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Laboratory procedure of virus causing encephalitis
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Acute Encephalitis Syndrome (AES) poses a great public health problem in India, occurring both in epidemics and sporadically. Although bacteria, viruses and protozoan parasites may cause encephalitis, among these; the viruses are the most common and important cause of encephalitis Japanese Encephalitis virus has been considered as leading cause of...
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... was a study in Rajasthan for monitoring AES, and they were reported Enterovirus (EV) (4.50%), Dengue Virus (DV) (3.94%), Human Metapneumovirus (MPV) (3.80%), Mumps Virus (MV) (2.67%) and Rubella Virus (RV) (0.84%). EV-71 virus is an important agent developing encephalitis most often as sporadic cases as shown in Fig. 1 [7]. ...
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Introduction:
Japanese encephalitis (JE) is a vector-borne, viral illness caused by the Japanese Encephalitis Virus. Permanent neurologic or psychiatric sequelae can occur in 30%-50% of those with encephalitis; hence, JE is a cause of major public health concern. For the ease of diagnosis and facilitation of surveillance, National Vector Borne Dis...
Citations
... etiologic agent is not identified; in cases with identified etiology, viruses are responsible in majority of cases 3 . Children and young adults are common victims of encephalitis. ...
Acute encephalitis syndrome has been a major health problem worldwide due to its high morbidity and mortality. Theaim of this study was to find out the demographic profile of acute encephalitis syndrome and to determine theassociation of the outcome of the disease with the demographic factors and respiratory symptoms at presentation. Thisobservational analytic cross-sectional study was conducted in the departments of Medicine, Paediatrics, andNeurology in Bangabandhu Sheikh Mujib Medical College Hospital in Bangladesh from September 2013 to August2014. People of all ages who fulfilled the inclusion criteria of acute encephalitis syndrome were included in the study.In this study, 270 cases were diagnosed with acute encephalitis syndrome. Most cases were clustered around the agegroups of 0-5 year (24.1%), 6-17 year (24.8%), and 18 -45 year (28.5%). Death was higher among the 18-45 agegroups (33.3%) as well as in males (59.3%). Apart from neurological symptoms, respiratory symptoms on presentationwere present in 66.9% cases with 89.6% death and this association was found statistically significant (p value <0.001, AOR 6.96, COR 5.3 with 95% CI). Influence of socio-demographic factors and delay in seeking hospitaladmission on adverse outcome was not statistically significant. Most cases occurred in January-February (12.6% and11.1%) and in July (14.4%). Overall mortality was 17.8%. Encephalitis presenting with respiratory symptoms inassociation carries higher mortality.
... In the state of Kerala, over 25 million people have been vaccinated against COVID-19. In India, the crude annual incidence of CAE is approximately 8.35-10 per million [10]. ...
ChAdOx1 nCoV-19 vaccine (AstraZeneca) has been associated with rare adverse events following vaccination such as thrombosis with thrombocytopenia syndrome, inflammatory myositis, and autoimmune encephalitis. Para-infectious or post-infectious myelin oligodendrocyte glycoprotein-associated disorders (MOGAD) have been reported in association with coronavirus disease. However, post-vaccine MOGAD (PV-MOGAD) has not yet been reported. Here, we report three cases of PV-MOGAD who presented with a prolonged severe headache after the ChAdOx1 vaccination. Other features of MOGAD such as optic neuritis or tumefactive demyelination appeared much later. Aseptic meningitis can be a presenting feature of PV-MOGAD. When patients present with a severe headache after the ChAdOx1 vaccination, PV-MOGAD should be considered along with thrombosis with thrombocytopenia syndrome.
... Comparatively, the incidence of PVE is estimated at 0.4-0.8 per million doses after ChAdOX1 vaccination and 0.2 per million with the mRNA vaccine (BNT162b2) [3,7]. Our population showed a calculated crude incidence of PVE of ~ 0.24 cases per million (2 cases per 8.19 million vaccinees), similar to that for mRNA vaccines. ...
Introduction:
Post-ChAdOx1 vaccine (AZD1222) adverse events following immunization (AEFI) are uncommon. Recently described neurological events include thrombocytopenia with thrombosis syndrome (TTS) with cerebral venous thrombosis and Guillain-Barré syndrome. There are very few AEFI reports following COVID vaccination from India, because of underreporting or other factors. A few cases of acute transverse myelitis (ATM) and post-vaccinal encephalitis have also been reported.
Materials and methods:
Over 11 months, in 2 districts of Kerala, India, 8.19 million people were vaccinated with the ChAdOx1 vaccine.
