Study of acute viral meningoencephalitis in children in sub-Himalayan Tarai region: Clinico-epidemiological, etiological, and imaging profile

Abstract

Introduction: Sub-Himalayan Tarai region of India is an endemic area for viral meningoencephalitis where rising trend of disease prevalence has been observed over last 3 years. Objective: This study was conducted to find the viral etiology, clinical profile, and epidemiology of meningoencephalitis cases and correlate them with imaging results. Materials and Methods: A hospital-based prospective observational study was conducted over a period of 1-year (1st January-31st December 2011). Children aged 1 month to 12 years admitted with the diagnosis of viral meningoencephalitis were included in the study. Cerebrospinal fluid and serum
immunoglobulin enzyme-linked immunosorbent assay was done for herpes simplex 1 virus, measles, mumps, rubella, varicella, Japanese encephalitis, dengue, and human immunodeficiency virus, on all suspected patients. Neuroimaging (Magnetic resonance imaging brain or computed tomography head) was also performed. Results: Mean age was 5.2±3.46 years (range 1 month to 12 years) with a Male:Female ratio of 1.8:1. A maximum number of cases was recorded in monsoon. Paramyxovirus (mumps) was the most common detected virus followed by Japanese encephalitis cases. Case fatality rate for Japanese encephalitis was
54.55% (95% confidence interval 39.54-69.56), and the majority of the deaths occurred in the age group of 3-7 years (38.46%). At 6 months follow-up, 71.4% were absolutely symptom free, while rest had weakness of all limbs, mental retardation, or aphasia. Conclusion: Significant encephalitis is prevalent in all districts of North Bengal. Most prevalent are JE and mumps which are vaccine preventable.