Journal of Pediatric Critical Care (Jan 2020)
Changing trend in sporadic acute encephalitis syndrome in Indian children – A retrospective cohort study
Abstract
Background: Acute encephalitis syndrome (AES) is a common cause of admission to the pediatric intensive care unit (PICU). In the past decade, noninfective etiologies are emerging as important contributor of AES. Materials and Methods: A retrospective chart review (clinical, laboratory, and neuroradiological parameters; etiology; and outcome) of children with AES in the age group of 1 month–18 years admitted to a tertiary referral hospital PICU over 6 years was done. For inclusion, AES was defined as an acute onset of fever and encephalopathy with/without seizures or other neurologic signs. Children with febrile seizures and inborn errors of metabolism were excluded from the study. Results: A total of 121 cases of AES were included in the study with a mean age of 5.74 ± 4.76 years and male-to-female ratio of 2:1. Infection (67.8%) was found to be the most common etiology, followed by autoimmune (21.5%) and undetermined/inflammatory (10.7%). Probable viral encephalitis (37.18%), pyogenic meningitis (18.18%), and tubercular meningitis (TBM) (6.66%) were common among infective etiology. Autoimmune encephalitis was diagnosed in 14 (11.57%), acute disseminated encephalomyelitis (ADEM) in 10 (8.26%), and acute necrotizing encephalopathy (ANE) in 10 (8.26%) cases. Abnormal behavior, reduced speech, sleep disturbances, and seizures were the common presenting features of autoimmune encephalitis. Neuroimaging was available in 113 (93.38%) cases, and 42 (34.71%) were reported as abnormal. In all cases of ANE and 80% of ADEM, neuroimaging was diagnostic. Initial magnetic resonance imaging of the brain was normal in all autoimmune cases except one with limbic encephalitis. Among all cases, 62.81% of the cases recovered completely, 33.06% had sequelae, and 4.13% died. Conclusion: Although central nervous system infections still remain the most common cause of AES, noninfective etiologies such as autoimmune encephalitis, ADEM, and ANE should also be considered early in the differential diagnoses of AES to tailor appropriate investigations and institute early immunotherapy to reduce morbidity.
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