The etiological diagnosis and outcome in patients of acute febrile encephalopathy: A prospective observational study at tertiary care center

Modi, Aniyang; Atam, Virendra; Jain, Nityanand; Gutch, Manish; Verma, Rajesh

doi:10.4103/0028-3886.96394

Cited by 25 publications

(40 citation statements)

References 9 publications

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“…In the study by Modi et al of out 120 patients, pyogenic meningitis was found in 44 (36.7%) was the commonest etiology followed by acute viral encephalitis (AVE) 34 (28.33%). [1,10] In present study as well as in study done by Bhalla et al1 and Modi et al4 the maximum burden of disease was of pyogenic meningitis and viral meningoencephalitis. But there was difference in percentage of various etiologies.…”

Section: Discussionsupporting

confidence: 74%

“…[1] In present study 30.43% of the patients had seizures which was in concordance with our study. Fever, headache and altered sensorium were also the most common presenting complaints of patients in other studies by Kashinkunti et al and Modi et al [10,11] In our study a total of 48 (41.73%) patients had acute pyogenic/bacterial meningitis. Twenty four patients (20.86%) had viral meningoencephalitis.…”

Section: Discussionsupporting

confidence: 73%

“…In the present study the total number of cases of acute viral meningoencephalitis was 24 (21%) which was comparable to study done by Bhalla et al and Modi et al (29% and 28%) respectively. [1,10] Our study highlights the fact that despite of previous presumption that viral encephalitis is very low in hilly region, it is significantly present in the hills also and any patient of acute febrile encephalopathy irrespective of from hilly or plain region should be considered for diagnosis of viral encephalitis. In our study we had a total of seven (6.08%) patients of cerebral malaria.…”

Section: Discussionmentioning

confidence: 67%

“…Similarly mean age in cerebral malaria, sepsis associated encephalopathy and enteric encephalopathy ranged from 28-37years. [1,10] Fever and altered sensorium was the most common symptom seen in 100% of patients. Forty seven patients (40.86%) had headache and 35 patients (30.43%) had seizures at time of presentation or had recent history of seizures.…”

Section: Discussionmentioning

confidence: 99%

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Acute Febrile Encephalopathy: An Experience from Tertiary Care Centre

Singh¹,

Satyawali²,

Kumar³

et al. 2017

AIMDR

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Background: Acute febrile encephalopathy (AFE) is a very common cause of hospitalization and constitutes a medical emergency. Emergency clinicians need to diagnose accurately, timely administration of antimicrobials and adjunctive therapies to avoid complications. Aims: To study the etiological profile and outcome of patients with acute febrile encephalopathy. Methods: A prospective hospital based study conducted on the patients admitted in Medicine department, Dr susheela tiwari hospital during the period of August 2012 to July 2014. All patients (>18 years) with history of fever, less than 15 days duration and with altered sensorium were included in the study. Result: Out of total 115 studied with mean age of 40.47±17.89 yrs (range of 14 -85 years) and male: female ratio of 1.3: 1. 48 (41.73%), 24 (20.86%) and, 20 (17.3%) patients had acute pyogenic meningitis, viral meningoencephalitis and tubercular meningitis respectively. 7 (6.08%) patients had cerebral malaria followed by 5 (4.3%) patients sepsis associated encephalopathy. 30 (62.0%), 7 (29.1%) and16 (80%) patients in acute pyogenic meningitis, acute viral meningoencephalitis and tubercular meningitis respectively survived without neurological deficit. 9 (18.7%), 8 (33.3%) and 2 (10%) patients in acute pyogenic meningitis, viral meningoencephalitis, tubercular meningitis respectively had residual neurological deficit at discharge. There were 25 deaths (21.7%) in present study. Conclusion: The causes of acute febrile encephalopathy varies from infectious causes to noninfectious metabolic disorders. Acute pyogenic meningitis was the leading cause of AFE followed by acute viral meningoencephalitis.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Acute Febrile Encephalopathy: An Experience from Tertiary Care Centre

