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Virological investigations of acute encephalopathy in India
Insights
Japanese encephalitis is a significant cause of acute childhood encephalopathy, with 23% of unexplained cases testing positive. Many other conditions can mimic these symptoms, and Japanese encephalitis has a high mortality rate.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Acute encephalopathic illnesses in children present a diagnostic challenge.
- Identifying the etiology of encephalopathy is crucial for appropriate management and prognosis.
Purpose of the Study:
- To investigate the causes of acute encephalopathy in children.
- To determine the prevalence of Japanese encephalitis and other infectious agents.
Main Methods:
- Clinical and laboratory assessments of 740 children with acute encephalopathy.
- Cerebrospinal fluid and blood analyses, including virological investigations for arboviruses.
- Viral isolation from throat swabs using monkey kidney tissue cell lines.
Main Results:
- A firm diagnosis was established in 38% of cases; pyogenic meningitis, measles encephalopathy, and electrolyte imbalance were common.
- Japanese encephalitis was identified in 23% of patients with unexplained encephalopathy.
- Other identified viruses included adenovirus, parainfluenza, influenza, poliovirus, Coxsackie, and echovirus. The mortality rate for Japanese encephalitis was 37%.
Conclusions:
- Japanese encephalitis is a major cause of acute childhood encephalopathy in the studied region.
- Clinical presentation can mimic other disorders requiring specific treatments.
- Prompt diagnosis and management are vital due to the high mortality associated with Japanese encephalitis.
Abstract:
A total of 740 consecutive children aged between 6 months and 12 years who presented with acute encephalopathic illnesses during a three year period were assessed both clinically and by laboratory investigations. Cerebrospinal fluid was examined for the presence of cells or other abnormal substances, and any organisms were cultured. Blood examination included white cell count and estimations of haemoglobin, urea, glucose, and electrolyte concentrations and serum alanine aminotransferase and aspartate aminotransferase. A firm diagnosis was established in 278 patients (38%). Pyogenic meningitis (n = 134), measles encephalopathy (n = 38), and electrolyte imbalance (n = 23) were important causes in this group, cerebral malaria (n = 4) was uncommon and there were no cases of Reye's syndrome. The diagnoses of the remaining 462 were combined under the heading 'acute unexplained encephalopathy'. Altogether 394 of the 462 patients underwent virological investigations for arboviruses and 92 (23%) had one or more indicators of Japanese encephalitis. No other arboviruses could be isolated. Throat swabs from 187 patients with acute unexplained encephalopathy were studied on monkey kidney tissue cell lines of which 14 were positive (8%). These were identified as adenovirus, parainfluenza, influenza, poliomyelitis, Coxsackie, and echovirus; in two cases the virus was untypable. Japanese encephalitis is an important cause of acute childhood encephalopathy in this region. Clinical features of the illness may be mimicked by several disorders which require specific treatment. Thirty four of the 92 died (37%).