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Acute Febrile Encephalopathy

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Dr Ashok Rai Varanasi, UP    18 January 2018

  1. Encephalopathy describes a clinical syndrome of altered mental status, manifesting as reduced consciousness or altered behavior.
  2. Encephalitis means inflammation of the brain. It is strictly a pathological diagnosis, but surrogate clinical/imaging markers may provide evidence of inflammation.
  3. Acute encephalitis syndrome (AES) is said to be present in a person of any age, at any time of the year with acute onset of fever and change in mental status and/or new onset of seizures. Other features include irritability, somnolence, abnormal behavior.
  4. Etiology of AES - Infections; acute disseminated encephalomyelitis (ADEM); autoimmune encephalitis; vasculitis; collagen vascular disease; paraneoplastic encephalitis.
  5. Common symptoms of encephalitis - Sudden fever; lethargy; headache; tremors or convulsions; change in consciousness; irritability or restlessness; vomiting and diarrhea.
  6. Japanese encephalitis (JE) is a mosquito borne flavivirus disease. It is the leading form of viral encephalitis in Asia in children below 15 years of age. In India, JE is currently endemic in 215 districts from 22 states and Union Territories. An epidemiological shift of JE to older children and adults is mainly due to the introduction of routine JE vaccination in children. JE is a notifiable disease since September 2016.
  7. IAP ACVIP 2016 guideline on JE - Vaccination from 1 to 18 years in endemic regions and those who will be traveling to endemic regions, 2 doses at Day 0 and Day 28.
  8. Plasmapheresis is indicated in ADEM after high dose IV corticosteroid failure and in autoimmune encephalitis. Potential utility of IVIG has been reported in severe steroid resistant post-infectious encephalomyelitis. IVIG may be of value in ADEM with peripheral nerve involvement.
  9. Litchi encephalitis - It refers to seasonal outbreak of acute unexplained neurological illness; usually occurs in mid May to July. It usually presents with seizures and changed mental status, frequently with onset in early morning.
  10. Rickettsial infection should be suspected in any febrile child with: patient coming from endemic area; history of contact with pets like dogs and history of tick bite; classical triad of fever, rash and headache (irritability in younger children); rash without coryza; rash extending over palms and soles, palpable purpura, necrotic rash, gangrene, eschar, lymphadenopathy; edema over body, pain in legs with hepatosplenomegaly, leukocytosis, anemia, thrombocytopenia; children presenting with fever, rash, convulsion and altered sensorium; pyrexia of unknown origin; fever not responding to routine antibiotics.
  11. Management of AES - Management of airways and breathing; management of circulation; control of convulsion and intracranial pressure; control of temperature; fluid and electrolytes and calories/nutrition; general management; specific treatment of any treatable cause; investigations, samples collection and transportation; reporting of case; rehabilitation.

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