ABSTRACT
Acute febrile encephalopathy is a common syndrome in the tropics with high mortality encountered by emergency physicians. In order to study the aetiology of acute febrile encephalopathy and its mortality and functional outcome over one year, data on all patients >18 years of age with short duration of fever (<14 days) and altered mental status were collected and followed up until one month after discharge. Non-infectious aetiology, found in 29%, portends a poor outcome.
Subject(s)
Acute Febrile Encephalopathy/etiology , Acute Febrile Encephalopathy/diagnosis , Acute Febrile Encephalopathy/mortality , Female , Humans , India/epidemiology , Male , Middle Aged , Patient Outcome Assessment , Prospective Studies , Syndrome , Tertiary Care CentersABSTRACT
We evaluated 146 patients with acute encephalitis syndrome caused by Orientia tsutsugamushi, after median interval of 5 months of hospitalization, to estimate the proportion and spectrum of disability. Fifty-six (38.4%) had mild, whereas 19 (13%) had moderate to severe degree of disability. Most patients had impairment in the domain of cognition and behavior.
Subject(s)
Acute Febrile Encephalopathy/microbiology , Orientia tsutsugamushi/pathogenicity , Scrub Typhus/complications , Acute Febrile Encephalopathy/mortality , Child , Child, Preschool , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , India , Scrub Typhus/microbiologyABSTRACT
OBJECTIVE: Although the mortality among previously healthy children with acute encephalopathy (AE) is approximately 5%, their detailed clinical course has not been clarified. The objective of the present study was to describe the detailed clinical course, in minutes, of fatal AE. METHODS: We retrospectively reviewed the medical records of five patients (from 6â¯months to 14â¯years of age) who previously had no neurological disorders and were diagnosed with brain death due to AE between 2002 and 2018 at Kobe Children's Hospital. RESULTS: The initial clinical symptoms were convulsion in three cases and impaired consciousness in two. The earliest noted brain imaging abnormality was 7.5â¯h after neurological symptom detection. Liver enzymes and creatinine levels increased at initial examination, and sodium elevated gradually. All patients met the criteria of systemic inflammatory response syndrome, disseminated intravascular coagulation, and shock within 14â¯h of symptom detection. High dose steroids and targeted temperature management were initiated 3.5-14â¯h after onset. Despite these therapies, patients were diagnosed with brain death from 16â¯h to 4â¯days after initial neurological symptoms. AE diagnoses were made between 4â¯h 29â¯min and 4â¯days after initial neurological symptoms and included hemorrhagic shock and encephalopathy syndromes, Reye-like syndrome, and acute necrotizing encephalopathy in two, two, and one patient(s), respectively. CONCLUSIONS: We revealed the time series' of clinical events (e.g. SIRS, shock, DIC, AE diagnosis, brain death, and treatments) and laboratory findings relative to initial neurological symptom in fatal AE.
Subject(s)
Acute Febrile Encephalopathy/mortality , Brain Diseases/mortality , Acute Disease , Acute Febrile Encephalopathy/diagnosis , Acute Febrile Encephalopathy/physiopathology , Adolescent , Brain Death , Brain Diseases/diagnosis , Brain Diseases/physiopathology , Child , Child, Preschool , Female , Humans , Infant , Male , Retrospective Studies , Seizures , Time FactorsSubject(s)
Acute Febrile Encephalopathy/mortality , Acute Febrile Encephalopathy/prevention & control , Child Nutrition Disorders/complications , Glucose/administration & dosage , Acute Febrile Encephalopathy/etiology , Child , Child Health/legislation & jurisprudence , Child Health Services/legislation & jurisprudence , Child Health Services/organization & administration , Child, Preschool , Humans , India , Socioeconomic FactorsABSTRACT
BACKGROUND: Seasonal outbreaks of acute encephalitis syndrome (AES) with high fatality have been occurring in Gorakhpur, Uttar Pradesh, India, for several years. We conducted investigations during the 2016 outbreak to identify the etiology. METHODS: We included 407 hospitalized AES patients with cerebrospinal fluid pleocytosis (>5 cells/mm) in our study. These patients were clinically examined; their blood and cerebrospinal fluid samples were collected and investigated for scrub typhus (ST), Japanese encephalitis virus (JEV), dengue virus and spotted fever group of Rickettsia by serology and/or polymerase chain reaction. RESULTS: Of the 407 AES patients, 266 (65.4%), 42 (10.3%) and 29 (7.1%) were diagnosed to have ST, JEV and dengue infection, respectively. Four patients were diagnosed to have spotted fever group of Rickettsia infection. A significantly higher proportion of ST patients with AES had hepatomegaly, splenomegaly and facial edema. The common hematologic and biochemical abnormalities among ST-positive patients include thrombocytopenia, raised liver enzymes and bilirubin levels. The case fatality ratio was significantly higher among ST-negative AES patients (36.2% vs. 15.2%; P < 0.05). CONCLUSIONS: ST accounted for approximately two third of the AES case-patients. Efforts are required to identify the etiology of AES case-patients who are negative for ST, JEV and dengue fever.
Subject(s)
Acute Febrile Encephalopathy/epidemiology , Disease Outbreaks , Acute Febrile Encephalopathy/etiology , Acute Febrile Encephalopathy/mortality , Child , Child, Preschool , Dengue/diagnosis , Dengue/epidemiology , Encephalitis, Japanese/diagnosis , Encephalitis, Japanese/epidemiology , Female , Hospitalization , Humans , Immunoglobulin M/blood , India/epidemiology , Infant , Male , Polymerase Chain Reaction , Rickettsia Infections/diagnosis , Rickettsia Infections/epidemiology , Scrub Typhus/diagnosis , Scrub Typhus/epidemiology , SeasonsSubject(s)
Acute Febrile Encephalopathy/diagnosis , Coinfection/diagnosis , Spotted Fever Group Rickettsiosis/diagnosis , Tuberculosis, Meningeal/diagnosis , Acute Febrile Encephalopathy/microbiology , Acute Febrile Encephalopathy/mortality , Coinfection/microbiology , Coinfection/mortality , Fatal Outcome , Humans , Male , Mycobacterium tuberculosis/genetics , Mycobacterium tuberculosis/isolation & purification , Rickettsia/genetics , Rickettsia/isolation & purification , Spotted Fever Group Rickettsiosis/microbiology , Spotted Fever Group Rickettsiosis/mortality , Tuberculosis, Meningeal/microbiology , Tuberculosis, Meningeal/mortality , Young AdultABSTRACT
To determine the contribution of Orientia tsutsugamushi, the agent of scrub typhus, as a cause of acute encephalitis syndrome (AES) in Assam, India, we conducted a retrospective study of hospital patients with symptoms of AES during 2013-2015. Our findings suggest that O. tsutsugamushi infection leads to AES and the resulting illness and death.
