Clinico-etiological profile of Acute Encephalitic syndrome from Northern India

Objective: Encephalitis is a state of inflammation of brain parenchyma accompanied by altered sensorium with or without fever and seizures, the etiology of which differs on a regional and seasonal basis. Knowing about this will help in formulating appropriate surveillance and treatment protocols.

Methods: This was a prospective observational study conducted in a tertiary hospital in North India where children (1month to 18 years of age) with either acute, subacute chronic encephalitis fulfilling the inclusion and exclusion criteria were enrolled during a study period from Jan-2020 to Jan-2022. CSF, Plasma and serum samples were collected analyzed for various infective(viral, bacterial, fungal and parasite) and non-infective etiologies.

Results: Thirty seven children were enrolled out of which 54%(20) were males. The mean age of the children were 6.9 years (+/-3.8 ) with a median age of 8 years(5 months to 13 years ). 45.9% (17/37) presented with seizures and 29.7% (11/37) had clinical signs of raised ICP with 13.5%(5/37) having focal neurological deficits. The mortality rate was 10.8%(4/37). 29% (9/37) tested positive for mycoplasma, leptospirosis, dengue and scrub typhus,5.4%(2/37) tested positive for Tuberculosis, 2.7%(1/37) tested positive for chikungunya, enterovirus, pneumococcus and JE.(8.1%) 3/37 were positive for para-infectious autoimmune etiologies (2 ADEM[Acute Disseminated Encephalomyelitis] and 1 NMDA[N-Methyl-D-Aspartate] encephalitis)

Conclusion: Dengue, leptospirosis, scrub typhus and mycoplasma were the most common etiologies noted. Autoimmune etiologies like NMDA encephalitis and ADEM must also be kept as differentials, due to therapeutic implications. The magnitude and aetiologies of encephalitis in pediatric population need to be studied further.
Keywords: Encephalitis