Acute Febrile Encephalopathy in Children: A Prospective Study of Clinical Features, Etiology, Mortality, and Risk Factors from Western India

Abstract

Introduction:Acute febrile encephalopathy (AFE) in children is a medical emergency and could be a manifestation of many systemic and central nervous system pathologies. The clinical features of AFE are nonspecific and etiological spectrum variable depending on the studied population.Materials and Methods:A prospective, observational study was carried out including children aged between 1 month and 12 years with AFE admitted to the Pediatric Intensive Care Unit of a tertiary care hospital in Western India. The primary objective was to assess the clinical presentation and etiology of AFE while the secondary objectives were to correlate the clinical and etiological findings and to determine the risk factors associated with mortality.Results:Out of the ninety children with AFE included in this study, male:female ratio was 1.2:1; most of them were aged between 1 and 5 years and came with a history of < 7 days (82.2%). All of them had altered sensorium, about 2/3rd had seizures and 47.8% having a Glasgow Coma Score (GCS) <8. Etiology remained elusive in about 40% of the cases, and viral infections were the most common among the ones with an identifiable cause. A variety of morbidity (shock, disseminated intravascular coagulopathy, respiratory failure, etc.) and high mortality (40%) was observed with risk factors associated with mortality being GCS < 8, the presence of raised intracranial pressure, shock, and respiratory failure.Conclusion:AFE, though a rare diagnosis in children, is associated with significant morbidity and high mortality in a developing country like India.

A Study on Clinical Features, Aetiology, Outcomes and Predictors of Mortality and Morbidity in Children With Acute Encephalitis Syndrome in Eastern India

“…In contrast to our study, they found maximum sequelae in bacterial meningoencephalitis (61.7%) followed by viral encephalitis (31.9%). Our study corroborates with the study by Kirti Gupta et al (2) that showed highest mortality in the group with inconclusive aetiology (50%) followed by viral group (25%) and bacterial meningoencephalitis group (16.6%).…”

“…Similarly, Kirti Gupta et al (2) showed that fever and altered sensorium were present in 100% cases. Seizure was present in 71.1% cases and vomiting in 35.6% cases, which were less than our study.…”

“…We found 8.9% cases of TBM. Another study by Kirti Gupta et al (2) showed bacterial meningoencephalitis in 28.9% cases, viral meningoencephalitis in 23.3% cases and in 38.9% cases no aetiology were found. Among bacterial aetiology, they found Pneumococcus (30.8%), Streptococcus pyogenes (15.4%), Staphylococcus (7.6%), Enteric meningoencephalitis (5.6%) and TBM in 8.9% cases which are almost similar to our findings.…”

“…Similarly, other variables like refractory seizure, shock and respiratory failure were other risk factors as seen in our study. Kirti Gupta et al (2) showed that GCS < 8, shock, raised intracranial tension and respiratory failure were the risk factors associated with higher mortality. Meligy and his colleagues in Egypt in 2018 (10) showed mechanical ventilation was a risk factor for fatality.…”

“…The clinical features as well as aetiology varies widely across the globe as well as in various areas of same country. (2) Paediatricians in developing countries face major challenge in treating AES due to lack of adequate investigative facilities and wide range of presenting features leading to diagnostic dilemma. Although, viruses are regarded as the major aetiologic agents for AES worldwide, the syndrome can be caused by a varied group of bacterial and parasitic agents as well.…”