Investigating the Causes of Febrile Encephalopathy in Elderly Patients Admitted to Imam Reza Hospital in Mashhad during the 2013 to 2014

Reza, Naderi Hamid; Sareh, Sheybani F Sajjadi

doi:10.4172/2314-7326.s2-002

Cited by 1 publication

(6 citation statements)

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“…In 11% of cases, the diagnosis could not be achieved. [ 11 ] The proportion of patients with no definitive etiological diagnosis in our study (9.5%) is lower than that seen in a study by Mueller et al . [ 8 ] and Bhalla et al .…”

Section: Discussioncontrasting

confidence: 86%

“…Neck rigidity was present in 26% of cases by Bhalla et al . [ 11 ] In our study, the mean GCS was 8.14+/–1.3 with median of 8 and 27.6% of patients had GCS below or equal to 7. Similarly, Modi et al .…”

Section: Discussionmentioning

confidence: 45%

“…from Eastern Nepal reported a <72 h duration of altered sensorium for 96.3% children they studied. [ 10 , 11 ] The possible cause in our study as PGIMER, Chandigarh, India, being a tertiary care hospital and most of our patients were referred from other hospitals. 65.7% of cases were referred after being treated outside in our study.…”

Section: Discussionmentioning

confidence: 99%

“…The most common etiology in our study was tubercular meningitis although various other studies have reported pyogenic meningitis to be the predominant cause of AES and there is increase in number of cases of dengue and scrub meningoencephalitis. [ 7 , 11 , 12 , 15 ] Earlier study done from the same Institute by Bhalla et al . showed viral meningoencephalitis in 29.9% of case followed by pyogenic meningitis in 25.2% of cases and 7.8% of cases of tubercular meningitis, 12.7% into septic associated encephalopathy, leptospirosis for 3.14% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…[ 8 ] and Bhalla et al . [ 11 ] Possible explanations could be better diagnosis with the CSF TB-PCR and PGIMER being a tertiary care center with a large number of referred patients.…”

Section: Discussionmentioning

confidence: 99%

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Changing Clinical Profile and Predictors of Mortality in Patients of Acute Febrile Encephalopathy from North India

Ary,

Singh,

Suri

et al. 2023

Journal of Global Infectious Diseases

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Introduction: Acute encephalitis syndrome (AES) or acute febrile encephalopathy is a clinical condition characterized by altered mental status occurring after or along with a short febrile illness. In developing countries, infections are the predominant cause of AES. Prominent infections known to cause AES include viruses (such as herpes simplex virus [HSV], Japanese Encephalitis [JE] virus, dengue, enteroviruses [EVs]), bacteria, fungus, and parasites. In the present study, we aim to analyze the etiology, clinical features, and predictors of mortality in patients presenting with acute febrile encephalopathy or acute encephalitic syndrome. The present study was a prospective observational study conducted at Post Graduate Institute of Medical Education and Research a tertiary care center in Chandigarh, India. Methods: A total of 105 patients with ≥18 years of age with fever (body temperature >101° F for duration ≤14 days) and altered sensorium (Glasgow coma scale [GCS] score ≤10) lasting for more than 24 h, either accompanying the fever or following it were enrolled. Demographic and clinical details were recorded on pro forma. Cerebrospinal fluid (CSF) analysis was performed for all the enrolled patients at admission for cytology, CSF glucose to blood glucose ratio, protein levels, gram stain and culture sensitivity, adenosine deaminase levels, polymerase chain reaction for HSV/EV/mycobacterium tuberculosis (TB) and immunoglobulin M Enzyme-linked immune assay for JE. Computed tomography of the brain was done in all patients while magnetic resonance imaging (MRI) of the brain was carried out in 75 patients. Results: Among the 105 patients, tubercular meningitis was seen in 27 (25.7%) patients followed by acute pyogenic meningitis in 18 (17.1%) patients. Probable viral encephalitis was present in 12 (11.4%) cases. Septic encephalopathy (n = 10) and scrub typhus encephalitis (n = 8), HSV encephalitis (n = 6), dengue encephalitis (n = 4), leptospirosis (n = 3) were the other infections causing acute febrile encephalitis in our study. In addition to fever and altered sensorium common symptoms observed were headache (52.4%), vomiting (35.2%), and seizures (29.5%). The factors predicting increased mortality were female gender, fever of more than 38°C at admission, GCS <7, MRI showing disease-related findings like altered signal intensity bilateral medial temporal and insular area in herpes simplex encephalitis, etc., changes, and the group of patients where a definite diagnosis could not be established during the hospital stay. Conclusions: Tubercular meningitis/central nervous system TB is the predominant cause of acute febrile encephalopathy in developing countries. Scrub and dengue encephalitis are emerging as an important cause of acute febrile encephalopathy and occur predominantly in postmonsoon seasons. Acute febrile encephalopathy remains an important cause of mortality in patients presenting to Emergency Department (ER). The strongest predictors of mortality are low GCS and undiagnosed cases of AES.

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Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[ 8 ] and Bhalla et al . [ 11 ] Possible explanations could be better diagnosis with the CSF TB-PCR and PGIMER being a tertiary care center with a large number of referred patients.…”

Section: Discussionmentioning

confidence: 99%

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