 2003 to 2019. A total of 9566 AES patients and 266 death cases were reported during these 17 years. Six hundred and forty-two (6.7%) patients were JE with 16 deaths. The incidence of AES increased from 0.47-0.51-1.36 cases per 100,000 population with a preponderance of cases in adults. CFR reduced from 6.25% - 6.94% in 2003-2005 to 0.78% in 2019. AES cases occurred all year round in all the age groups with a male predilection JE vaccination coverage had reached 83% by 2019. The patients were mainly from the north-eastern region of Thailand. Integrated surveillance regular monitoring, strengthening, and making immunization sustainable is required to improve and maintain progress toward JE control and prevention.

Changing Clinical Profile and Predictors of Mortality in Patients of Acute Febrile Encephalopathy from North India.

Acute encephalitis syndrome (AES) or acute febrile encephalopathy is a clinical condition characterized by altered mental status occurring after or along with a short febrile illness. In developing countries, infections are the predominant cause of AES. Prominent infections known to cause AES include viruses (such as herpes simplex virus [HSV], Japanese Encephalitis [JE] virus, dengue, enteroviruses [EVs]), bacteria, fungus, and parasites. In the present study, we aim to analyze the etiology, clinical features, and predictors of mortality in patients presenting with acute febrile encephalopathy or acute encephalitic syndrome. The present study was a prospective observational study conducted at Post Graduate Institute of Medical Education and Research a tertiary care center in Chandigarh, India. A total of 105 patients with ≥18 years of age with fever (body temperature >101° F for duration ≤14 days) and altered sensorium (Glasgow coma scale [GCS] score ≤10) lasting for more than 24 h, either accompanying the fever or following it were enrolled. Demographic and clinical details were recorded on pro forma. Cerebrospinal fluid (CSF) analysis was performed for all the enrolled patients at admission for cytology, CSF glucose to blood glucose ratio, protein levels, gram stain and culture sensitivity, adenosine deaminase levels, polymerase chain reaction for HSV/EV/mycobacterium tuberculosis (TB) and immunoglobulin M Enzyme-linked immune assay for JE. Computed tomography of the brain was done in all patients while magnetic resonance imaging (MRI) of the brain was carried out in 75 patients. Among the 105 patients, tubercular meningitis was seen in 27 (25.7%) patients followed by acute pyogenic meningitis in 18 (17.1%) patients. Probable viral encephalitis was present in 12 (11.4%) cases. Septic encephalopathy (n = 10) and scrub typhus encephalitis (n = 8), HSV encephalitis (n = 6), dengue encephalitis (n = 4), leptospirosis (n = 3) were the other infections causing acute febrile encephalitis in our study. In addition to fever and altered sensorium common symptoms observed were headache (52.4%), vomiting (35.2%), and seizures (29.5%). The factors predicting increased mortality were female gender, fever of more than 38°C at admission, GCS <7, MRI showing disease-related findings like altered signal intensity bilateral medial temporal and insular area in herpes simplex encephalitis, etc., changes, and the group of patients where a definite diagnosis could not be established during the hospital stay. Tubercular meningitis/central nervous system TB is the predominant cause of acute febrile encephalopathy in developing countries. Scrub and dengue encephalitis are emerging as an important cause of acute febrile encephalopathy and occur predominantly in postmonsoon seasons. Acute febrile encephalopathy remains an important cause of mortality in patients presenting to Emergency Department (ER). The strongest predictors of mortality are low GCS and undiagnosed cases of AES.

Etiological Profile and Clinico Epidemiological Patterns of Acute Encephalitis Syndrome in Tamil Nadu, India.

Establishing the etiological cause of acute encephalitis syndrome (AES) is challenging due to the distinct distribution of various etiological agents. This study aims to determine the etiological profiles of both viruses and bacteria and their associated clinico-epidemiological features among the AES suspected cases in Tamil Nadu, India. Samples of 5136 suspected AES cases from January 2016 to December 2020 (5 years) were subjected to the detection of etiological agents for AES through serological and molecular diagnosis methods. Further, the clinical profile, age- and gender-wise susceptibility of cases, co-infection with other AES etiological agents, and seasonality pattern with respect to various etiological agents were examined. AES positivity was established in 1480 cases (28.82%) among the 5136 suspected cases and the positivity for male and female groups were 57.77% and 42.23%, respectively. The pediatric group was found to be more susceptible than others. Among the etiological agents tested, the Japanese encephalitis virus (JEV) was the predominant followed by Cytomegalovirus, Herpes Simplex virus, Epstein-Barr virus, Varicella Zoster virus, and others. Co-infection with other AES etiological agents was observed in 3.5% of AES-positive cases. Seasonality was observed only for vector-borne diseases such as JEV, dengue virus, and West Nile virus infections in this study. AES was found to be a significant burden for Tamil Nadu with a diverse etiological spectrum including both sporadic and outbreak forms. Overlapping clinical manifestations of AES agents necessitate the development of region-specific diagnostic algorithm with distinct etiological profiles for early detection and effective case management.

