Clinico-aetiological profile and outcome in children with acute febrile encephalopathy
DOI:
https://doi.org/10.18203/2349-3291.ijcp20221377Keywords:
CNS infections, Encephalopathy, Acute febrile encephalopathy, Cerebral malariaAbstract
Background: Acute febrile encephalopathy (AFE) is a medical emergency as well as diagnostic and therapeutic challenge in children. Objective of this study was to assess clinico-aetiological profile and outcome in children with AFE.
Methods: This prospective observational study was carried out at tertiary care hospital Udaipur, from January 2020 to July 2021. Total 61 children aged 1 month to 18 years who were admitted in PICU with fever ≤2 weeks duration and altered sensorium either at onset or following fever were enrolled. Patient’s detailed history and physical examination including detailed neurological examinations were recorded on pre-structured performa. The investigations included CBC with PBF, ESR, malarial parasite, dengue, scrub typhus, typhi-dot, blood sugar, KFT, electrolytes, LFT, calcium, CSF examination, urine examination, X-ray chest. ABG, serum ammonia, blood culture for bacteriological studies and CT/MRI brain were performed whenever required.
Results: 61 patients were admitted with fever and loss of sensorium. The most common clinical sign was the pallor (63.9%) and vomiting (55.7%) was the most common clinical symptom. Cerebral malaria was the commonest cause (31.1%) of AFE followed by suspected viral encephalitis (14.7%) and pyogenic meningitis 9 (14.7%). Out of total 61 patients, 45 (73.8%) patients were discharged and 16 (26.2%) patients were expired. Maximum mortalities were seen in Reye’s syndrome (5 out of 6 cases) and was most in age group <5 years of age (26 cases).
Conclusions: Cerebral malaria was the leading cause of AFE followed by suspected viral encephalitis and pyogenic meningitis. While determining the aetiology of AFE in a malarial endemic area, cerebral malaria should be considered in all patients. Reye’s syndrome should also be considered in patients of AFE should be evaluated to diagnose or rule out this entity.
References
Bhalla A, Suri V, Varma S, Sharma N, Mahi S, Singh P et al. Acute febrile encephalopathy in adults from Northwest India. J Emerg Trauma Shock. 2010;3:220-4.
Yeolekar ME, Trivedi TH. Febrile Encephalopathy: Challenges in Management. J Assoc Physicians India. 2006;54:845-7.
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(8):801-5.
Bokade CM, Gulhane RR, Bagul AS, Thakre S. Acute febrile encephalopathy in children and predictors of mortality. J Clin Diagn Res. 2014;8(8):PC09-11.
Bansal A, Singhi SC, Singhi PD, Khandelwal N, Ramesh S. Non-traumatic coma. Indian J Pediatr. 2005;72:467-73.
Kumar R, Mathur A, Kumar A, Sethi G, Sharma S, Chaturvedi UC. Virological investigation of acute encephalopathy in India. Arch Dis Child. 1990;65:1227-30.
Singh RR, Chaudhary SK, Bhatta NK, Khanal B, Shah D. Clinical and etiological profile of acute febrile encephalopathy in Eastern Nepal. Indian J Pediatr. 2009;76(11):1109-11.
Gwer S, Thuo N, Idro R, Ndiritu M, Boga M, Newton C et al. Changing trends in incidence and aetiology of childhood acute non-traumatic coma over a period of changing malaria transmission in rural coastal Kenya: a retrospective analysis. Br Med J Open. 2012;2:e000475.
Anga G, Barnabas R, Kaminiel O, Tefuarani N, Vince J, Ripa P et al. The aetiology, clinical presentations and outcome of febrile encephalopathy in children in Papua New Guinea. Ann Trop Paediatr. 2010;30:109-18.
Kothari VM, Karnad DR, Bichile LS. Tropical infections in the ICU. J Assoc Physicians India 2006;54:291-8.
Gupta K, Purani CS, Mandal A, Singh A. Acute Febrile Encephalopathy in Children: A Prospective Study of Clinical Features, Etiology, Mortality, and Risk Factors from Western India. J Neurosci Rural Pract. 2018;9(1):19-25.
Sharma P, Sarmah BK, Kayastha P, Shrestha A, Tiwari D. Clinical Profile of Children with Acute Febrile Encephalopathy in a Tertiary Health Care Center of Nepal. J Nepal Paediatr Soc. 2015;35(3):224-30.
Tripathy SK, Mishra P, Dwibedi B, Priyadarshini L, Das RR. Clinico-epidemiological study of viral acute encephalitis syndrome cases and comparison to nonviral cases in children from Eastern India. J Global Infect Dis. 2019;11:7-12.
Khichi YR, Kumar A, Yadav S. Study of acute encephalic syndrome in children. J Coll Med Sci Nepal. 2010;6(1):7-13.
Biswas R, Basu K, Tripathi I, Roy SK. A study on etiology, clinical profile and outcome of acute febrile encephalopathy in children: A prospective study at a tertiary care center of Eastern India. Asian Journal of Medical Sciences. 2009;12(4):86-91.
Basu R. An Epidemiological Study on Clinical Profile and Short-Term Outcome in Children of Acute Encephalitis Syndrome in A Tertiary Care Centre of West Bengal with Special Reference to The Various Prognostic Markers. IOSR-JDMS. 2018;17(2):14-9.
Khodapanahandeh F, Najarkalayee NG. Etiology and outcome of Non traumatic coma in children admitted to pediatric intensive care unit. Iran J Pediatr. 2019;19(4):393-8.
Karthika JR. Profile of children admitted with acute encephalitis syndrome Sep 2018 master’s thesis Government Theni Medical College, Theni. Available at: http://repository -tnmgrmu.ac.in/id/eprint/9454. Accessed on 21 December 2021.
Kuntal M, Swarnkar K. Clinical Profile and Predictor of Adverse Outcome in Children with Acute Encephalitis Syndrome: A Cross-Sectional Study. JKIMSU. 2020;9(1):18-26.