Jain Parul, Prakash Shantanu, Khan Danish N, Garg Ravindra Kumar, Kumar Rashmi, Bhagat Amit, Ramakrishna V, Jain Amita
Department of Microbiology, King George's Medical University, Lucknow, India.
Department of Neurology, King George's Medical University, Lucknow, India.
J Vector Borne Dis. 2017 Oct-Dec;54(4):311-316. doi: 10.4103/0972-9062.225835.
BACKGROUND & OBJECTIVES: It is imperative to know the aetiology of acute encephalitis syndrome (AES) for patient management and policy making. The present study was carried out to determine the prevalence of common aetiological agents of AES in Uttar Pradesh (UP) state of India.
Serum and/or CSF samples were collected from AES patients admitted at Gandhi Memorial and Associated Hospital, King George's Medical University, Lucknow, a tertiary care centre, UP during 2014-16. Cerebrospinal fluid (CSF) and serum samples from cases were tested for IgM antibodies against Japanese encephalitis virus (anti-JEV), and dengue virus (anti-DENV) by ELISA; and for enterovirus, herpes simplex virus (HSV) and varicella zoster virus (VZV) by real-time PCR. Serum samples of cases having sufficient CSF volume, were also tested for anti-scrub typhus IgM antibodies and for Neisseria meningitides, Streptococcus pneumoniae and Haemophilus influenzae.
JEV and DENV (8% each) were the most common identified aetiology from the 4092 enrolled patients. Enterovirus, HSV and VZV, each were detected in <1% AES cases. Co-positivity occurred in 48 cases. Scrub typhus (31.8%) was the most common aetiology detected. Haemophilus influenzae and S. pneumoniae were detected in 0.97 and 0.94% cases, respectively, however, N. meningitides was not detected in any of the cases. About 40% of the JEV/DENV positive AES cases were adults. The gap between the total number of AES cases and those with JEV/ DENV infection increased during monsoon and post-monsoon seasons.
INTERPRETATION & CONCLUSION: Scrub typhus, JEV and DENV are the main aetiological agents of AES in UP. DENV and JEV can no longer be considered paediatric diseases. The prevalence of non-JEV/DENV aetiology of AES increases in the monsoon and post-monsoon seasons.
了解急性脑炎综合征（AES）的病因对于患者管理和政策制定至关重要。本研究旨在确定印度北方邦（UP）AES常见病原体的流行情况。
2014 - 2016年期间，从勒克瑙乔治国王医科大学甘地纪念及附属医院（一家三级医疗中心，位于UP）收治的AES患者中采集血清和/或脑脊液样本。通过酶联免疫吸附测定（ELISA）检测病例的脑脊液（CSF）和血清样本中抗日本脑炎病毒（抗JEV）和登革病毒（抗DENV）的IgM抗体；通过实时聚合酶链反应（PCR）检测肠道病毒、单纯疱疹病毒（HSV）和水痘带状疱疹病毒（VZV）。对脑脊液量充足的病例的血清样本，还检测抗恙虫病东方体IgM抗体以及脑膜炎奈瑟菌、肺炎链球菌和流感嗜血杆菌。
在4092名登记患者中，日本脑炎病毒（JEV）和登革病毒（DENV）（各占8%）是最常见的已确定病因。肠道病毒、HSV和VZV在AES病例中的检出率均低于1%。48例出现了共同阳性。恙虫病（31.8%）是检测到的最常见病因。流感嗜血杆菌和肺炎链球菌的检出率分别为0.97%和0.94%，然而，未在任何病例中检测到脑膜炎奈瑟菌。约40%的JEV/DENV阳性AES病例为成年人。在季风季节和季风后季节，AES病例总数与JEV/DENV感染病例数之间的差距增大。
恙虫病、JEV和DENV是UP地区AES的主要病原体。DENV和JEV不能再被视为仅见于儿童的疾病。AES的非JEV/DENV病因在季风季节和季风后季节的患病率增加。
