Gupta Kirti, Purani Charul S, Mandal Anirban, Singh Amitabh
Department of Pediatrics, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India.
Department of Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India.
J Neurosci Rural Pract. 2018 Jan-Mar;9(1):19-25. doi: 10.4103/jnrp.jnrp_93_17.
Acute febrile encephalopathy (AFE) in children is a medical emergency and could be a manifestation of many systemic and central nervous system pathologies. The clinical features of AFE are nonspecific and etiological spectrum variable depending on the studied population.
A prospective, observational study was carried out including children aged between 1 month and 12 years with AFE admitted to the Pediatric Intensive Care Unit of a tertiary care hospital in Western India. The primary objective was to assess the clinical presentation and etiology of AFE while the secondary objectives were to correlate the clinical and etiological findings and to determine the risk factors associated with mortality.
Out of the ninety children with AFE included in this study, male:female ratio was 1.2:1; most of them were aged between 1 and 5 years and came with a history of < 7 days (82.2%). All of them had altered sensorium, about 2/3 had seizures and 47.8% having a Glasgow Coma Score (GCS) <8. Etiology remained elusive in about 40% of the cases, and viral infections were the most common among the ones with an identifiable cause. A variety of morbidity (shock, disseminated intravascular coagulopathy, respiratory failure, etc.) and high mortality (40%) was observed with risk factors associated with mortality being GCS < 8, the presence of raised intracranial pressure, shock, and respiratory failure.
AFE, though a rare diagnosis in children, is associated with significant morbidity and high mortality in a developing country like India.
儿童急性发热性脑病（AFE）是一种医疗急症，可能是许多全身性和中枢神经系统疾病的表现。AFE的临床特征不具有特异性，病因谱因研究人群而异。
开展了一项前瞻性观察性研究，纳入了印度西部一家三级医院儿科重症监护病房收治的1个月至12岁患有AFE的儿童。主要目的是评估AFE的临床表现和病因，次要目的是关联临床和病因学发现，并确定与死亡率相关的危险因素。
本研究纳入的90例AFE患儿中，男女比例为1.2:1；大多数患儿年龄在1至5岁之间，病程<7天（82.2%）。所有患儿均有意识改变，约2/3有惊厥，47.8%的患儿格拉斯哥昏迷评分（GCS）<8。约40%的病例病因仍不明确，在可明确病因的病例中，病毒感染最为常见。观察到多种并发症（休克、弥散性血管内凝血、呼吸衰竭等）和高死亡率（40%），与死亡率相关的危险因素为GCS<8、颅内压升高、休克和呼吸衰竭。
AFE在儿童中虽为罕见诊断，但在印度这样的发展中国家，其与显著的发病率和高死亡率相关。
