Clinicoepidemiology, risk factors and outcome assessment of virus induced acute encephalitis syndrome: A hospital based prospective study in Eastern India.

Abstract

Abstract Background: Acute encephalitis syndrome (AES) is a serious public health problem in India, whose cause has remained unknown for remarkable proportion of cases. Method: During the study, cases were enrolled from tertiary care hospitals of Cuttack and Bhubaneswar. All the cases were screened for viral cause by serology and molecular diagnostics Subjects were followed up for twelve months to assess disease outcome. Logistic regression analysis was used to identify the risk factors associated with poor outcome. Results: A total of 345(19.8%) subjects could be diagnosed with viral etiology and HSV-1 was the most common252(14.51 %) followed by HSV-2 (49,2.82%), Measles(36, 2.07%), JEV(18,1.04%),Enterovirus (15),VZV(7),dengue(7),EBV(2) mumps(2) and,HEV(1).Most common symptoms in addition to fever were convulsion (85%) and altered sensorium (95%). Comparison of clinical features among viral AES and undiagnosed AES cases showed that fever, diarrhoea, respiratory problem, rash, convulsion, Vomiting, altered sensorium and meningeal signs were significantly different between these two groups (p<0.05). Also the factors like age(p=0.015),low GCS score(p=0.021),hospital stay(0.024) and ,referral delay (0.03) were significantly associated with poor outcome. Conclusion: HSV-1 was the commonest virus causing sporadic AES in this part of India. In this investigation low GCS score, longer hospital stay and referral delay were observed to be independent risk factors for poor outcome. Case fatality was observed in 25.75%. Thus immediate detection of HSV-1 and special attention to risk factors could help in proper management of AES cases.