Spectrum of Pediatric Acute Febrile Encephalopathy in Hilly Areas of Northwestern Himalayas

Abstract Background and Aim: The etiological profile of acute febrile encephalopathy (AFE) varies across different geographic areas and in different seasons across the world. Limited literature in children suggests central nervous system (CNS) infections to be the most common cause of AFE in India and developing countries. Most of these studies have been done in the plains of India, and no study has been done in the Himalayan region of northwestern India, where most of the vectors causing AFE in other parts of India, like mosquitoes, are not found. Therefore, this leads to a lacuna in available data on the etiological profile in this region with an elevation of 1000–21,000 ft from the sea level. Our aim was to study the clinical and etiological profile of pediatric AFE and the risk factors associated with mortality in AFE in Himachal Pradesh, a hilly Himalayan state of India located in northwestern Himalayas. Materials and Methods: This was a prospective, descriptive, observational study conducted in the pediatric intensive care unit (PICU) of Indira Gandhi Medical College Shimla, for a period of 1 year, in which all children aged from 1 to 18 years with clinical evidence of AFE and meeting the inclusion criteria were enrolled and studied for the clinical features, etiology, and risk factors for mortality. Chi-square test was used to find the significance of study parameters on a categorical scale between two or more groups. A P value of 0.05 or less was considered as statistically significant. Results: Sixty-nine patients were enrolled in the study. Fever, altered sensorium, vomiting, seizures, and headache were the most common symptoms. The most common clinical sign was raised ICT, followed by low Glasgow coma scale (GCS). The most common etiology was CNS infections. Among these, scrub encephalitis was the most common cause that was seen in 15.8%, followed by viral and tubercular meningitis in 14.4% and 11.1%, respectively. Eighteen patients out of 69 with AFE died, giving a case fatality rate of 26%. Shock, GCS <8, ventilatory support, MODS, DIC, and delayed presentation were significant risk factors associated with mortality. Conclusions: Infectious causes attributed maximum to the etiology of AFE, and among them, scrub encephalitis was the most common cause of AFE.