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.

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.

A study of Acute Encephalitis Syndrome – Clinical profile, aetiology, and outcome

We aimed to study the clinical profile and etiology of Acute Encephalitis Syndrome (AES) in a tertiary care centre of western India.All patients evaluated by the neurology department, who fulfilled the standardised case definition for encephalitis (given by International Encephalitis Consortium) over 2 year period were screened. Routine laboratory investigations, CSF, Neuroimaging and EEG were done in all patients. Short term follow-up of one month was done to see the outcome.: Out of total 85 patients of AES seen over two years; viral etiology was identified in 26 (30.5%) patients; 8 (9.4%) patients had autoimmune cause and in 53 (62.4%) patients, no specific ethology could be found. Long duration of symptom onset to hospitalisation, seizures, abnormal behaviour, involuntary movements (automatism, dyskinesia, or dystonia), and autonomic dysfunction favours a diagnosis of autoimmune encephalitis. At one month, good outcome (mRS <2) was seen in 51(60%) patients and 34 (40%) patients had a poor outcome (mRS > 2), out of which 29(34.1%) patients expired. Viral encephalitis was the commonest cause of AES; followed by autoimmune encephalitis. Specific cause could not be ascertained in large number of patients, even after extensive evaluation. AES patients had prolonged hospital stay and significant morbidity and mortality.

A study of the outcome of acute encephalitis syndrome in children

Background: Acute encephalitis syndrome (AES) is defined as a person of any age, at any time of the year, with acute onset of fever and a change in mental status (including symptoms such as confusion, disorientation, coma, inability to talk) and/or new onset of seizures (excluding simple febrile seizures) [WHO]. Japanese encephalitis (JE) is one of the leading causes of AES affecting children and adolescents in the tropical countries. Objective of the study were to study the outcome of children with AES. The study was conducted in the department of pediatrics, Gauhati medical college and hospital, Guwahati from 1st July 2016 to 30th June 2017.Methods: Patients admitted in the pediatrics department of Gauhati medical college and hospital, Guwahati with diagnosis of AES during the study period were taken into account based on inclusion and exclusion criteria.Results: It has been observed that age, awareness among caregivers, poor GCS, multiple seizures, shock are important factors in the outcome of AES.Conclusions: From the present study, prognosis of the cases may be predicted and measures taken to improve outcome

ACUTE ENCEPHALITIS SYNDROME IN CHILDREN: A DESCRIPTIVE CROSSSECTIONAL STUDY IN A RURAL BASED TERTIARY CARE HOSPITAL IN INDIA

Background: Acute Encephalitis Syndrome (AES) is a group of clinically similar neurologic manifestations due to encephalitis. AES is an important cause of mortality and morbidity in children in various parts of India. Most of the study has been done in adult population. So, I have done this study to evaluate clinical prole, short-term outcome and changing trends of etiologies of acute encephalitis in children. Methods: This is an institution-based descriptive cross-sectional study including sixty children aged one month to twelve years conducted over a period of one and half years in the pediatric department of a rural based medical college in India. Data collected in predesigned case record proforma and analysed with SPSS software version 25. Results: Incidence rate 4 per 1000 patients per year with 2 to 6 years age group with males predominating. Important presenting complaints were fever, convulsion, abnormal behavior, rash, vomiting, headache, lethargy, aphasia and quadriparesis. Poor Glasgow coma score (GCS), meningeal sign and raised intra cranial pressure were important examination ndings. Dengue and scrub typhus were important emerging etiologies replacing Japanese encephalitis. Overall mortality is around 13%. Conclusions:All febrile children with altered sensorium should be investigated for central nervous system (CNS) infection, unless clear evidence of another diagnosis. Viruses are the main culprit with Dengue and Scrub typhus being the important emerging etiology. Timely diagnosis and treatment can reduce morbidity and mortality signicantly.