CLINICAL PROFILE AND OUTCOME OF ACUTE INFECTIOUS ENCEPHALITIS: A PROSPECTIVE OBSERVATIONAL STUDY
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Keywords
Acute infectious encephalitis; altered sensorium; seizures; mechanical ventilation; mortality
Abstract
Background: Acute infectious encephalitis (AIE) is a neurological emergency characterized by inflammation of the brain parenchyma and is associated with significant morbidity and mortality. The clinical spectrum ranges from mild alteration of consciousness to severe neurological impairment with multiorgan dysfunction. Identification of clinical features and severity markers associated with poor outcome is essential for early risk stratification and optimal management.
Objectives: To evaluate the clinical profile, severity parameters, and short-term outcomes of patients diagnosed with acute infectious encephalitis.
Materials and Methods: This prospective observational study included 100 adult patients diagnosed with acute infectious encephalitis and admitted to a tertiary care hospital. Detailed clinical evaluation, neurological assessment, severity scoring, and laboratory investigations were performed. Data regarding intensive care requirement, mechanical ventilation, and in-hospital outcomes were recorded and analyzed using descriptive statistics.
Results: Fever and altered sensorium were present in all patients. Seizures, hypotonia, focal neurological deficits, hypotension, and raised intracranial pressure were frequently observed. A significant proportion of patients had severe neurological impairment at admission, reflected by low Glasgow Coma Scale scores and high organ dysfunction scores. Nearly half of the patients required mechanical ventilation. Overall survival was 70%, while mortality was 30%. Poor outcomes were predominantly associated with severe neurological dysfunction, systemic instability, and need for intensive care support.
Conclusion: Acute infectious encephalitis remains associated with substantial morbidity and mortality. Severity at presentation, neurological complications, and systemic involvement are key determinants of outcome. Early recognition and aggressive supportive management are crucial to improving survival and neurological recovery.
References
2. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016 Apr;15(4):391-404.
3. Granerod J, Tam CC, Crowcroft NS, Davies NW, Borchert M, Thomas SL. Challenge of the unknown. A systematic review of acute encephalitis in non-outbreak situations. Neurology. 2010 Sep 7;75(10):924-32.
4. Granerod J, Cousens S, Davies NW, Crowcroft NS, Thomas SL. New estimates of incidence of encephalitis in England. Emerg Infect Dis. 2013;19(9):1455–62.
5. George BP, Schneider EB, Venkatesan A. Encephalitis hospitalization rates and inpatient mortality in the United States, 2000-2010. PloS one. 2014 Sep 5; 9(9): e104169. doi:10.1371/journal.pone.0104169.
6. Boucher A, Herrmann JL, Morand P, Buzelé R, Crabol Y, Stahl JP, Mailles A. Epidemiology of infectious encephalitis causes in 2016. Med Mal Infect. 2017 May; 47(3): 221-235.
7. Vora NM, Holman RC, Mehal JM, Steiner CA, Blanton J, Sejvar J. Burden of encephalitis-associated hospitalizations in the United States, 1998–2010. Neurology. 2014 Feb 4;82(5):443-51..
8. Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D et al. Aetiology of Encephalitis Study Group. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010 Dec;10(12):835-44.
9. World Health Organization. Why encephalitis matters? [Internet]. Geneva: World Health Organization [cited 2023 Oct 1]. Available from: https://iris.who.int/bitstream/handle/10665/366223/9789240069176- eng.pdf?isAllowed=y&sequence=1.
10. Wang H, Zhao S, Wang S, Zheng Y, Wang S, Chen H, et al. Global magnitude of encephalitis burden and its evolving pattern over the past 30 years. J Infect 2022; 84: 777-787.
11. World Health Organization. Japanese encephalitis surveillance standards. WHO recommended standards for Surveillance of Selected Vaccine-Preventable Diseases 2006. available: http://www.path.org/files/WHO_surveillance_standards_JE.pdf.
12. Campbell GL, Hills SL, Fischer M, Jacobson JA, Hoke CH, Hombach JM, Marfin AA, Solomon T, Tsai TF, Tsu VD, Ginsburg AS. Estimated global incidence of Japanese encephalitis: a systematic review. Bull World Health Organ. 2011; 89: 766-74.
13. Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH. Beyond viruses: clinical profiles and etiologies associated with encephalitis. Clin Infect Dis. 2006 Dec 15;43(12):1565-77.
14. Sonneville R, Klein I, de Broucker T, Wolff M. Outcome and sequelae of infectious encephalitis. J Clin Neurol. 2020;16(3):345–357.
15. Whitley RJ, Gnann JW. Viral encephalitis: familiar infections and emerging pathogens. Lancet. 2002 Feb 9;359(9305):507-13.
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Dr. Arshied Hussain Bhat
Department Of Medicine, Government Medical College, Srinagar
Dr. Sajad Ahmad Tak
Department Of Medicine, Government Medical College, Srinagar
Dr. Ghulam Hassan
Department Of Medicine, Government Medical College, Srinagar
