Clinical Profile and Outcome of Japanese Encephalitis in Children Admitted with Acute Encephalitis Syndrome

Abstract

Japanese encephalitis (JE) is an arthropod borne viral disease. Children are most commonly affected in Southeast Asian region showing symptoms of central nervous system with several complications and death. The clinical characteristics and outcomes in pediatric JE patients hospitalized with acute encephalitis syndrome (AES) are still poorly understood. A prospective study was conducted in pediatric ward of Assam Medical College Hospital to evaluate the clinical profile and outcome of JE in children. A total of 223 hospitalized AES cases were enrolled during March to December 2012. Serum and cerebro spinal fluids were tested for presence of JE specific IgM antibody. 67 (30%) were found to be JE positive. The most common presenting symptoms in JE patients were fever (100%), altered sensorium (83.58%), seizure (82.08%), headache (41.79%), and vomiting (29.85%). Signs of meningeal irritation were present in 55.22% of cases. Around 40.29%, JE patients had GCS ≤ 8. Among the JE patients, 14.7% died before discharge. The complete recoveries were observed in 63.9% of cases, while 21.3% had some sort of disability at the time of discharge. JE is still a major cause of AES in children in this part of India. These significant findings thus seek attentions of the global community to combat JE in children.

Original Research Article: Clinical Profile and Outcome of Patients with Acute Encephalitis Syndrome in a Tertiary Care Hospital, Assam, India.

“…It could be explained by younger patients were more affected probably because of lack of cumulative immunity due to natural infection. A male preponderance was seen in our study which was similar with various earlier studies (8,9,10,15). It could be explained probably due to males are exposed more in outdoor activities in regards to females who mostly stay indoors.…”

“…Seizure was seen in (43.3%) cases. Similar observations were made by different researchers in earlier studies (8,9,10,12). In our study, after detailed evaluation of all laboratory investigation reports , it was found that the most common cause of AES was acute ( Non JE) encephalitis (78.3%) .…”

“…Our study also indicates that patients mostly affected were from rural areas of Assam (93.4%) and belong to low socioeconomic group. Similar observations were made by Kakoti G et al (2013) 90% in upper Assam and Kumar R at el (2006) in Uttar Pradesh, India (10,11). In month wise distribution of cases , (78.3%) patients were observed in the month of July ,August , September and October suggesting peak incidence in monsoon and post monsoon period.…”

“…It was followed by acute JE positive (21.7 %) encephalitis. Kakoti G et al (2013) found 30% JE positive encephalitis ( 8,10). This clearly shows that the most common cause of AES was acute viral (Non JE) encephalitis at the community level.…”

“…Currently in Assam, JE vaccination with live vaccine (SA-14-14-2) has been included in routine immunization programme as per National Immunization Schedule (NIS). Previously to clear the backlog in children 1-15 years of age mass vaccination programme was conducted in 11 JE endemic districts of Assam in a phase wise manner since May 2006 (10).…”