RESUMO
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 yr) presenting to the emergency with fever (> 380 C) of less than 2 wk 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.
Assuntos
Doença Aguda , Adolescente , Área Programática de Saúde , Criança , Pré-Escolar , Diagnóstico Diferencial , Encefalite Japonesa/epidemiologia , Encefalite Japonesa/etiologia , Encefalite Japonesa/fisiopatologia , Encefalite Viral/epidemiologia , Encefalite Viral/etiologia , Encefalite Viral/fisiopatologia , Febre/epidemiologia , Febre/fisiopatologia , Cefaleia/epidemiologia , Humanos , Lactente , Recém-Nascido , Meningite Viral/epidemiologia , Meningite Viral/etiologia , Meningite Viral/fisiopatologia , Hipertonia Muscular/epidemiologia , Nepal/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Vômito/epidemiologiaRESUMO
Durante el año 1993 se presentó un aumento de 3 veces el número promedio de casos de meningitis asépticas en el Hospital Roberto del Río. Se presentan las características clínicas de 50 niños mayores con meningitis aséptica, y se detallan las de 16 casos de ellos con diagnóstico comprobado de meningitis por enterovirus. El cuadro clínico fue benigno, no hubo complicaciones, muerte o secuelas al alta. Dentro de los hallazgos de laboratorio, se destaca el promedio de neutrófilos en el 30 por ciento de los casos en la punción lumbar de control,luego de 24 horas o más de evolución de la enfermedad.El echovirus 30 fue el enterovirus predominante. Se comparan los hallazgos con la literatura, y se comenta la utilidad de una segunda punción lumbar en casos como éstos