A study on etiology, clinical profile and outcome of acute febrile encephalopathy in children: A prospective study at a tertiary care center of Eastern India

Abstract

Background: Acute febrile encephalopathy (AFE) is defined as fever associated with acute alteration of consciousness, with or without seizure, motor and/ or sensory deficit and total duration of illness one week or less. It is associated with significant morbidity and mortality in children. Various etiologies have been implicated in its causation and differ as per geographical. Efforts to promptly identify the underlying etiology and institute appropriate treatment early and adequately should be our goal so as to avoid any long-term sequelae and death.
 Aims and Objectives: To evaluate the clinical profile and aetiology of children presenting with fever and altered sensorium and to assess the predictors of morbidity & mortality related to Acute Febrile Encephalopathy.
 Materials and Methods: In this prospective, hospital-based study, a total of 282 children, between 1month to 12 years, presenting to the department of Pediatric Medicine, Calcutta National Medical College, Kolkata, West Bengal, India with fever and altered sensorium were clinically evaluated and investigated. Each patient was examined for vital signs, detailed systemic examination with focus on neurological examination. The etiology of AFE was evaluated based on detailed history, a meticulous clinical examination and relevant investigations.
 Results: The incidence of AFE was 5% of the total hospital admissions. Demographic profile showed 166 (58.8%) males, 116 (41.2%) females and 48% of the study population less than 5 years of age. The most important presenting complaints apart from fever and altered sensorium, were convulsion and vomiting. Raised Intracranial tension (58%), low GCS (58%) and shock (48%) were commonest presenting signs. CNS infections were the most common cause of AFE encountered. Low GCS, refractory seizures, multi-organ failure respiratory failure were significantly associated with death (p<0.005).
 Conclusions: CNS infections are the leading cause of febrile encephalopathy. Toxic- metabolic and unknown etiologies contributed maximum to the mortality. Low GCS, shock, refractory seizures, multi-organ failure and respiratory failure are associated with higher risk of mortality. Most of the morbidities were observed in auto-immune encephalitis and ADEM and as most of them were curable, early institution of appropriate treatment will decrease morbidity.

Clinical profile and outcome of acute febrile encephalopathy in children

“…7 The average duration of fever reported was slightly more in study done by Biswas et al who found mean duration of 4.62 days. 14 In our study, average duration of altered sensorium was 19.07 hours whereas the illness duration was 16.2±7.9 days. In the present study, refusal to feed was seen in only 6 patients (17.1%).…”

“…Deepthi reported neck stiffness in 44 (52.4%) cases. 9,14 In the month of November maximum cases 8 (22.9%) were seen. Most of the cases were reported during monsoon period, followed by post-monsoon and pre-monsoon.…”

Outcome predictors in patients (older than 14 years) with acute febrile encephalopathy: Role of cerebrospinal fluid analysis

“…CSF has a similar electrolyte composition to plasma, except that the former contains less K+, a lower pH, and a greater Cl-content. 1,5 CSF has a protein content of around 250 mg/L. In general, the CSF is devoid of antibodies and complements.…”

“…AFE is one of the commonly encountered problems by the physician in emergency departments. 1 There are distinct regional and seasonal variations in the symptoms and prognosis of AFE. Bacterial meningitis (BM), Japanese encephalitis (JE), cerebral malaria (CM), and typhoid encephalopathy are the common types of AFE and result in fever with an altered mental state.…”

“…4 Most AFE patients were found to make complete neurological recovery once the underlying cause was identified and treated promptly, appropriately, and adequately. 1 Despite AFE being a significant cause of hospital admissions of adults in India, only a few pieces of evidence have focused on the predictors of outcome in patients over 14 years. Hence in the present study, we tried to analyze the cause of encephalopathy following a short febrile illness in patients older than 14 years.…”