Results:
During this period, we encountered five cases of autoimmune central nervous system (CNS) AEFI following ChAdOX1 (Oxford/AstraZeneca, Covishield™) vaccination. These included three cases of acute disseminated encephalomyelitis (ADEM), one case of opsoclonus myoclonus ataxia syndrome (OMAS), and one case of limbic encephalitis. The calculated crude incidence of post-ChAdOX1 autoimmune CNS AEFI was approximately 0.24 cases per million for encephalitis and 0.36 per million for ADEM. This was compared to the crude annual incidence of community-acquired ADEM worldwide (3.2-4 per million) and the crude annual incidence of community-acquired encephalitis in India (8.35-10 per million).
Conclusion:
There was no increase in the incidence of post-vaccination CNS AEFI (ADEM or encephalitis) as compared to the community incidence of ADEM or encephalitis. While this emphasizes the safety of ChAdOX1 nCoV-19 vaccination for COVID-19, it is important to recognize these post-vaccination autoimmune syndromes early to initiate immunosuppressive therapy.
... [3] Growing evidence in literature suggest that O. tsutsugamushi does invade the CSF and CNS invasion may be seen in 2%-5% cases of tsutsugamushi disease. [3,11,12] In our study of the 81 patients studied, 5 of them had neurological involvement (6.17%). Therefore, in newer emerging areas, ST should be considered as one of the causes of aseptic meningitis during the seasonal outbreaks of ST. ...
Scrub typhus is an acute febrile illness caused by Orientia tsutsugamashi. CNS is the most crucial target in other rickettsial diseases and historically, the neurological disease burden was considered low in scrub typhus. However, there is growing evidence in literature that O. tsutsugamushi does invade the CSF and CNS invasion may be seen in 2–5 % cases of tsutsugamushi disease. O. tsutsugamushi parasitises endothelial cells both in the periphery as well as in the brain. The disease is characterized by focal or disseminated vasculitis and perivasculitis. Scrub typhus has protean manifestations. CNS involvement is rare but it should be considered as an important differential in the setting of known areas of scrub typhus outbreak. Meningoencephalitis with or without focal neurological deficits is the commonest clinical picture. However, the neurological manifestations can be highly variable. In our case series out of 81 patients who were diagnosed with scrub typhus, only 5 patients had neurological manifestations. All patients presented with altered sensorium. GCS was decreased in all patients. It was
... It is obvious that AES cases have not been limited to only JE etiology. [9] In this changed perspective of wide range of causal agents and the rapid rate of neurological impairment because of CNS infection, clinicians face the challenge of a small window period between diagnosis and treatment, [9,10] resulting high CFR specially in pediatric age group. ...
... It is obvious that AES cases have not been limited to only JE etiology. [9] In this changed perspective of wide range of causal agents and the rapid rate of neurological impairment because of CNS infection, clinicians face the challenge of a small window period between diagnosis and treatment, [9,10] resulting high CFR specially in pediatric age group. ...
Background:
Acute Encephalitis Syndrome (AES) in children contributes considerable morbidity and mortality in endemic region. A study was conducted to see the clinico-epidemiological characteristics of hospitalized AES children and to find out if there is any correlation of clinico-epidemiological factors with case fatality rate (CFR).
Methods:
This hospital-based observational prospective study was conducted in a tertiary care teaching hospital of Assam, India from 16th May, 2019 to 15th May, 2020. We enrolled clinically diagnosed 140 hospitalized AES children consecutively as per WHO case definition. Cerebrospinal fluid and serum samples were tested for JEV-specific IgM antibodies.
Results:
Out of 140 AES children 84 (60%) were male and 5-12 years age group had the highest 79 (56.4%) number of cases. Primarily cases were from rural areas 132 (94.3%). In addition to fever, major clinical manifestations were seizures 114 (81.4%), altered sensorium 128 (91.4%), meningeal signs 62 (44.3%), and <8 GCS 42 (30%). CFR was 27.7%. Significantly high CFR was seen among AES children with GCS <8 (P-value 0.0001) and presence of meningeal signs (P-value 0.0007). A higher proportion of non-survivors 55.6% were non JE AES. Monthly incidence of AES/Death showed a peak in the month of July.
Conclusion:
AES in children is a significant public health problem in the study area with high CFR. Presence of GCS <8 and meningeal irritation are the important predictors of mortality in AES children. Preponderance of non-JE AES case fatality in children warrant further exploration and appropriate public health interventions.