Duration of seroprotection of the live attenuated SA-14-14-2 Japanese encephalitis vaccine in children in India.

Acute encephalitis syndrome (AES) is a major public health concern in India, and the Japanese Encephalitis (JE) virus is the most common cause of viral encephalitis in Asia affecting children under the age of 15years. In India, despite the introduction of the JE vaccine (SA-14-14-2) in the immunization programme, JE continues to account for 15-20% of AES cases to date. This study evaluates the immunogenicity of live attenuated SA-14-14-2 JE vaccine in terms of persistence of the humoral response after two doses. A cross-sectional study was conducted among 266 children belonging to one of the JE endemic regions of Uttar Pradesh, India. Blood samples were taken from children (2-10years) and grouped according to the duration (in years) after two doses of the vaccine (5 groups with a class interval of 2years). Informed written consent was obtained from the parents/guardians. All the samples collected were tested for the presence of anti-JEV-specific IgG antibodies by enzyme-linked immunosorbent assay (ELISA) and further confirmed by micro neutralization test (MNT) and immunofluorescence assays. Of the 266 samples tested by ELISA for anti-JEV-specific IgG antibodies, 260 (97.74%) were negative and 6 (2.26%) were equivocal. The geometric mean immune status ratio across the five groups, 0-2years (n = 59), 2-4years (n = 73), 4-6years (n = 65), 6-8years (n = 48) and 8-10years (n = 21) post-two doses of SA-14-14-2 JE vaccine was 1.143, 1.059, 1.138, 1.075 and 1.130, respectively, and the geometric mean titre obtained from MNT across the five groups was 10.77, 8.400, 8.453, 9.517 and 9.674, respectively. The study showed a decreasing trend of anti-JEV specific IgG antibody titres across the five groups based on the duration following two doses of SA-14-14-2 vaccine. The results emphasize the significance of booster doses of vaccine for children living in endemic areas.

Clinicoepidemiological profile and outcome among children with acute encephalitis syndrome from Central India

Background: Acute encephalitis syndrome (AES) is defined as the acute onset of fever and a change in mental status and/or new onset of seizures (excluding simple febrile seizures) in a person of any age at any time of the year. Aims and Objectives: The objectives of the study were as follows: (a) To study clinicoepidemiological profile and outcome among children with AES admitted at M.Y.H. Hospital and MGM Medical College, Indore, M.P., and (b) to study prognostic factors associated with bad outcomes. Materials and Methods: This prospective observational study was conducted over 12 months (July 2019–August 2020) at the pediatric department of our hospital. Inclusion criteria: Inpatient children aged 6 months–14 years meeting the case definitions of acute encephalitis syndrome. Exclusion criteria: Simple febrile seizures. Results: Out of 50 AES cases, majority were between 1 and 5 years of age (40%). There were more males 31 (62%) than 19 (38%) females. Most of the cases were reported during the monsoon period 29 (58%) followed by post-monsoon 13 (26%) and pre-monsoon 8 (16%). Out of 50 cases, all had fever and altered sensorium, 37 (74%) had convulsions, 14 (28%) had vomiting, and 9 (18%) had headache. Out of 50 cases, 42 (84%) had viral etiology including 7 (14%) of dengue encephalitis and 1 (2%) of case of human immunodeficiency virus encephalitis. Only 5 (10%) cases had bacterial etiology. Those who needed inotropes and mechanical ventilation showed significant mortality. Conclusion: The peak of AES cases occurred during the monsoon period. A higher proportion of such cases had viral etiology on cerebrospinal fluid analysis. Use of inotropes and mechanical ventilation was identified to be associated with significant mortality.

Infectious causes of acute encephalitis syndrome hospitalizations in Central India, 2018-20.

We enhanced surveillance of hospitalizations of all ages for acute encephalitis syndrome (AES) along with infectious aetiologies, including the Japanese encephalitis virus (JEV). From October 2018 to September 2020, we screened neurological patients for AES in all age groups in Maharashtra and Telangana States. AES cases were enrolled at study hospitals along with other referrals and sampled with cerebrospinal fluid, acute and convalescent sera. We tested specimens for non-viral aetiologies viz. leptospirosis, typhoid, scrub typhus, malaria and acute bacterial meningitis, along with viruses - JEV, Dengue virus (DENV), Chikungunya virus (CHIKV), Chandipura virus (CHPV) and Herpes simplex virus (HSV). Among 4977 neurological hospitalizations at three study site hospitals over two years period, 857 (17.2%) were AES. However, only 287 (33.5%) AES cases were eligible. Among 278 (96.9%) enrolled AES cases, infectious aetiologies were identified in 115 (41.4%) cases, including non-viral in 17 (6.1%) cases - leptospirosis (8), scrub-typhus (3) and typhoid (6); and viral in 98 (35.3%) cases - JEV (58, 20.9%), HSV (22, 7.9%), DENV (15, 5.4%) and CHPV (3, 1.1%). JEV confirmation was significantly higher in enrolled cases than referred cases (10.2%) (p<0.05). However, the contribution of JEV in AES cases was similar in both children and adults. JE was reported year-round and from adjacent non-endemic districts. The Japanese encephalitis virus continues to be the leading cause of acute encephalitis syndrome in central India despite vaccination among children. Surveillance needs to be strengthened along with advanced diagnostic testing for assessing the impact of vaccination.

