Clinical and prognostic features among children with acute encephalitis syndrome in Nepal; a retrospective study

Abstract

BackgroundAcute encephalitis syndrome (AES) is commonly seen among hospitalized Nepali children. Japanese Encephalitis (JE) accounts for approximately one-quarter of cases. Although poor prognostic features for JE have been identified, and guide management, relatively little is reported on the remaining three-quarters of AES cases.MethodsChildren with AES (n = 225) were identified through admission records from two hospitals in Kathmandu between 2006 and 2008. Patients without available lumbar puncture results (n = 40) or with bacterial or plasmodium infection (n = 40) were analysed separately. The remaining AES patients with suspected viral aetiology were classified, based on positive IgM antibody in serum or cerebral spinal fluid, as JE (n = 42) or AES of unknown viral aetiology (n = 103); this latter group was sub-classified into Non-JE (n = 44) or JE status unknown (n = 59). Bad outcome was defined as death or neurological sequelae at discharge.ResultsAES patients of suspected viral aetiology more frequently had a bad outcome than those with bacterial or plasmodium infection (31% versus 13%; P = 0.039). JE patients more frequently had a bad outcome than those with AES of unknown viral aetiology (48% versus 24%; P = 0.01). Bad outcome was independently associated in both JE and suspected viral aetiology groups with a longer duration of fever pre-admission (P = 0.007; P = 0.002 respectively) and greater impairment of consciousness (P = 0.02; P < 0.001). A higher proportion of JE patients presented with a focal neurological deficit compared to patients of unknown viral aetiology (13/40 versus 11/103; P = 0.005). JE patients weighed less (P = 0.03) and exhibited a higher respiratory rate (P = 0.003) compared to Non-JE patients.ConclusionsNepali children with AES of suspected viral aetiology or with JE frequently suffered a bad outcome. Despite no specific treatment, patients who experienced a shorter duration of fever before hospital admission more frequently recovered completely. Prompt referral may allow AES patients to receive potentially life-saving supportive management. Previous studies have indicated supportive management, such as fluid provision, is associated with better outcome in JE. The lower weight and higher respiratory rate among JE patients may reflect multiple clinical complications, including dehydration. The findings suggest a more systematic investigation of the influence of supportive management on outcome in AES is warranted.

Aetiologies of Central Nervous System infections in adults in Kathmandu, Nepal: A prospective hospital-based study

“…JEV is endemic in the Terai (southern) region of Nepal [Figure 1] and in the densely populated Kathmandu valley131531. JEV rarely infects adults living in endemic regions presumably because of exposure to virus during childhood and subsequent immunity32.…”

“…However, these studies have relied on JEV confirmation primarily by single serum serology in the context of an encephalitic illness which may potentially overestimate the disease burden in an endemic setting. Previous hospital-based studies in Nepalese children have shown S. pneumoniae and H. influenzae type b as the most common bacterial pathogens and JEV as the major viral pathogen for CNS infections13141516. However, the etiology of encephalitis apart from JEV and the pathogens involved in CNS infections in adults remain unknown.…”

Immunogenicity of a live-attenuated Japanese encephalitis vaccine in children and adolescents after hematopoietic stem cell transplantation

“…25,26 Our study carefully included a group of patients who were at least 24 months post HSCT with a low risk of immature immune recovery, had discontinued any immunosuppressive agents at least 6 months prior to the study, and were without any clinical or laboratory evidence of chronic GVHD. Our data revealed that these patients had total lymphocyte and CD4+ cell counts of 41000 and 400 cells/mm 3 , respectively. We demonstrated that there were no serious adverse reactions to the JE vaccine (SA 14-14-2) in our patients.…”

“…Approximately half of the patients with JE suffer from long-term neurological deficits or death. 3 Immunization against JE virus is the most effective strategy for preventing JE infection. After the JE immunization program was implemented in Nepal, the incidence of JE was dramatically decreased.…”

Serum neuron specific enolase is increased in pediatric acute encephalitis syndrome

“…These clinical findings represent the patient has acute inflammation of the brain and are used by clinicians to identify patients with acute encephalitis. Acute encephalitis can be related with severe complications, including seizures, limb paresis, impaired consciousness or death4567). Biomarker of neuronal damage in intracranial infection is importance to recognize to predict outcome and disease severity.…”