Goel Shipra, Chakravarti Anita, Mantan Mukta, Kumar Surinder, Ashraf Md Anzar
Postgraduate MD, Department of Microbiology, Maulana Azad Medical College, New Delhi, New Delhi, India.
Director Professor, Department of Microbiology, Maulana Azad Medical College, New Delhi, New Delhi, India.
J Clin Diagn Res. 2017 Sep;11(9):DC25-DC29. doi: 10.7860/JCDR/2017/27413.10648. Epub 2017 Sep 1.
Acute Encephalitis Syndrome has heralded the emergence of multiple virulent pathogens, which may result in severe morbidity and mortality. In India, encephalitis is not notified and there has been a dearth of analysis for trends in encephalitis death rates and causation. A downward trend has been observed in encephalitis deaths, due to 'known' causes, which can be largely explained by improvement in diagnostic, treatment, and prevention methods. There is still a very high proportion of encephalitis deaths in developing countries, where the aetiological diagnosis of the pathogen is not established and thus, lies the importance of monitoring encephalitis morbidity and mortality with a view to improve pathogen diagnosis and identify emerging infectious diseases.
To formulate a diagnostic approach to viral acute encephalitis syndrome in paediatric age group.
A cross-sectional study including 50 paediatric patients, clinically diagnosed with acute encephalitis syndrome using WHO criteria was conducted. The CSF of all the patients was evaluated to diagnose the aetiology for viral pathogens. ELISA was used for diagnosing Japanese encephalitis and dengue encephalitis; and multiplex real time PCR was used for detecting HSV-1, HSV-2, Varicella zoster virus, Mumps virus, Enterovirus and Parechovirus.
Confirmed diagnosis was established in 11 (22%) of 50 cases. A confirmed or probable viral agent of encephalitis was found in 7 (14%), bacterial agent was found in 2 (4%), non-infectious aetiology was found in 2 (4%). Fatal outcome was independently associated with patient age.
Despite extensive testing, the aetiologies of more than three fourth of the cases remains elusive. Nevertheless the result from the present study may be useful for future design of early diagnosis and treatment of the disease. New strategies for pathogen identification and continued analysis of clinical features and case histories should help us improve our ability to diagnose, treat and prevent encephalitis.
急性脑炎综合征预示着多种致病性病原体的出现，这可能导致严重的发病率和死亡率。在印度，脑炎未被通报，且缺乏对脑炎死亡率趋势和病因的分析。由于“已知”原因，脑炎死亡人数呈下降趋势，这在很大程度上可以通过诊断、治疗和预防方法的改进来解释。在发展中国家，脑炎死亡比例仍然很高，在这些国家病原体的病因诊断尚未确立，因此，监测脑炎的发病率和死亡率对于改善病原体诊断和识别新发传染病至关重要。
制定小儿年龄组病毒性急性脑炎综合征的诊断方法。
进行了一项横断面研究，纳入50例临床诊断为急性脑炎综合征的儿科患者，采用世界卫生组织标准进行诊断。对所有患者的脑脊液进行评估以诊断病毒病原体的病因。酶联免疫吸附测定法用于诊断日本脑炎和登革热脑炎；多重实时聚合酶链反应用于检测单纯疱疹病毒1型、单纯疱疹病毒2型、水痘带状疱疹病毒、腮腺炎病毒、肠道病毒和帕里病毒。
50例病例中有11例（22%）确诊。7例（14%）发现确诊或可能的脑炎病毒病原体，2例（4%）发现细菌病原体，2例（4%）发现非感染性病因。致命结局与患者年龄独立相关。
尽管进行了广泛检测，但超过四分之三病例的病因仍不明确。然而，本研究结果可能对该疾病未来的早期诊断和治疗设计有用。病原体鉴定的新策略以及对临床特征和病史的持续分析应有助于提高我们诊断、治疗和预防脑炎的能力。
