Clinical profile and outcome of children admitted with acute encephalitis syndrome


  • Arpita Adhikari Department of Pediatrics, LTMGH, Sion, Mumbai, Maharashtra, India
  • Mona Gajre Department of Pediatrics, LTMGH, Sion, Mumbai, Maharashtra, India
  • Rini Kothari Department of Pediatrics, LTMGH, Sion, Mumbai, Maharashtra, India
  • Nayan Chaudhari Department of Pediatrics, LTMGH, Sion, Mumbai, Maharashtra, India
  • Deepali Sangale Department of Pediatrics, LTMGH, Sion, Mumbai, Maharashtra, India



AES, Glasgow coma scale, Neurological sequalae


Background: Acute encephalitis syndrome (AES) is an important cause of mortality and morbidity in children. We undertook this study for better understanding of clinical profile and outcome of AES in our settings.

Methods: It was a prospective observational study. We studied 15 patients of AES admitted in a tertiary care hospital from December 2016 to May 2017. For investigating AES cases, WHO case definition was adopted. Clinically a case of AES is defined as fever or recent history of fever with change in mental status (including confusion, disorientation, coma, or inability to talk) and/or new onset of seizures (excluding simple febrile seizures). Other early clinical findings could include an increase in irritability, somnolence or abnormal behavior greater than that seen with usual febrile illness. We evaluated their clinical characteristics and outcomes at the time of discharge.

Results: Fever, altered sensorium, seizures and headache were the most common symptoms observed in this study. Among 15 cases of AES patients, 6 (40%) recovered completely, while 5 (33.33%) cases had neurological sequelae with a wide range of severity varying from mild to severe at the time of discharge, 4 (26.66%) patient died in the hospital.  

Conclusions: This study offers a description of the present etiology, clinical presentation and short-term outcome of AES. Use of mechanical ventilation, lower Glasgow coma score, and concurrent seizures are predictors for a poor outcome. Reporting and appropriate workup of all cases would strengthen the AES surveillance and help in reducing the morbidity and mortality due to this disorder.


Hinson VK, Tyor WR. Update on viral encephalitis. J Curr Opin Neurol 2001;14(3):369-74.

McGrath N, Anderson NE, Croxson MC, Powell KF. Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome. J Neurol Neurosurg Psychiat. 1997;63(3):321-6.

Utley TFM, Ogden JA, Gibb A. The long-term neuropsychological outcome of herpes simplex encephalitis in a series of unselected survivors. J Cognit Behav Neurol. 1977;10(3):180-18

Raschilas F, Wolff M, Delatour F, Chaffaut C, De Broucker T, Chevret S, et al. Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicenter study. Clinic Infect Diseas. 2002;35(3):254-60.

Erlanger TE, Weiss S, Keiser J. Past, present, and future of Japanese encephalitis. J Emerg Infect Dis. 2009;15(1):1

Solomon T. Control of Japanese encephalitis-within ourgrasp? N Engl J Med. 2006;355(9):869

Solomon T, Hart IJ, Beeching NJ. Viral encephalitis: a clinician’s guide. J Pract Neurol. 2007;7(5):288-305

Stahl JP, Mailles A, Dacheux L. Epidemiology of viral encephalitis in 2011. J Me´d et Mal Infect 2011;41(9):453-46

Wang WS, Liu CP. The clinical presentation, diagnosis, treatment, and outcome of encephalitis: five years of experienceat a medical center in Northern Taiwan. Int J Gerontol. 2011;5(1):9-12.

Wang L, Hu W, Magalhaes RJS. The role of environmental factors in the spatial distribution of Japaneseencephalitis in mainland China. Environm Int. 2014;73:1-9.

Jing Zhou, Xinyue Qin. Clinical features and influencing factors of prognosis in patients with viral encephalitis (in Chinese).J Chin Gener Prac Chin. 2012;15(34):3975-7

Arunachalam N, Rajendran R. Studies on Japanese encephalitis in Kurnool district, Andhra Pradesh. CRME Annual Report.

Dutta P, Khan SA, Khan AM, Borah J, Sarmah CK, Mahanta J. The effect of insecticide-treated mosquito nets (ITMNs) on Japanese encephalitis virus seroconversion in pigs and humans. The Am J Tropic Medic Hyg. 2011;84(3):466-72.

Solomon T, Thao TT, Lewthwaite P, Ooi MH, Kneen R, Dung NM, et al. A cohort study to assess the new WHO Japanese encephalitis surveillance standards. Bulletin of the World Health Organization. 2008;86:178-86.

Rayamajhi A, Singh R, Prasad R, Khanal B, Singhi S. Study of Japanese encephalitis and other viral encephalitis in Nepali children. Pediat Int. 2007;49(6):978-84.

Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. J Lancet. 1975;305(7905):480–484

World Health Oraganisation. Acute Encephalitis Syndrome. Japanese encephalitis surveillance standards. January 2006. From WHO-recommended standards for surveillance of selected vaccine-preventable diseases. WHO/V&B/03.01.Available at: http://www. who. int/vaccines-documents/DocsPDF06/843.pdf. Accessed on 08 January 2020.

Sapkal GN, Bondre VP, Fulmali PV, Patil P, GopalkrishnaV, Dadhania V, et al. Enteroviruses in patients with acute encephalitis, Uttar Pradesh, India. Emerg Infect Dis. 2009;15:295-8.

Karmarkar SA, Aneja S, Khare S, Saini A, Seth A, Chauhan BK. A study of acute febrile encephalopathy with special reference to viral etiology. Indian J Pediatr. 2008;75:801-5

Rao BL, Basu A, Wairagkar NS, Gore MM, Arankalle VA, Thakare JP, et al. A large outbreak of acute encephalitis with high fatality rate in children in Andhra Pradesh, India, in 2003, associated with Chandipura virus. Lancet. 2004;364:869-74.

Chadha MS, Arankalle VA, Jadi RS, Joshi MV, Thakare JP, Mahadev PV, et al. An outbreak of Chandipura virus encephalitis in the eastern districts of Gujarat state, India. Am J Trop Med Hyg. 2005;73:566-70.

Harit AK, Ichhpujani RL, Gupta S, Gill KS, Lal S, Ganguly NK, et al. Nipah/Hendra virus outbreak in Siliguri, West Bengal, India in 2001. Indian J Med Res. 2006;123:553-60.

Kalantri SP, Joshi R, Riley LW. Chikungunya epidemic: an Indian perspective. Natl Med J India. 2006;19:315-22.

Kumar R, Tripathi S, Tambe JJ, Arora V, Srivastava A, Nag VL. Dengue encephalopathy in children in Northern India: clinical features and comparison with non dengue. J Neurol Sci. 2008;269:41-8.

Steiner I. Herpes simplex virus encephalitis: new infection or reactivation? Curr Opin Neurol. 2011;24:268-74.

Kabilan L, Ramesh S, Srinivasan S, Thenmozhi V, Muthukumaravel S, Rajendran R. Hospital-and laboratory-based investigations of hospitalized children with central nervous system-related symptoms to assess Japanese encephalitis virus etiology in Cuddalore District, Tamil Nadu, India. J Clinic Microbiol. 2004;42(6):2813-5.

Potula R, Badrinath S, Srinivasan S. Japanese encephalitis in and around Pondicherry, South India: a clinical appraisal and prognostic indicators for the outcome. J Tropic Pediat. 2003;49(1):48-53.

Kumar R, Tripathi P, Singh S, Bannerji G. Clinical features in children hospitalized during the 2005 epidemic of Japanese encephalitis in Uttar Pradesh, India. Clinic Infect Disea. 200643(2):123-31.

Chen KM, Tsai HC, Sy CL, Lee SS, Liu YC, Wann SR, et al. Clinical manifestations of Japanese encephalitis in southern Taiwan. J Microbiol Immunol Infect. 2009;42(4):296-302.

Fourth Biregional Meeting on the Control of Japanese Encephalitis (JE): Report of the Meeting Bangkok,Thailand, 7- 8 June 2009,” Tech. Rep.,WHO, Regional Office for South-East Asia, 2010.

Avabratha KS, Sulochana P, Nirmala G, Vishwanath B, Veerashankar M, Bhagyalakshmi K. Japanese encephalitis in children Bellary Karnataka: Clinical profile and sequelae. Int J B0iomed Res. 2012;3(2):100-5.

Ooi MH, Lewthwaite P, Lai BF, et al. The epidemiology, clinical features, and long-term prognosis of Japanese encephalitis in central Sarawak, Malaysia. J Clin Infect Dis. 2008;47(4):458-68.

Koskiniemi M, Rantalaiho T, Piiparinen H, von Bonsdorff CH, Färkkilä M, Järvinen A, et al. Infections of the central nervous system of suspected viral origin: a collaborative study from Finland. J Neurovirol. 2001;7(5):400-8.

Wu YC, Huang YS, Chien LJ, Lin TL, Yueh YY, Tseng WL, et al. The epidemiology of Japanese encephalitis on Taiwan during 1966-1997. The Am J Tropic Medic Hyg. 1999;61(1):78-84.

Fowler Å, Stödberg T, Eriksson M, Wickström R. Childhood encephalitis in Sweden: etiology, clinical presentation and outcome. Europ J Paediat Neurol. 2008;12(6):484-90.

Vashishtha VM, Ramachandran VG. Vaccination policy for Japanese encephalitis in India: Tread with caution!. Ind Pediat. 2015;52(10):837-9.






Original Research Articles