Analysis of outcome of acute encephalitis syndrome after inclusion of coverage against scrub typhus


  • Ruchi Jha Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, India
  • Anil Kumar Jaiswal Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, India



Acute encephalitis syndrome, Azithromycin, Scrub typhus, Standard operating procedure


Background: Acute encephalitis syndrome (AES) has emerged as a major epidemic in Bihar and is associated with high mortality. Owing to the increasing burden of disease and its associated morbidity and mortality, studies were undertaken to evaluate specific etiology of AES. Some studies suggested emergence of scrub typhus as a major cause of AES accounting for about 25% of the cases1. A Standard Operating Procedure (SOP) was developed for treatment of AES cases in Bihar which included addition of Injection Azithromycin (@ 10 mg/kg for 7 to 10 days in case of suspected mycoplasma/rickettsial infection. The objective of the study is to compare the outcome of AES before and after the inclusion of coverage against rickettsial infection.

Methods: It is a randomized controlled trial conducted in the Department of Pediatrics, Patna Medical College and Hospital, Patna from January 2016 to August 2018.

Results: Total number of patients enrolled in both the groups were 127 and 88 respectively. No significant difference were seen in the baseline socio- demographic characteristics of the two groups. Case Fatality Rate in the 1st group (without inclusion of Azithromycin) was 39.3% while in the 2nd Group (with Azithromycin) was 12.5%.

Conclusions: Due to the emergence of scrub typhus as a major etiological factor for AES, inclusion of coverage against it along with measures like widespread immunization against Japanese Encephalitis and prompt management of complications and euglycemia, can result in steady decline in the death rates due to AES.


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