Clinical profile and outcome of acute febrile encephalopathy in children
DOI:
https://doi.org/10.18203/2349-3291.ijcp20232250Keywords:
Acute febrile encephalopathy, Viral encephalitis, Children, Clinical profileAbstract
Background: This prospective observational study aims at studying clinical profile of patients with acute febrile encephalopathy.
Methods: This study was conducted in patients of acute febrile encephalopathy admitted in PICU at tertiary care centre during November 2019 to May 2021 in age group one month to 18 years. 35 patients satisfied the inclusion criteria.
Results: 51.4% children belonged to age group less than 60 months and 40% children belonged to age group 61-120 months. Other than fever and altered sensorium (diagnostic criteria), seizures (74.3%), vomiting (60%), headache (22.9%) and refusal to feed (17.1%), were the major complaints. Raised ICT was found in 20 (57.1%). 20 (57.1%) patients had hyponatremia (Na+ <135). MRI brain abnormalities were found in 13 patients with majority finding being edema 8 (61.5%). 15 (62.5 %) patients had CSF cell count between 5-100/µl. 16 (45.7%) children presented with GCS score 10-12. In the present study, most common diagnosis was rickettsia encephalitis in 10 patients (28.6%) followed by Dengue encephalitis 6 (17.1%) and probable Viral encephalitis 6 (17.1%). There was no mortality in the present study.
Conclusions: Seizure, headache and vomiting were the other common presenting features in a case of acute febrile encephalopathy. This indicates raised intracranial tension. Rickettsia followed by Dengue and probable Viral encephalitis were the common etiological diagnosis. Many cases are viral in nature and since no particular or highly effective therapy is available, early diagnosis, emergent treatment of raised intracranial pressure and hyponatremia and implementation of aggressive supportive care may reduce mortality and morbidity as in present study.
References
Bokade CM, Gulhane RR, Bagul AS, Thakare SB. Acute Febrile Encephalopathy in Children and Predictors of Mortality. J Clin Diagn Res. 2014;8(8): PC09-11.
Karmarkar SA, Aneja S, Khare S. A study of acute febrile encephalopathy with special reference to viral etiology. Indian J Pediatr. 2008;75(8):801-5.
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.
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;76:1109-11.
Mohamad A, Mikati, Dmitry T. The Nervous System. Nelsons Textbook of Paediatrics. USA: Springer; 2019:3092-3.
Gilles AO, Philippe GM, Thomas B. Management of critically ill children with traumatic brain injury. Indian J Pediatr. 2008;23:32-7.
Debnath DJ, Wanjpe A, Kakrani V, Singru S. Epidemiological study of acute bacterial meningitis in admitted children below twelve years of age in a tertiary care teaching hospital in Pune, India. Med J DY Patil Univ. 2012;5(1):28.
Mani R, Pradhan S, Nagarathna S, Wasiulla R, Chandramuki A. Bacteriological profile of community acquired acute bacterial meningitis: a ten-year retrospective study in a tertiary neuro-care centre in South India. Indian J Med Microbiol. 2007;25(2):108-14.
Deepthi A, Bekkam M. Study on clinical profile and etiology of acute febrile encephalopathy in children aged between 2 months to 14 years attending to a tertiary care hospital, Eluru, Andhra Pradesh, India. Int J Pediatr Res. 2018;5(11):575-81
Yevich SJ, Sánchez JL, DeFraites RF, Rives CC, Dawson JE, Uhaa IJ, et al. Seroepidemiology of infections due to spotted fever group rickettsiae and Ehrlichia species in military personnel exposed in areas of the United States where such infections are endemic. J Infect Dis. 1995;171(5):1266-73.
Hilton E, DeVoti J, Benach JL, Halluska ML, White DJ, Paxton H, et al. Seroprevalence and seroconversion for tick-borne diseases in a high-risk population in the northeast United States. Am J Med. 1999;106(4):404-9.
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):019-25.
Bansal A, Singhi SC, Singhi PD, Khandelwal N, Ramesh S. Non traumatic coma. Indian J Pediatr. 2005;72:467-73.
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 J Med Sci. 2021;12(4):86-91.
Kamble S, Raghvendra B. A clinico-epidemiological profile of acute encephalitis syndrome in children of Bellary, Karnataka, India. Int J Community Med Public Health. 2016;3(11):2997-3002.
Sarkar A, Taraphdar D, Mukhopadhyay SK, Chakrabarti S, Chatterjee S. Molecular evidence for the occurrence of Japanese encephalitis virus genotype I and III infection associated with acute encephalitis in patients of West Bengal, India, 2010. Virol J. 2012; 9(1):1-6.
Sudhir SK, Prasad MS. Acute Encephalitis Syndrome (AES) associated with sociocultural and environmental risk factors in infants/children of Muzaffarpur, Bihar-hospital-based, prospective study. J Evid Based Med Health. 2018;5(1):23-6.
Yashodhara P, Madhavi N. Clinical profile and outcome of viral encephalitis in pediatric department in Government General Hospital, Guntur. Int J Sci Res. 2015;4(1):2142-6.
