ORIGINAL RESEARCH PAPER Volume - 11 | Issue - 01 | January - 2022 | PRINT ISSN No. 2277 - 8179 | DOI : 10.

36106/ijsr

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH

A CLINICO-EPIDEMIOLOGICAL PROFILE OF ACUTE ENCEPHALITIS

SYNDROME(AES) IN CHILDREN

Paediatric Medicine
Post Graduate, Department of Paediatrics, RCSM, GMC & CPR Hospital, Kolhapur,
Dr. Narendra B. R* Maharashtra. *Corresponding Author
Associate Professor, Department of Paediatrics, RCSM, GMC & CPR Hospital ,
Dr. Deepa S Phirke Kolhapur, Maharashtra.
ABSTRACT
BACKGROUND:According to World Health Organization (WHO) Denition- Clinically a case of Acute Encephalitis Syndrome is dened as a
person of any age at any time of year, with the acute onset of fever and a change in mental status such as confusion, disorientation, coma or inability
to talk and/or new onset of seizures. Initially Tuberculosis meningoencephalitis and bacterial meningoencephalitis were common causes but now
there is a change in paradigm of Acute Encephalitis Syndrome to viral meningoencephalitis.
METHODS: A descriptive observational study was undertaken at the department of pediatrics,in a tertiary care hospital in a city in Western
Maharashtra. Children aged 0- 12 years fullling the WHO denition of AES were included as study subjects. Detailed history for necessary
demographic characteristics and clinical examination ndings were tabulated and analyzed.To establish the relationship between two quantitative
variables relative statistical analysis was applied.
RESULTS: A total of 60 cases formed as study subjects. With higher proportion of subjects were between 5 to 12 years (46.7%).Majority of them
being males 33 (55%).A majority of cases were reported during post-monsoon period 26 (43.3%).All cases had altered sensorium, 90% cases had
fever. With the use of CSF parameters majority of cases had viral encephalitis(58.3%), followed by bacterial encephalitis(26.7%).Out of 60 cases
53 cases(88.3%) were immunized.
CONCLUSIONS: The percentage of AES cases in this study was 1.55%. Most common age group affected is below 5 years to 12 years. Male
children are more affected than females with a ratio of 1.4:1 .Most common presenting symptom was altered sensorium (100%) followed by fever
(90%).Meningeal sign was present in 18 patients (30%).Out of 60 cases viral aetiology was found in 35 cases (58.3%), followed by bacterial
aetiology in 16(26.7%).
KEYWORDS
AES,Viral,Bacterial,CSF.
INTRODUCTION patients as per inclusion criteria were included in the study.
According to World Health Organization (WHO) Denition-
Clinically a case of Acute Encephalitis Syndrome is dened as a person Detailed history for necessary demographic characteristics like
of any age at any time of year, with the acute onset of fever and a age,sex,seasonal variation were tabulated and analyzed. Immunisation
change in mental status such as confusion, disorientation, coma or history was noted and analysed.
inability to talk and/or new onset of seizures1.
The percentage of total Acute Encephalitis Syndrome (AES) patients
Major cause of encephalitis is found to be CNS infections and more was calculated.Patients were examined andthe clinical manifestations
than 100 causative agents are identied2. Recurrent epidemics of were tabulated as per their frequency. Routine investigations and
encephalitis of unknown aetiology have occurred in India .There have lumbar puncture was done in all patients except in those where it was
been more than 44,000 cases and nearly 6000 deaths from encephalitis contraindicated.Radioimaging,serological tests and CBNAAT was
in India, Between 2008 and 2014, particularly in Uttar Pradesh and performed wherever necessary as per the probable aetiology.
Bihar. There has been a rise in encephalitis, with over 125 children
