Clinical and etiological profile of acute febrile encephalopathy in Eastern Nepal
- 177 Downloads
- 4 Citations
Abstract
Objective
To investigate the clinical and etiological profile of acute febrile encephalopathy in children presenting to a tertiary care referral center of Eastern Nepal.
Methods
107 children (aged 1 month to 14 yrs) presenting to the emergency with fever (> 38° C) of less than 2 weeks duration with altered sensorium with/or without seizure were prospectively investigated for etiological cause. The investigations included blood and CSF counts, blood and CSF cultures, peripheral smear and serology for malarial parasite, and serology for Japanese encephalitis (JE) virus. Other investigations included EEG and CT or MRI wherever indicated.
Results
The most common presenting complaints apart from fever and altered sensorium were headache and vomiting. Convulsions, neck rigidity, hypertonia, brisk deep tendon reflexes, extensor plantar response and focal neurological deficits were seen in 50%, 57%, 22.4%, 28%, 39.3% and 9.3% of the subjects, respectively. The diagnoses based on clinical presentation and laboratory findings were pyogenic meningitis in 45 (42%), non JE viral encephalitis in 26 (25%), JE in 19 (18%), cerebral malaria in 8 (7%), herpes encephalitis and tubercular meningitis in 4 (4%) each, and typhoid encephalopathy in 1 case.
Conclusion
Pyogenic meningitis and viral encephalitis including JE are the most common causes of acute presentation with fever and encephalopathy. Preventive strategies must be directed keeping these causes in mind.
Key words
Encephalopathy Japanese encephalitis Viral encephalitisPreview
Unable to display preview. Download preview PDF.
References
- 1.John TJ. Outbreaks of Killer Brain Disease in Children: Mystery or Missed Diagnosis? Indian Pediatr 2003; 40: 863–869.PubMedGoogle Scholar
- 2.Rathi AK, Kushwaha KP, Singh YD et al. JE virus encephalitis: 1988 epidemic at Gorakhpur. Indian Pediatr 1993; 30: 325–333.PubMedGoogle Scholar
- 3.Vashishtha VM, Nayak NC, John TJ, Kumar A. Recurrent annual outbreaks of a hepato-myo-encephalopathy syndrome in children in western Uttar Pradesh, India. Indian J Med Res 2007; 125: 523–533.PubMedGoogle Scholar
- 4.Kumar R, Mathur A, Kumar A, Sethi GD, Sharma S, Chaturvedi UC. Virological investigations of acute encephalopathy in India. Arch Dis Child 1990; 65: 1227–1230.CrossRefPubMedGoogle Scholar
- 5.Mehrotra RM, Mathur AK, Khan AM, Chaturvedi UC, Kapoor AK. Acute encephalopathy: a clinicopathological study. Indian J Med Res 1971; 59: 705–714.PubMedGoogle Scholar
- 6.DGHS. National Vector Borne Disease Control Programme, Directorate General of Health Services. New Delhi: Malaria Drug Resistance 2004, New Delhi: Ministry of Health and Family Welfare, 2004.Google Scholar
- 7.Directorate of National Vector Borne Disease Control Programme. Report of Meeting of an Expert Group, New Delhi: NVBDCP, 2004.Google Scholar
- 8.Kundu R, Ganguly N, Ghosh TK, Choudhury P, Shah RC. Diagnosis and management of malaria in children: Recommendations and IAP plan of action. Indian Pediatr 2005; 42: 1101–1114.PubMedGoogle Scholar
- 9.Kumar R, Tripathi P, Singh S, Bannerji G. Clinical features in children hospitalized during the 2005 epidemic of Japanese encephalitis in Uttar Pradesh, India. Clin Infect Dis 2006; 43:123–131.CrossRefPubMedGoogle Scholar