Acute encephalitis syndrome (AES) is a major public health concern in India as the aetiology remains unknown in the majority of cases with the current testing algorithm. We aimed to study the incidence of Japanese encephalitis (JE) and determine the aetiology of non‐JE AES cases to develop an evidence‐based testing algorithm. Cerebrospinal fluid (CSF) samples were tested for Japanese encephalitis virus by ELISA and polymerase chain reaction (PCR). Multiplex real‐time PCR was done for Dengue , Chikungunya , West Nile , Zika , Enterovirus , Epstein Barr Virus , Herpes Simplex Virus , Adenovirus , Cytomegalovirus , Herpesvirus 6 , Parechovirus , Parvovirus B19 , Varicella Zoster Virus , Scrub typhus, Rickettsia species, Leptospira , Salmonella species, Streptococcus pneumoniae , Haemophilus influenzae , Neisseria meningitidis, Plasmodium species and by ELISA for Mumps and Measles virus. Of the 3173 CSF samples, 461 (14.5%) were positive for JE. Of the 334 non‐JE AES cases, 66.2% viz. Scrub typhus (25.7%), Mumps (19.5%), Measles (4.2%), Parvovirus B19 (3.9%) Plasmodium (2.7%), HSV 1 and 2 (2.4%), EBV and Streptococcus pneumoniae (2.1% each), Salmonella and HHV 6 (1.2% each) were predominant. Hence, an improved surveillance system and our suggested expanded testing algorithm can improve the diagnosis of potentially treatable infectious agents of AES in India.
Acute encephalitis syndrome (AES) in children results in significant neurocognitive deficits or mortality. It is pertinent to study the AES patterns periodically to identify the changes in the etiological trends and outcomes. Our objective was to find the etiological agents of AES, mode of diagnosis, treatment given, and outcomes.
We reviewed the electronic records of children aged 1 month to 15 years who were admitted with AES in our centre from January 2015 to December 2019. We analyzed the the clinical, laboratory, and radiological profile of these children and adolescents in relation to their outcome. Poor outcome was defined as death, discharge against medical advice with neurological deficits, or Glasgow Outcome Score Extended (GOS-E) d≤ 5 at the time of discharge.
Among 250 patients admitted with AES during the study period, a definitive etiological diagnosis was established in 56.4% of children (30.4% viral, 22% bacterial). Scrub typhus (11.2%) and dengue (9%) were the two most common underlying illnesses. Serology helped in clinching the diagnosis in 30% of children. A surge in AES cases in the post-monsoon season was observed in our cohort. Third-generation cephalosporin drugs (85.7%) and acyclovir (77.7%) were the most commonly used empiric antimicrobial drugs. About one-third of children (n = 80) had a poor outcome. GCS ≤ 8 at presentation and requirement for invasive ventilation were found to be significant predictors of poor outcome.
A definitive diagnosis was obtained in about half of the children with AES. Viral (30.4%) and rickettsial infections (22%) were the common etiologies identified. Poor outcome was observed in 32 % of patients.
In this study, we examined the possible causes behind the unusual behaviour of 2019 Summer Monsoon (SM) and also investigated whether 2019 SM is as a clear glimpse of emerging climate change, using high resolution datasets of Indian Meteorological Department(rainfall) and ERA 5 reanalysis (0.25o X 0.25o). In our analysis, we found that, 2019 SM season is the end result of ongoing climatic changes in the recent period (2006–2021) and their association with prevailing positive Indian Ocean Dipole (pIOD) and El Nino conditions. Our study found climate change signals like significant warming of Western Indian Ocean (WIO) (altered the North – South (meridional) Tropospheric Temperature gradient (TTg)), rainfall increment over Northwestern India (due to variation in the strength of southwesterlies), changes in timings of onset and withdrawal, shift in monsoon propagation and frequent incidence of El Nino as well as intense pIOD conditions during the SM season, in the recent 16 year period (2006–2021). We found a significant weakening/strengthening in monsoon circulation in June/September. We noticed that among these 16 years, 2019 stood as a perfect example of a monsoon in warming scenario with severe heat waves, extreme pIOD conditions and erratic monsoon features. Though 2019 monsoon rainfall (like 1994) is about 110% of Long Period Average and experienced El Nino alongside pIOD conditions like 1994 and 1997, we found drastic variability in monsoon features of 2019. The post onset conditions and rainfall variability in 2019 are mainly influenced by TTg fluctuations due to warmer WIO (specifically Arabian Sea), weakening/strengthening of circulation in June/September and extreme rainfall reception in short period. As decadal frame is the time scale on which anthropogenic climate change emerges, the vagaries we noticed in the 16 year period (especially 2019) should not be neglected.