reported to have died in one hospital in Gorakhpur alone in 20163. Characteristic CSF ndings were analysed. Aetiology of Acute
Encephalitis Syndrome (AES) was determined by characteristic
However, alternate novel viral-aetiologies for AES outbreaks clinical ndings, CSF picture, and relevant investigations.The
including Enteroviruses, Chandipura virus and Nipah virus are found different aetiologies were analysed to see for any change in paradigm
in the recent studies even in the JE endemic regions. High mortality is of Acute Encephalitis Syndrome (AES).
seen in explosive AES cases and hence is a major public health concern
in India4. RESULTS
Table 1 :Age wise distribution of cases
Moreover similar symptoms are seen in a number of other infectious Age (in years) Number of Children Percentage
conditions, and distinguishing encephalitis from other conditions is a <1 12 20%
challenging task. 1-5 20 33.3%
5-12 28 46.7%
Initially Tuberculous Meningoencephalitis and bacterial Total 60 100%
Meningoencephalitis were common causes but now there is a change
in paradigm of Acute Encephalitis Syndrome to viral Out of total cases 28 (46.7%) cases had age between 5-12 years, 20
(33.3%) cases had age between 1-5 years and 12 (20%) cases had age
meningoencephalitis.Hence there is a need of studies to analyze the
less than 1 year.
changing clinical prole and etiology of AES in children.
Table 2:Gender wise distribution of cases
AIM AND OBJECTIVES:
1. To nd out the percentage of Acute Encephalitis Syndrome (AES) Gender Number of Children Percentage
cases. Female 27 45%
2. To study the various demographic features and clinical Male 33 55%
presentation in Acute Encephalitis Syndrome (AES). Total 60 100%
Out of total children 33 were males and 27 were females. The male
METHODOLOGY dominance was observed in the study subjects
The study was done at Tertiary Care Centre in the Department of
Pediatrics,in a tertiary care hospital in a city in Western Table 3: Season wise comparison of cases
Maharashtraafter due permission from the Institutional Ethic and
Scientic Committee and Review Board and after taking Written Season Number of Children Percentage
Informed Consent from the patient's parents / legal guardian. Total 60 Pre Monsoon 12 20%
International Journal of Scientific Research 1
Volume - 11 | Issue - 01 | January - 2022 PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr
7 10
Monsoon 22 36.7% et al ,Rayamajhi et al predominant aetiology was viral followed by
Post Monsoon 26 43.3% bacterial and Tubercolous Meningitis.In a study conducted by SA
Total 60 100% Kamarakar11 in 2005 although predominant aetiology was viral
encephalitis(37.3%), pyogenic meningitis also accounted for
Out of 60 cases majority of the cases were seen in post monsoon 33.8%.This shows the change in paradigm to viral meningoencephalitis
season(43.3%) followed by monsoon season(36.7%).
CONCLUSION
Table 4:Signs and Symptoms We studied 60 cases of acute encephalitis syndrome among 3847
Signs And Symptoms Number of Children Percentage patients admitted in our hospital during study period. The percentage
Fever 48 90% of AES cases in this study was 1.55%.Most common age group
affected is below 5 years to 12 years. Male children are more affected
Seizure 37 71.6% than females with a ratio of 1.4:1.Most common presenting symptom
Altered Sensorium 60 100% was altered sensorium (100%) followed by fever (90%). Meningeal
Headache 8 13.3% sign was present in 18 patients (30%). Out of 60 cases viral aetiology
Vomiting 29 48.3% was found in 35 cases (58.3%), followed by bacterial aetiology in
Loose Stools 6 10% 16(26.7%).
Meningeal Signs 18 30%
Limitations
Shock 4 6.6%
The major limitation of this study was investigations like PCR
All the cases had altered sensorium(100%),90% of cases had fever and forspecic viral aetiology could not be done due to nancial
71.6% presented with seizures. constraints.

