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Clinical sequelae of Japanese encephalitis in children
Insights
Japanese encephalitis (JE) in children leads to significant neurological handicaps, with over 45% experiencing major sequelae like motor deficits and mental retardation. Early illness factors influence long-term outcomes.
Area of Science:
- Neurology
- Virology
- Pediatrics
Background:
- Japanese encephalitis (JE) is a significant cause of acute encephalitis in children.
- Long-term neurological sequelae following JE infection are a major concern.
Purpose of the Study:
- To investigate the virology and long-term neurological outcomes of Japanese encephalitis in children.
- To determine the prevalence and types of sequelae in JE survivors.
Main Methods:
- Virological investigations including viral isolation and serological tests (HI antibodies, IgM) were performed.
- Survivors were followed up for 12-18 months and over 2 years to assess neurological sequelae.
- Statistical analysis was used to identify factors associated with severe sequelae.
Main Results:
- A high rate of major sequelae (45.5%) was observed, including motor deficits, mental retardation, and convulsions.
- Minor deficits were noted in 25.4% of patients, while only 29.2% fully recovered.
- Prolonged illness and focal neurological deficits were linked to more severe outcomes.
Conclusions:
- Japanese encephalitis is a critical cause of neurological handicap in the studied region.
- Neurological deficits can persist but may show improvement over time.
- Understanding risk factors is crucial for managing JE and its long-term effects.
Abstract:
Over a five and a half year period, virological investigations for Japanese encephalitis (JE) were conducted in children admitted with acute encephalitis like illness to a large city hospital. The diagnosis of Japanese encephalitis was made by viral isolation from cerebrospinal fluid and/or a four-fold or higher rise in haemagglutination inhibiting antibodies in paired sera followed by demonstration of specific IgM antibodies by HI test after treatment with 2-mercapto ethanol. All children surviving the illness were contacted by post and followed up for sequelae. A total of 55 children could be followed up after 12-18 months and 22 of these even after 2 yr. A high rate of major sequelae (45.5%) in the form of frank motor deficits (32.7%), mental retardation (21.8%) and/or convulsions (18.2%) was observed. Neurological deficits were of diverse types and improved even after 2 yr of the illness. Fourteen patients (25.4%) had only minor deficits in the form of scholastic backwardness, behavioural problems and/or subtle neurological signs. Only 16 (29.2%) patients were completely normal on follow up. JE may therefore be an important cause of neurological handicap in this area. Sequelae of the disease were more severe if the initial illness was prolonged (P < 0.001, CI 2.45, 12.64), or associated with focal neurological deficits (P < 0.001, CI 1.97, 7.02).