Genotypic Characterization of Orientia tsutsugamushi Isolated From Acute Encephalitis Syndrome and Acute Febrile Illness Cases in the Gorakhpur Area, Uttar Pradesh, India.

Scrub typhus infections caused by Orientiatsutsugamushi (OT), continue to remain underdiagnosed globally, due to the lack of distinctive symptoms. The elusive nature of the Acute Encephalitis Syndrome (AES) outbreak in Gorakhpur, Uttar Pradesh that claimed numerous pediatric lives was the driving force of this study which involved serological diagnosis (IgM–ELISA), isolation of OT in cell culture, confirmation by PCR, and characterization by Sanger sequencing. In total, 12 out of 36 patients were seropositive, of which 4 were positive by PCR. Upon enrichment in cell culture, additional 3 patients (including two seronegative) were detected positive by PCR. In total, three of these 7 patients were found to be infected with two strains of OT. Taken together, this study for the first time reports the occurrence of dual infections in addition to three circulating OT genotypes (Gilliam, Kato, and Karp-like) and highlights the significance of enriching OT in cell culture systems for efficient molecular detection.

ACUTE ENCEPHALITIS SYNDROME IN A TERTIARY CARE SETTING WITH SPECIAL REFERENCE TO JAPANESE ENCEPHALITIS: AN OBSERVATIONAL STUDY IN ASSAM, INDIA

Acute Encephalitis Syndrome (AES) is a major public health problem and Japanese Encephalitis (JE) is one of the most important causes of AES. Therefore, it is crucial to know the etiology of AES for patient management and decision making. The present study aimed to assess the morbidity and mortality prole of AES/JE patients admitted in tertiary care setting. An observational prospective cross-sectional study was conducted among 140 hospitalized AES patients admitted in Pediatric and Medicine ward of Jorhat Medical College and Hospital (JMCH), Jorhat over a period from August, 2017 to July 2018. Blood serum and cerebrospinal uids (CSF) were tested for presence of JE specic IgM antibody by Mac ELISA during acute illness of AES. The data were compiled and analyzed using the IBM SPSS, V23.0. Of the total 140 AES cases, majority (60%) were below 15 years age (p-value 0.180). Signicantly higher proportion of AES cases were from rural areas (94.3%) (p-value &lt;0.0001). The male and female ratio was 1.3:1. The most common presenting symptoms in AES patients were fever (100%), change in mental status (100%), seizure (56.4%) and headache (42.9%). Signs of meningeal irritation were present in 69.3% of cases. Around 22.9% AES patients had GCS ≤ 8. A total 49 (35%) cases were found to be laboratory conrmed JE following detection of JE specic IgM antibody. Among the JE patients, only 4.1% were immunized with SA 14-14-2 vaccine and 14% died before discharge. The complete recoveries were observed in 78% of cases. JE is one of the major causes of AES which is highly prevalent in this part of India. The signicant ndings in the present study calls for policy decision to combat JE.

Recent Treatment Therapies for Autoimmune Encephalitis

Autoimmune encephalitis is a rare condition but its contribution to total acute encephalitis syndrome cases has been observed to increase in recent years. The cause of auto immune encephalitis is due to the presence of antibodies against intracellular or extracellular receptors of neurons. Out of these receptors extracellular receptors are very important for which different options of medication and therapies are adopted. In this article a brief overview regarding treatment options available to clinicians have been discussed.

EPIDEMIOLOGICAL TRENDS OF JAPANESE ENCEPHALITIS IN MADHYA PRADESH FROM 2016 TO 2020

INTRODUCTION: Many large outbreaks have been recorded in various sections of the nation since 1955. In 1973, a severe epidemic in the Bankura District of West Bengal resulted in a 42.6 percent death rate. Following that, the illness spread to neighboring states, resulting in a series of epidemics across the country. METHODOLOGY: It is a retrospective observational study conducted among all lab-conrmed IgM ELISApatients positive for JE in Madhya Pradesh from 2016-2020. The data was collected from IDSP, and it included the number of cases by years, months, districts, and, geographical details were collected from the Department of Land Survey, and the projected population data were collected from the census. RESULT: Analysis of data revealed that from 2016 to 2020, a total of 81 Acute encephalitis syndrome cases with 10 deaths were reported in Madhya Pradesh. All these cases were lab-conrmed cases of Japanese Encephalitis. During this period, the average case fatality rate was 12.34%, with a morbidity rate of 0.11 per lakh population. CONCLUSION: In all JEendemic states in India, safe and efcient JE vaccinations are available to prevent the disease and lower the risk of JE and AES; nonetheless, all visitors to JE-endemic areas should take steps to avoid mosquito bites, especially during peak season. Prevention of Japanese encephalitis can be bought about by early diagnosis and apt treatment.