Table 5:Immunization History REFERENCES

1. WHO – recommended standards for surveillance of selected vaccine preventable
Immunized Number of cases Percentage diseases. Geneva: WHO; 2006.
Yes 53 88.3% 2. Jemila S Hamid, Christopher Meaney and the UK Health Protection Agency; Etiology of
Encephalitis Study Group Potential risk factors associated with human encephalitis; application
No 7 11.7% of canonical correlation analysis, BMC Medical Research Methodology 2011, 11:120.
Total 60 100% 3. Jai Prakash Narain, A. C. Dhariwal, C. Raina MacIntyre et al; Acute encephalitis in
India: An unfolding tragedy; Indian J Med Res. 2017 May;145(5): 584–587.doi:
Out of 60 cases 53 children were immunized and 7 cases are not 10.4103/ijmr.IJMR_409_17.
immunized 4. Sourish Ghosh and Anirban Basu et al; Acute Encephalitis Syndrome in India: The
Changing Scenario; Ann Neurosci. 2016 Sep; 23(3): 131–133.Published online 2016
Sep 9. doi: 10.1159/000449177.
Table 6: CSF Suggestive Diagnosis 5. Sneha Kamble and Bellara Raghvendra et al; A clinico-epidemiological prole of acute
encephalitis syndrome in children of Bellary, Karnataka,India.Int J Community Med
CSF suggestive Number of cases Percentage Public Health. 2016 Nov;3(11):2997-3002.
6. Saumyen De, Sanjana Samanta et al;. Clinical Prole and Outcome of Children
Viral 35 58.3% Admitted with Acute Encephalitis Syndrome in a tertiary Care hospital in West Bengal,
Bacterial 16 26.7% India. (IOSR-JDMS.2015 Nov PP 08-12.
7. R. JAYA KARTHIKA et al: PROFILE OF CHILDREN ADMITTED WITH ACUTE
Tubercular 4 6.7% ENCEPHALITIS SYNDROME; July 2016 – June 2017.
Dengue 4 6.7% 8. Y.R.Khinchi, A. Kumar et al.study of acute encephalitis syndrome in children.2010 august .
9. Rakesh kumar, Dr. Mridul Bhushan ,Dr. P.Nigam et al; Pattern of infections in adult
Chikungunya 1 1.6% patients presenting as acute encephalitis syndrome (aes);International Journal of
Total 60 100 Medical Science and Education pISSN- 2348 4438.
10. Ajit Rayamajhi, Imran Ansari, Krishna P Bista, Daniel E Impoinvil, Sam Nightingale,
The results were predicted based on cell count, sugar and protein in Rajendra K BC, Chandeshwor Mahaseth,Tom Solomon and Michael J Grifths;Clinical
and prognostic features among children with acute encephalitis syndrome in Nepal;
CSF .With the use of above CSF parameters majority were diagnosed retrospective study BMC.Infectious Diseases 2011, 11:294.
as viral aetiology (58.3%) followed by bacterial aetiology (26.7%). 11. Karmarkar SA, Aneja S, Khare S, Saini A, Seth A, Chauhan BK, et al. A study of acute
febrile encephalopathy with special reference to viral etiology. Indian J Pediatr
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DISCUSSION
The predominant age group in our study was found to be between 5 to
12 years. Similar results were observed in study done by Sneha et
al5,Saumyen et al6 whereas in a study conducted by Jaya Karthika et al7
the predominant age group was < 1year.

The proportion of AES was high in males (55%) than females (45%) in
our study. Similar results were observed in studies done in our country
by Sneha et al5, Y.R.Khinchi et al8,JayaKarthika et al7.

In our study the seasonal occurrence of AES cases was peak during
post-monsoon(October –February) which was similar with ndings in
study by Sneha et al5,Y.R.Khinchi et al8, In a study conducted by
Rakesh Kumar et al9 most VE cases were seen during the hot and wet
months between July and October.

Meningeal signs were seen in 30% of the cases. In a study done by

JayaKarthika et al7 meningeal signs were observed in 32.1%cases and
in another study done by Y.R.Khinchi8 meningeal signs were observed
in 49.1% cases.

The predominant presentation in our study was altered

sensorium(100%) followed by fever(90%),seizures(71.6%).Similar
presentation were observed in studies done by Y.R.Khinchi et
al8,Saumyen et al6.In a study conducted by Jaya Karthika et
al7fever(94.6%) was the predominant symptom followed by altered
sensorium(85.7%), seizures In our study majority of the cases were
fully immunised (88.3%).In a study conducted by Sneha et al5 48.5%
were fully immunised, 29.4% were partially immunised and 22.1%
were not immunised.

In our study viral encephalitis(58.3) was predominant followed by

bacterial (26.7%),.In a study conducted by Sneha et al5, Jaya Karthika
2 International Journal of Scientific Research