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Acute Encephalitis Syndrome in Gorakhpur, Uttar Pradesh, 2016: Clinical and Laboratory Findings.
Pediatr Infect Dis J. 2018 11; 37(11):1101-1106.PI

Abstract

BACKGROUND

Seasonal outbreaks of acute encephalitis syndrome (AES) with high fatality have been occurring in Gorakhpur, Uttar Pradesh, India, for several years. We conducted investigations during the 2016 outbreak to identify the etiology.

METHODS

We included 407 hospitalized AES patients with cerebrospinal fluid pleocytosis (>5 cells/mm) in our study. These patients were clinically examined; their blood and cerebrospinal fluid samples were collected and investigated for scrub typhus (ST), Japanese encephalitis virus (JEV), dengue virus and spotted fever group of Rickettsia by serology and/or polymerase chain reaction.

RESULTS

Of the 407 AES patients, 266 (65.4%), 42 (10.3%) and 29 (7.1%) were diagnosed to have ST, JEV and dengue infection, respectively. Four patients were diagnosed to have spotted fever group of Rickettsia infection. A significantly higher proportion of ST patients with AES had hepatomegaly, splenomegaly and facial edema. The common hematologic and biochemical abnormalities among ST-positive patients include thrombocytopenia, raised liver enzymes and bilirubin levels. The case fatality ratio was significantly higher among ST-negative AES patients (36.2% vs. 15.2%; P < 0.05).

CONCLUSIONS

ST accounted for approximately two third of the AES case-patients. Efforts are required to identify the etiology of AES case-patients who are negative for ST, JEV and dengue fever.

Authors+Show Affiliations

From the BRD Medical College.ICMR-National Institute of Virology, Gorakhpur Unit, Gorakhpur, Uttar Pradesh, India.ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India.ICMR-National Institute of Virology, Gorakhpur Unit, Gorakhpur, Uttar Pradesh, India.Christian Medical College and Hospital, Vellore, Tamil Nadu, India.Christian Medical College and Hospital, Vellore, Tamil Nadu, India.From the BRD Medical College.ICMR-National Institute of Virology, Gorakhpur Unit, Gorakhpur, Uttar Pradesh, India.ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India.ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India.ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India.Christian Medical College and Hospital, Vellore, Tamil Nadu, India.Indian Council of Medical Research, New Delhi, India.Freelance Scientist.Indian Council of Medical Research, New Delhi, India.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29746378

Citation

Mittal, Mahima, et al. "Acute Encephalitis Syndrome in Gorakhpur, Uttar Pradesh, 2016: Clinical and Laboratory Findings." The Pediatric Infectious Disease Journal, vol. 37, no. 11, 2018, pp. 1101-1106.
Mittal M, Bondre V, Murhekar M, et al. Acute Encephalitis Syndrome in Gorakhpur, Uttar Pradesh, 2016: Clinical and Laboratory Findings. Pediatr Infect Dis J. 2018;37(11):1101-1106.
Mittal, M., Bondre, V., Murhekar, M., Deval, H., Rose, W., Verghese, V. P., Mittal, M., Patil, G., Sabarinathan, R., Vivian Thangaraj, J. W., Kanagasabai, K., Prakash, J. A. J., Gupta, N., Gupte, M. M., & Gupte, M. D. (2018). Acute Encephalitis Syndrome in Gorakhpur, Uttar Pradesh, 2016: Clinical and Laboratory Findings. The Pediatric Infectious Disease Journal, 37(11), 1101-1106. https://doi.org/10.1097/INF.0000000000002099
Mittal M, et al. Acute Encephalitis Syndrome in Gorakhpur, Uttar Pradesh, 2016: Clinical and Laboratory Findings. Pediatr Infect Dis J. 2018;37(11):1101-1106. PubMed PMID: 29746378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute Encephalitis Syndrome in Gorakhpur, Uttar Pradesh, 2016: Clinical and Laboratory Findings. AU - Mittal,Mahima, AU - Bondre,Vijay, AU - Murhekar,Manoj, AU - Deval,Hirawati, AU - Rose,Winsley, AU - Verghese,Valsan Philip, AU - Mittal,Mahim, AU - Patil,Gajanan, AU - Sabarinathan,Ramsamy, AU - Vivian Thangaraj,Jeromie Wesley, AU - Kanagasabai,Kaliaperumal, AU - Prakash,John Antony Jude, AU - Gupta,Nivedita, AU - Gupte,Manish M, AU - Gupte,Mohan D, PY - 2018/5/11/pubmed PY - 2019/6/14/medline PY - 2018/5/11/entrez SP - 1101 EP - 1106 JF - The Pediatric infectious disease journal JO - Pediatr. Infect. Dis. J. VL - 37 IS - 11 N2 - BACKGROUND: Seasonal outbreaks of acute encephalitis syndrome (AES) with high fatality have been occurring in Gorakhpur, Uttar Pradesh, India, for several years. We conducted investigations during the 2016 outbreak to identify the etiology. METHODS: We included 407 hospitalized AES patients with cerebrospinal fluid pleocytosis (>5 cells/mm) in our study. These patients were clinically examined; their blood and cerebrospinal fluid samples were collected and investigated for scrub typhus (ST), Japanese encephalitis virus (JEV), dengue virus and spotted fever group of Rickettsia by serology and/or polymerase chain reaction. RESULTS: Of the 407 AES patients, 266 (65.4%), 42 (10.3%) and 29 (7.1%) were diagnosed to have ST, JEV and dengue infection, respectively. Four patients were diagnosed to have spotted fever group of Rickettsia infection. A significantly higher proportion of ST patients with AES had hepatomegaly, splenomegaly and facial edema. The common hematologic and biochemical abnormalities among ST-positive patients include thrombocytopenia, raised liver enzymes and bilirubin levels. The case fatality ratio was significantly higher among ST-negative AES patients (36.2% vs. 15.2%; P < 0.05). CONCLUSIONS: ST accounted for approximately two third of the AES case-patients. Efforts are required to identify the etiology of AES case-patients who are negative for ST, JEV and dengue fever. SN - 1532-0987 UR - https://www.unboundmedicine.com/medline/citation/29746378/Acute_Encephalitis_Syndrome_in_Gorakhpur_Uttar_Pradesh_2016:_Clinical_and_Laboratory_Findings_ L2 - http://dx.doi.org/10.1097/INF.0000000000002099 DB - PRIME DP - Unbound Medicine ER -