Challenges for nurses in caring for patients with acute encephalitis: lack of knowledge, time and rehabilitation

Aim: To explore the experiences of registered nurses providing care to adult patients affected by encephalitis, from admission into hospital through to discharge. Study design: A qualitative phenomenological methodology was used. Sample and setting: Eight registered nurses in a city centre teaching hospital. Methods: Data collection took place using in-depth, semi-structured interviews. Data were analysed and themes identified using framework analysis. Findings: Three key findings were identified: nurses felt that they lacked knowledge of encephalitis, lacked time to give these patients the care they needed, and they lacked access to rehabilitation for patients with encephalitis. Conclusion: This study provides the first evidence on nurses' experiences of providing care to patients affected by encephalitis. It has shown that they often lack the knowledge and time to give adequate support to patients. They also lack access to rehabilitation for these patients.

Management of Acute Encephalitis Syndrome Endemic during COVID-19 Pandemic in India

The second wave of COVID-19 has worst impacted the country like India. However, the third wave is much predicted and may be infection among the children at risk. The endemic of diseases that outbreak from time to time in particular regions of India have shown several challenges to the health system in the past. The most likely endemic is Acute Encephalitis Syndrome (AES) for few states of India that is reported during the pre-monsoon and post-monsoon season. However, AES had the highest chances of being found in pediatric age only with very few exceptions. The symptoms are confusing for diagnosing COVID-19 patients, and a great fear that the symptoms may overlap with AES. The sudden outbreak of AES during the current COVID-19 pandemic may intersect the demand for health resources, oxygen and isolated beds. The common insistence among the AES and COVID-19 patients will be oxygen demands, wards-bed (in NICU, PICU) and drugs. Hence, early preparedness is of utmost demand, simultaneously strengthening health infrastructures in this aspect is obvious. Key words: Acute Encephalitis Syndrome, AES, COVID-19 pandemic in India.

Epidemiological study of Acute Encephalitis Syndrome and Japanese Encephalitis burden in Sivasagar district of Assam, India

Japanese Encephalitis (JE) is among the most common cause of viral encephalitis in human beings caused by the Japanese Encephalitis virus (JEV). It is found worldwide, especially in Southeast Asia and less commonly in the western pacific regions and Australia.North East India is identified as hotspot for Japanese encephalitis and is considered a major health problem in Assam. The present study assesses the epidemiology of Acute Encephalitis Syndrome (AES) and JE cases of the Sivasagar district of Assam for 2011-20.Epidemiological data of AES and JE such as disease burden, case fatality rate (CFR), etc. were collected from NVBDCP Unit of Sivasagar district. Data were obtained as a part of routine AES/JE control programme for the period 2011-20. The overall AES and JE casesduring 2011-20 were 1081 and 588, and death cases 333 and 180, respectively.The CFR of the district was found to be 30.61%. AES and JE cases were highest in Galekey and Patsaku block. The AES/JE cases were significantly higher in elderly (>30 years) and male population of the district. The peak AES/JE active and death cases were reported in June and July in the study period. Routine JE vaccination was found to be carried out since 2011-20 in the agegroup 9-18 months, covering more than 50% of the target population size. Similarly, during the 2011-12 and 2014-15, JE vaccination campaign was carried out in 1-15- and 16-60-years age-group. The prevalence of AES/JE cases in the Sivasagar district of Assam is declining. Nevertheless, there is an urgent need to intensify the AES/JE surveillance programme to detect the cases and develop strategy for better JE management. The immunization coverage for 9-18 months should be increased.

