Study on Japanese encephalitis in a tertiary care center

Abstract

Context: Japanese encephalitis (JE) stands foremost among the etiologies of encephalitis in Southeast Asia, causing mortality and residual disability. A profile of the disease is invaluable in aiding effective management. Aims: The aim of the study was to observe differing clinical features of JE from non-JE encephalitis and identify morbidity and mortality patterns. Settings and Design: This was a prospective observational study conducted in patients aged ≥13 years admitted in medical wards with clinically suspected encephalitis from January 2011 to December 2016. Subjects and Methods: Persons with clinically suspected acute encephalitis were evaluated with medical history taking, clinical examination, neuroimaging, serology, and cerebrospinal fluid (CSF) analysis. Statistical Analysis Used: The results were statistically analyzed with Fisher's exact test with two-tailed P value. Results: Out of 795 patients with clinically suspected acute encephalitis, 87 were positive for IgM JE. JE positivity was significantly higher in persons aged above 50 and during the months from February to July. The male:female ratio was 1.49:1. JE patients presented with fever and neurological symptoms (100%), which included altered sensorium (56.32%), meningismus (55.17%), headache (33.33%), neurological deficits (11.49%), and seizures (3.45%). CSF was pleocytic >5 cells/mm3 in 74.71%, with lymphocyte predominance in 68.97% and mixed cellularity in 5.75%. About 59.77% had elevated protein, and 96.55% had normal sugar levels. Gastrointestinal complaints predominated significantly in patients aged below 50. Five patients died, all of whom were aged above 50 years. Conclusions: Persons aged above 50 years were especially susceptible to JE. Fever and neurological manifestations occurred in 100%, and the mortality was 5.75%.

Keywords

• Acute encephalitis
• altered sensorium
• cerebrospinal fluid
• IgM ELISA
• Japanese encephalitis