Singh¹,

Satyawali²,

Kumar³

et al. 2017

AIMDR

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“…To the best of our knowledge, data thoroughly assessing the predictors of unfavorable outcome in HME patients do not exist in the literature. One more potential limitation of the studies published was that they included cases without virological confirmation (11)(12)(13), thus blurring the inferences made. Hence, in this multinational study, we included only HME patients with a definite virological diagnosis.…”

mentioning

confidence: 99%

Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

Erdem

Çağ

Öztürk-Engin

et al. 2015

Antimicrob Agents Chemother

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Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME outcomes, with special emphasis on the use and timing of antiviral treatment. Samples from 501 patients with molecular confirmation from cerebrospinal fluid were included from 35 referral centers in 10 countries. Four hundred thirty-eight patients were found to be eligible for the analysis. Overall, 232 (52.9%) patients experienced unfavorable outcomes, 44 died, and 188 survived, with sequelae. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.05), Glasgow Coma Scale score (OR, 0.84; 95% CI, 0.77 to 0.93), and symptomatic periods of 2 to 7 days (OR, 1.80; 95% CI, 1.16 to 2.79) and >7 days (OR, 3.75; 95% CI, 1.72 to 8.15) until the commencement of treatment predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to a favorable outcome.

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Incidence and clinical features of herpes simplex viruses (1 and 2) and varicella‐zoster virus infections in an adult Korean population with aseptic meningitis or encephalitis

Choi

Kim

et al. 2014

Journal of Medical Virology

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Since there are limited data on the incidence and clinical findings of central nervous system (CNS) infection by three α-herpesviruses including human herpes simplex virus 1 (HSV-1), HSV-2 and varicella-zoster virus (VZV) in Korea, a retrospective analysis of clinical data and polymerase chain reaction (PCR) results was performed in patients who presented with suspicion of acute viral meningitis and/or encephalitis at the emergency department of a tertiary referral hospital in Seoul, Korea. During the 3-year study period, a total of 224 cerebrospinal fluid (CSF) samples from 224 patients were examined. Among the 224 patients, 135 (60.3%) patients were identified as having aseptic meningitis (n = 70, 51.9%), encephalitis (n = 41, 30.4%) or meningoencephalitis (n = 24, 17.8%) at discharge. Twenty-four (17.8%) patients were identified as having VZV meningitis (n = 16, 11.9%), VZV meningoencephalitis (n = 2, 1.5%), HSV-2 meningitis (n = 4, 3.0%), or HSV-1 encephalitis (n = 2, 1.5%). Of the 24 patients infected with the three herpesviruses, immunocompromised patients accounted for 33.3% (n = 8). Skin rashes were observed in half (n = 9) of the patients with VZV, and none with HSV-1 or HSV-2. One patient with VZV meningitis and four patients with brain parenchymal involvement had neurologic sequelae. In conclusion, three herpesviruses are important causative agents of CNS infectious disease with significant morbidity in adults, regardless of the immunologic status. Therefore, CSF should be examined for HSV-1, HSV-2, and VZV using sensitive diagnostic methods in all cases of adult patients with clinical manifestations of CNS disease in order to identify the correct etiology and to determine appropriate therapy.

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The etiological diagnosis and outcome in patients of acute febrile encephalopathy: A prospective observational study at tertiary care center

Abstract: In this study, pyogenic meningitis was the leading cause of AFE, followed by AVE and cerebral malaria. The outcome in cases with AVE can be fatal or more disabling than other etiologies.

Cited by 25 publications

References 9 publications

Acute Febrile Encephalopathy: An Experience from Tertiary Care Centre

Acute Febrile Encephalopathy: An Experience from Tertiary Care Centre

Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

Incidence and clinical features of herpes simplex viruses (1 and 2) and varicella‐zoster virus infections in an adult Korean population with aseptic meningitis or encephalitis

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