Clinical profile and predictors of mortality of japanese encephalitis in children admitted with acute encephalitis syndrome

Background: Japanese encephalitis (JE) is the most prevalent and significant vector-borne viral encephalitis in human, with an estimated 30,000 to 50,000 of cases and 10,000 - 15,000 deaths annually worldwide. Mortality of JE is about 20% to 30% and 30–50% result in permanent neuropsychiatric sequelae. Aims and objectives: To determine the clinical profile and for a better understanding predictors of mortality of JE in children hospitalized with AES cases. Materials and methods: All cases admitted with symptoms suggestive of AES were included in the study. A detailed history was taken and investigations like CBG, CBC, electrolytes, peripheral smear were analyzed. Neuroimaging done was analyzed and abnormal findings documented. CSF analysis was done after taking consent from the parents. CSF was sent for cytology, biochemical analysis, AFB and gram stain. Viral analysis was done in CSF, which included antibodies for JE. The outcome of the patients was recorded at the time of discharge. Results: Most common age group was 5 – 12 years. There was no significant difference in death among the infants or older children. Male to female ratio was1.13:1. Common presentations were fever 64 (100%), seizures 52 (80.25%), dysglycemia 22 (34.37%) and found statistically insignificant with mortality. Twenty three JE patients (35.93%) presented with GCS<8, the mortality was significantly high (P<0.001).Those group of patients who had shock and required inotropes and the group of patients who had hyponatremia 21(32.81%), the mortality was significantly high (P <0.001 and p = 0.0017 respectively). Outcome at discharge was recorded for 64 patients. Among the 64 confirmed JE patients, 37(57.81%) were recovered completely, while 14 (21.8%) cases had neurological sequelae at the time of discharge. 13 (20.32%) patient died in the hospital Conclusion: The case fatality rate was observed 20.31% mortality due to JE in children admitted with AES. In the present study, Predictors of mortality in JE patients were GCS <8, hyponatremia, shock and use of inotrope significantly associated with mortality.