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Epidemiological Profile of Acute Viral Encephalitis
Rajesh Kumar1, Pankaj Kumar2, Manoj Kumar Singh1
1Department of Pediatrics, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India.
Insights
Herpes simplex virus 1 (HSV1) is a leading cause of acute encephalitis syndrome (AES) in Indian children, necessitating broader prevention strategies beyond Japanese encephalitis virus (JEV) vaccination.
Area of Science:
- Pediatrics
- Virology
- Epidemiology
Background:
- Acute Encephalitis Syndrome (AES) poses a significant public health challenge in children.
- Etiology of AES is diverse, with viral infections being a major concern.
Purpose of the Study:
- To investigate the causes and clinical-epidemiological characteristics of AES in children.
- To identify the spectrum of viral pathogens responsible for AES.
Main Methods:
- Observational study of 100 children diagnosed with AES.
- Viral isolation, IgM antibody detection via ELISA, multiplex PCR, and micro-neutralization tests were employed.
- Cerebrospinal fluid samples were analyzed for various viral agents.
Main Results:
- Herpes simplex virus 1 (HSV1) was identified as the most common viral etiology (31.50%) in probable viral encephalitis cases.
- Adenovirus, Parvovirus, Japanese encephalitis virus (JEV), Enterovirus, and Epstein Barr virus (EBV) were also detected.
- Cerebral edema and fronto-parietal hypodensities were common CT findings.
Conclusions:
- The etiological landscape of AES in India is shifting, with increasing reports of non-JEV viral causes.
- Current prevention strategies focusing solely on vector control and JEV vaccination may be insufficient.
- There is a need to explore and implement additional preventive measures for AES.
Objective:
To study the etiology and clinico-epidemiological profile of acute viral encephalitis in children with acute encephalitis syndrome (AES).
Methods:
An observational study including 100 patients fulfilling the criteria for AES was conducted in children of age group 1 mo - 16 y. Viral isolation was done on RD cells, HEp-2 cells and Vero cells from the cerebrospinal fluid samples of suspected viral encephalitis (VE) cases. An enzyme immunoassay for IgM antibodies was performed for measles, mumps, Varicella zoster virus (VZV), Herpes simplex virus 1 (HSV1) and Japanese encephalitis virus (JEV). Multiplex polymerase chain reaction (PCR) was done for Cytomegalovirus, Epstein Barr virus (EBV), HSV1 & 2, VZV, Enterovirus, Parecho virus, Human Herpes virus (HHV 6, 7) and Parvovirus B19. A micro neutralization test was performed for Enterovirus 71.
Results:
Out of enrolled 100 patients, 73 were of probable viral encephalitis. HSV1 (31.50%) was the commonest virus followed by Adenovirus (10.95%), Parvovirus (2.73%), JE virus (1.36%), Enterovirus (1.36%), EBV (1.36%), and mixed infection with HSV & EBV (1.36%). HSV 1 caused significant morbidity in children. The common computed tomography (CT) findings were hypodensities in the fronto- parietal lobe followed by cerebral edema.
Conclusions:
The landscape of AES in India has changed in the previous decade, and both outbreak investigations and surveillance studies have increasingly reported non-JEV etiologies; because of these findings there is a need to explore additional strategies to prevent AES beyond vector control and JEV vaccination.
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