A clinico-epidemiological study of acute encephalitis syndrome with multi organ dysfunction


  • Mahima Mittal Department of Pediatrics, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
  • Komal P. Kushwaha Department of Pediatrics, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
  • Ashok K. Pandey National Institute of Virology, Gorakhpur Unit, Gorakhpur, Uttar Pradesh, India
  • Milind M. Gore National Institute of Virology, Gorakhpur Unit, Gorakhpur, Uttar Pradesh, India




Acute encephalitis syndrome, Encephalitis, Myocarditis, Multi-organ dysfunction


Background: Acute Encephalitis Syndrome (AES) is a pressing public health problem in Eastern Uttar Pradesh, India. Japanese Encephalitis (JE), which has been endemic in this region, has shown a declining trend. AES not due to JE (Non JE) constitutes more than 75% of all cases and is associated with non-neurological clinical manifestations also. The etiology of Non JE AES is still unknown. We studied the clinic-epidemiological profile of AES, and compared Non JE AES to JE.

Methods: This study was done in a tertiary care hospital in children 1-15 years. Clinical features, CSF analysis, biochemical tests, radiological features and outcome were studied in AES cases.

Results: Out of 505 patients, 27 had an identifiable non-viral etiology. JE was a cause in 31/478(6.48%) patients. The remaining 447 patients were labeled as Non JE AES. Headache at presentation (25.8% vs. 10.7%) and hypertonia (22.6% vs. 9.8%) were significantly higher in JE patients. Swelling over the body (21.25%vs 3.2%) and hypotonia (25.7% vs. 3.2%) were significantly more common in Non JE AES. Although cardiac involvement and multi-organ involvement was more in Non JE AES, the difference was not statistically significant. Overall mortality was 32.42%.

Conclusions: JE is no longer an important cause of AES in this region. Swelling over the body, floppiness and multi organ involvement are predominant features of Non JE AES. Although many infectious diseases can present with similar features, a viral etiology seems most likely. Further efforts are needed to identify etiology.


Kneen R, Michael BD, Menson E, Mehta B, Easton A, Hemingway C, et al. Management of suspected viral encephalitis in children - Association of British Neurologists and British Pediatric Allergy immunology and Infection Group National Guidelines. J Infect. 2012;64:449-77

Saxena SK, Singh M, Pathak AK, Mathur A. Reply to 'Encephalitis outbreak finds Indian officials unprepared'. Nat Med. 2006;12:269-70.

Parida M, Dash PK, Tripathi NK, Ambuj, Sannarangaiah S, Saxena P. Japanese Encephalitis Outbreak, India, 2005. Emerg Infect Dis. 2006; 12(9):1427-30.

Mittal M, Kushwaha KP. AES: Clinical Presentation and Dilemmas in Critical Care Management .J. Commun. Dis. 2014;46(1):50- 65.

Ranjan P, Gore M, Selvaraju S, Kushwaha KP, Murhekar M: Changes in acute encephalitis syndrome after introduction of Japanese encephalitis vaccine in a region of India. J. Infect. 2014;69(2):200-2.

Bhatt GC, Bondre VP, Sapkal GN, Sharma T, Kumar S, Gore MM et al. Changing clinico-laboratory profiles of encephalitis patients in the eastern Uttar Pradesh region of India. Tropical doctor. 2012;42:106-08.

Sapkal GN, Bondre VP, Fulmali PV, Patil P, Gopalkrishna V, Dhadania V, et al. Enteroviruses in Patients with Acute encephalitis, Uttar Pradesh, India; Emerg Infect Dis. 2009;15(2):295.

Kumar A, Shukla D, Kumar R, Idris MI, Usha K. Misra, and Dhole T. Molecular Epidemiological Study of Enteroviruses Associated with Encephalitis in Children .Indian Journal of Clinical Microbiology. 2012;50(11):3509-12.

World Health Oraganisation. Acute Encephalitis Syndrome.Japanese encephalitis surveillance standards. From WHO-recommended standards for surveillance of selected vaccine-preventable diseases; 2006.

Joshi R, Kalantri SP, Reingold A, Colford JM Jr. Changing landscape of acute encephalitis syndrome in India: a systematic review: Natl Med J India. 2012;25(4):212-20.

Ranjan P, Gore M, Selvaraju S, Kushwaha KP, Srivastava DK, Murhekar M. Changes in acute encephalitis syndrome incidence after introduction of Japanese encephalitis vaccine in a region of India. J Infect. 2014;69:200-2.

Gunasekaran P, Kaveri K, Arunagiri K, Mohana S, Kiruba R, Kumar VS, et al. Japanese encephalitis in Tamil Nadu (2007-2009). The Indian Journal of Medical Research. 2012;135(5):680-82.

Kalita JJ, Misra UK, Pandey SS, Dhole TN. A Comparison of Clinical and Radiological Findings in Adults and Children With Japanese Encephalitis. Arch Neurol. 2003;60(12):1760-64.

Khean JG, Chong TT, Nee KC, Patrick SKT, Adeeba K, Sazilah AS, et al. Clinical Features Of Nipah Virus Encephalitis Among Pig Farmers In Malaysia .The New England Journal of Medicine. 2000;342(17):1229-35.

Chaudhuri A, Kennedy PGE. Diagnosis and treatment of viral encephalitis. Postgrad Med J. 2002;78:575-58.

Lauer B, Niederau C, Kuhl U, Schannwell M, Pauschinger M, Strauer BE, et al. Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol. 1997;30:1354-9.

Felker GM, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Baughman KL, et al. Echocardiographic findings in fulminant and acute myocarditis. J Am Coll Cardiol. 2000;36:227-232.

Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT, et al. International Consensus Group on Cardiovascular Magnetic Resonance in Myocarditis. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardioll .2009;53:1475-87.

Mong HO, Wong SC, Lewthwaite P, Cardosa MJ, Solomon T. Clinical features, diagnosis, and management of enterovirus 71. Lancet Neurol. 2010;9:1097-110.

Vaz LS, Gupta NK. Outbreak of scrub typhus in Jammu-a report. MJAFI. 2006;62:342-3.

Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S and Purty S . Outbreak of scrub typhus in Pondicherry. JAssoc Physicians India. 2010;58:24-8.

Chauhan V, Mahesh DM, Panda P, et al. Profile of Patients of Leptospirosis in Sub-Himalayan Region of North India. J Assoc Phys India. 2010;58:354-6.

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.

Mathai E, Rolain JM, Verghese GM, Abraham OC, Mathai D, Mathai M et al. Outbreak of scrub typhus in southern India during the cooler months. Ann N Y Acad Sci. 2003;990:359-64.

Faine S. Guidelines for the control of Leptospirosis. WHO offset publication. 1982;67.






Original Research Articles