The epidemiology, clinical features, and long-term prognosis of Japanese encephalitis in central sarawak, malaysia, 1997-2005.
BACKGROUND
Japanese encephalitis is a major public health problem in Asia. However, there is little data on the long-term outcome of Japanese encephalitis survivors.


METHODS
We prospectively evaluated children with serologically confirmed Japanese encephalitis over an 8.3-year period. The patients were assessed and their outcomes were graded with a functional outcome score at hospital discharge and at follow-up appointments. We examined how patient outcome at hospital discharge compared with that at long-term follow-up visits, when changes in outcome occurred, and the prognostic indicators of the eventual outcome.


RESULTS
One hundred and eighteen patients were recruited into the study, and 10 (8%) died during the acute phase of illness. At hospital discharge, 44 (41%) of the 108 patients who survived had apparent full recovery; 3 (3%) had mild, 28 (26%) had moderate, and 33 (31%) had severe neurological sequelae. Eighty six of the 108 patients were followed up for a median duration of 52.9 months (range, 0.9-114.9 months). During follow-up, 31 patients experienced improvement, but 15 patients experienced deterioration in their outcome grade. In most cases, assessment during the first 3-6 months after hospital discharge was predictive of the long-term outcome. More than one-half of the patients continued to experience neuropsychological sequelae and behavioral disorders. A combination of poor perfusion, Glasgow coma score < or =8, and > or =2 witnessed seizures predicted a poor long-term outcome with 65% sensitivity and 92% specificity.


CONCLUSIONS
Neurological assessment of Japanese encephalitis survivors at hospital discharge does not predict long-term outcome. Seizures and shock are treatable risk factors for a poor outcome at hospital discharge and at long-term follow-up visits.
Ooi
Mong How
MH
Department of Paediatrics, Sibu Hospital, Sibu, Malaysia.
Lewthwaite
Penny
P
Lai
Boon Foo
BF
Mohan
Anand
A
Clear
Daniela
D
Lim
Lina
L
Krishnan
Shekhar
S
Preston
Teresa
T
Chieng
Chae Hee
CH
Tio
Phaik Hooi
PH
Wong
See Chang
SC
Cardosa
Jane
J
Solomon
Tom
T
D002648:Child; D002675:Child, Preschool; D004664:Encephalitis Virus, Japanese / Q000302:isolation & purification; D004672:Encephalitis, Japanese / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000821:virology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000503:physiopathology; D009460:Neurologic Examination; D011379:Prognosis; D013997:Time Factors