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Japanese encephalitis in children in northern Thailand
1Department of Pediatrics, Faculty of Medicine, Maharaj Nakhon Chiang Mai Hospital, Chiang Mai University, Thailand.
Insights
Japanese encephalitis (JE) in children often causes severe neurological sequelae, including memory deficits and mental retardation. Early supportive care is crucial, but mortality and long-term disabilities remain significant challenges.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Japanese encephalitis (JE) is a significant public health concern, particularly in Asian countries.
- Pediatric populations are highly vulnerable to JE, often experiencing severe clinical manifestations and long-term complications.
Purpose of the Study:
- To describe the clinical characteristics, treatment, and outcomes of pediatric Japanese encephalitis cases.
- To analyze the incidence and types of neurological sequelae following JE in children.
Main Methods:
- Retrospective study of 59 children diagnosed with JE between 1984-1985.
- Analysis of clinical symptoms, neurological signs, laboratory findings (blood, CSF), and treatment modalities.
- Evaluation of mortality rates and neurological sequelae, including specific deficits.
Main Results:
- Common symptoms included altered consciousness, fever, headache, and convulsions.
- Neurological signs such as meningeal signs, hyperreflexia, and hemiplegia were prevalent.
- High rates of neurological sequelae (57%) were observed, with memory deficits and mental retardation being most common; mortality rate was 17%.
Conclusions:
- Japanese encephalitis poses a substantial risk of severe neurological impairment and mortality in children.
- Comprehensive supportive and symptomatic treatment is essential, but long-term neurological deficits remain a major concern.
- Further research into preventative strategies and improved treatment protocols for JE is warranted.
Abstract:
Fifty-nine children with Japanese encephalitis admitted in Maharaj Nakhon Chiang Mai Hospital since 1984-1985 were studied. The male to female ratio was 1.18:1. The age range was between 1 to 14 years old with 74% in the age range of 6-14 years. The symptoms included change of consciousness (100%), fever (96%), headache (76%), convulsions (59%) and vomiting (52%). The neurologic signs, namely positive meningeal signs (61%), hyperreflexia (61%), positive Babinski's sign (49%) hemiplegia (42%), papilledema (22%), and other cranial nerve palsies (23%) were seen. Abnormal respiration were found in 23% and 8% of cases had hypertension. Most children (81%) had blood leukocytosis with predominant neutrophils. The average CSF white blood cell count was 200 cells per mm. with lymphocytosis in 76 percent of the patients. The average CSF protein was higher than normal. Almost all cases had normal CSF sugar levels. The JEV antibody response, mostly primary type, Occurred in about 62 percent of cases. All children received symptomatic and supportive treatment, such as antipyretics, anticonvulsants, anticerebral edema agents, adequate respiration and nutrition and physical and occupational therapies. Associated complications were treated according to the individual's need. The mortality rate and neurological sequelae were found in 17% and 57% of cases respectively. Eighteen percent of the patients suffered severe neurological sequelae. The neurological sequelae included memory deficit (46%), mental retardation (42%), hemiplegia (34%), emotional and behavioral disturbance (24%), epilepsy (20%), motor aphasia (16%), cranial nerve palsies (16%), involuntary limb movement (8%) and blindness (2%).