Clinical and etiological profile of acute febrile encephalopathy in eastern Nepal.
OBJECTIVE
To investigate the clinical and etiological profile of acute febrile encephalopathy in children presenting to a tertiary care referral center of Eastern Nepal.


METHODS
107 children (aged 1 month to 14 yrs) presenting to the emergency with fever (> 38 C) of less than 2 weeks duration with altered sensorium with/or without seizure were prospectively investigated for etiological cause. The investigations included blood and CSF counts, blood and CSF cultures, peripheral smear and serology for malarial parasite, and serology for Japanese encephalitis (JE) virus. Other investigations included EEG and CT or MRI wherever indicated.


RESULTS
The most common presenting complaints apart from fever and altered sensorium were headache and vomiting. Convulsions, neck rigidity, hypertonia, brisk deep tendon reflexes, extensor plantar response and focal neurological deficits were seen in 50%, 57%, 22.4%, 28%, 39.3% and 9.3% of the subjects, respectively. The diagnoses based on clinical presentation and laboratory findings were pyogenic meningitis in 45 (42%), non JE viral encephalitis in 26 (25%), JE in 19 (18%), cerebral malaria in 8 (7%), herpes encephalitis and tubercular meningitis in 4 (4%) each, and typhoid encephalopathy in 1 case.


CONCLUSIONS
Pyogenic meningitis and viral encephalitis including JE are the most common causes of acute presentation with fever and encephalopathy. Preventive strategies must be directed keeping these causes in mind.
Singh
Rupa R
RR
Department of Pediatrics and Adolescent Medicine and 1Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Chaudhary
S K
SK
Bhatta
Nisha K
NK
Khanal
B
B
Shah
Dheeraj
D
D000208:Acute Disease; D000293:Adolescent; D002391:Catchment Area, Health; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004672:Encephalitis, Japanese / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D018792:Encephalitis, Viral / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005334:Fever / Q000453:epidemiology* / Q000503:physiopathology*; D006261:Headache / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008587:Meningitis, Viral / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D009122:Muscle Hypertonia / Q000453:epidemiology; D009390:Nepal / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014839:Vomiting / Q000453:epidemiology