To Study the Electroencephalogram Changes in Children with Acute Encephalitis

Aim: To study the electroencephalogram changes in children with acute encephalitis. Study design: Cross-sectional study. Place and duration of study: The cases were admitted from OPD and emergency over duration of 10 months from May2009 to March 2010 in Children Hospital PIMS, Islamabad. Method: Patients with Cerebral Palsy, Degenerative Brain disease, Cerebral Malaria and Meningitis were excluded. Written informed consent was taken from parents /guardians. All patients, from both genders, age varying from 4 months to 12 years, fitting the criteria of Acute Encephalitis according to ICD 9 & 10 were included in the study, which were 56 in total. All cases had Lumbar puncture and Cerebro Spinal Fluid examination. The findings of pleocytosis (WBC count more than5 u/l), protein and sugar were recorded. EEG (Electroencecephlogram) was done in 52 patients, frequencies and percentages were calculated of the findings. Results: The mean age was 4. 6 years, (varying from 4 months to 12 years) with a standard deviation of 3. 2. From a total of fifty six patients, 38(68%) were males and 18(32%) females. All cases presented with fever (100%). Cerebro Spinal Fluid examination, showed Pleocytosis in 30(54%) while 46(46%) had normal cell count. Cerebro Spinal Fluid protein content was normal in 45(80%) and increased in 11(20%). Cerebro Spinal Fluid sugar was normal in 50(89%) and 6(11%) had low. Electroencephalogram was done in fifty-two patients out of which 30(58%) were normal, 22(42%) were abnormal. Intermittent slowing was found in 17(77%) and 5(23%) cases had focal discharges along with intermittent slowing, out of which three were unilateral temporo-frontal discharges, two cases had other focal discharges on EEG. Conclusion: In patients with Acute Encephalitis, slowing of the rhythm was the most frequent abnormal Electroencephalogram finding, followed by focal discharges in children admitted in Children’s Hospital PIMS, Islamabad. Keywords: Acute Encephalitis, Electroencephalogram (electro encephalogram), Cerebro Spinal Fluid Pleocytosis, Fever

Incidence of Japanese encephalitis virus among patients presenting with acute encephalitis syndrome in a tertiary care hospital, West Bengal, India

Background: Japanese encephalitis virus (JEV) is a flavivirus related to dengue, yellow fever and West Nile viruses, and is spread by mosquitoes. JEV is the main cause of viral encephalitis in many countries of Asia with an estimated 68000 clinical cases every year. Although symptomatic Japanese encephalitis (JE) is rare, the case-fatality rate among those with encephalitis can be as high as 30%. Permanent neurologic or psychiatric sequelae can occur in 30-50% of those with encephalitis. This study was conducted to find the incidence of JEV IgM in patients presenting with acute encephalitis syndrome (AES) in Raiganj govt. medical college and hospital, Uttar Dinajpur, West Bengal, India.Methods: Blood and CSF samples were collected from patients presenting with AES. IgM antibody capture ELISA was performed on the CSF and serum samples by JE virus MAC ELISA kit.Results: The overall prevalence of JEV IgM was 13.8%. Among the positive cases male comprised of 71.4% and female 28.5%. The most common age group affected was above 16 years of age. JEV prevalence was present throughout the year with high number of cases between the monsoon and post monsoon seasons.Conclusions: This study demonstrates the endemicity of JEV in Uttar Dinajpur district of West Bengal, India. As most of the JE cases are asymptomatic strengthening the existing surveillance system is required to find out the actual scenario of JEV in West Bengal. Control of vectors, early diagnosis and treatment, vaccinations are the key to decrease the morbidity and mortality caused by JEV.

Acute encephalitis in primary Sjögren’s syndrome: A case report and literature review

ABSTRACT Acute encephalitis is an extremely rare condition in primary Sjogren’s syndrome (pSS), and its characteristics and prognosis remain unclear. Here, we report the case of pSS presented with acute encephalitis. She was admitted to our hospital for acute disturbance of consciousness. Acute encephalitis was diagnosed based on the results of the cerebrospinal fluid test (the increase of leucocyte counts, proteins, and interleukin-6 levels), magnetic resonance imaging, and single-photon emission computed tomography with 99mTc. The infectious aetiologies and underlying malignancies were excluded. Serum anti-Sjogren’s syndrome-related antigen A autoantibody was positive with extremely high titre. The biopsy specimen of her labial salivary gland revealed a focal lymphocytic sialadenitis with a score of grade 4 in the Greenspan grade. She also developed diffuse alveolar haemorrhage during the clinical course. She was diagnosed with pSS complicated with acute encephalitis followed by diffuse alveolar haemorrhage and successfully treated with pulse steroids, high dose of prednisolone and intravenous cyclophosphamide. Our present case and literature review suggest that acute encephalitis associated with pSS can be treatable with the immunosuppressive therapy, and thus early recognition and treatment initiation are important for this life-threatening condition. Thus, pSS should be included in the differential diagnosis of unexplained encephalitis. Notably, our case characteristically showed diffuse alveolar haemorrhage, adding new insights into the pathogenesis of acute encephalitis associated with pSS that capillaritis might be the underlying cause of this condition.