Clinical and Etiological Profile of Acute Febrile Encephalopathy in South Rajasthan, India

Abstract

Objective : To study the clinical and etiological profile of Acute Febrile Encephalopathy (AFE) in South Rajasthan. Methods : Children in the age of 1 month to 18 year with acute febrile encephalopathy were enrolled in the study. The investigations included CBC with PBF , ESR, Malarial parasite, blood sugar, kidney function test, electrolytes, liver function test, calcium, CSF examination, urine examination, X-ray chest PA view. ABG, serum ammonia, blood culture for bacteriological and virological studies and CT/ MRI brain were performed whenever required. Results : 85 patients were admitted with fever and loss of sensorium. Other clinical features included convulsion (64.70%), vomiting (45.88%), headache (16.47%), skin lesion (2.35%), parotid swelling (1.17%), signs of raised intracranial tension (21.17%), signs of meningeal irritation (18.82%), cranial nerve palsy (4.70%), abnormal involuntary movement (2.35%), hepatomegaly (55.29%), splenomegaly (38.82%), anemia (41.17%) and clinical icterus (7.05%). Cerebral malaria was the commonest cause 32 (37.64%) of AFE followed by bacterial meningitis 16 (18.82%) and Suspected Viral Encephalitis 15 (17.64%). Reye's syndrome was seen in 14 (16.47%) patients. Other etiologies were Tubercular meningoencephalitis and Hepatic encephalopathy 2 (2.35%) each, Meningococcemia, Mumps meningoencephalitis, Acute Disseminated Encephalomyelitis and Dengue encephalopathy 1 (1.17%) each. Conclusion : Cerebral Malaria was the leading cause of AFE followed by Bacterial Meningitis and Suspected viral encephalitis. While determining the etiology of AFE in a malaria endemic area, Cerebral Malaria should be considered in all patients. Reye's syndrome should also be considered and all patients of AFE should be evaluated to diagnose /rule out this entity.