A STUDY ON ETIOLOGY,CLINICAL FEATURES,DIAGNOSIS AND PROGNOSIS IN ACUTE FEBRILE ILLNESS

Abstract

Background: Acute febrile encephalopathy (AFE) is a clinical term used to an altered mental state that either accompanies or follows a short febrile illness and is characterized by a diffuse and nonspecific brain insult manifested by a combination of coma, seizures, and decerebration.
Materials and Methods: A prospective observational study was done in patients aged 13 years or above who were admitted with AFE at a Tertiary Care Center in Government General Hospital, Dept of General Medicine, Kurnool Medical College, Kurnool, Andhra Pradesh. The non-infectious causes of unconsciousness were excluded and then only a diagnosis of AFE was considered. Cerebrospinal fluid (CSF) analysis and imaging of brain was done to determine the possible etiology. Outcome was assessed at 1 month of follow up after discharge by using modified Rankin Scale (MRS). Data were analyzed and presented as mean, median, and percentages.
Results: Among the 50 patients 33 (66%) are male patients.43 patients (86%) were young adults .The common presenting symptoms are fever in 41 patients (82%), headache in 29 patients (58%), altered sensorium in 19 patients(38%). Out of 50 patients studied acute febrile encephalopathy was common in males when compared to female ,more common in age group 30-40 yearsAcute viral encephalitis was the most common cause accounting for 36 percentage in which Herpes Simplex Encephalitis 24 percentage
Japanese encephalitis 4 percentage and other undetermined viral etiology count for 10 percentage followed by pyogenic meningitis 28 percentage followed by tuberculous meningitis 12 percentage, cerebral malaria diagnosed 2 percentage sepsis associated encephalopathy 10 percentage in which 6 percentage leptospirosis and 4 percentage scrub typhus were diagnosised. Of all the total cases 2 patient died in whichone patient with HIV associated Cryptococcus meningitis other patient with pyogenic meningitis. MRS at discharge were five in pyogenic meningitis three in viral meningitis after one month, MRS was 2 in pyogenic meningitis and the rest it was less than one
Conclusions: In the present study we found that, most of the patients with meningoencephalitis were males and young adults in this study viral meningo encephalitis was the leading casue of acute febrile encephalopathy followed by pyogenic meningitis and tuberculous meningitis The outcome in cases with pyogenic meningitis can be fatal or more disabling than other aetiology.