ACUTE FEBRILE ENCEPHALOPATHY IN PEDIATRIC POPULATIONS: UNVEILING THE CLINICAL AND ETIOLOGICAL SPECTRUM IN HIMACHAL PRADESH

Sonam Tsomu, Kaikho Lajeo, *Oici Chakarborty

ABSTRACT

Background: Acute Febrile Encephalopathy (AFE) is a critical condition in pediatric healthcare, characterized by an altered mental state during or following a short febrile illness. This study aims to investigate the clinical and etiological profile of AFE in children in this region, to improve diagnostic accuracy and therapeutic interventions. Materials and Methods: This hospital-based cross-sectional study was conducted in the Pediatric Intensive Care Unit (PICU) at Indira Gandhi Medical College and Hospital, Shimla, over a one-year period from January 2020 to December 2020. All pediatric patients aged 1 to 18 years admitted with clinical evidence of AFE were included in the study. Data were collected on demographic details, clinical symptoms, signs, and relevant investigations, including neuroimaging and laboratory tests. Results: Out of 550 PICU admissions, 69 patients met the inclusion criteria for AFE, reflecting an incidence rate of 12.5%. The majority of patients were aged 10 to 18 years (43%), with a slight male predominance (56.5%). Fever and altered sensorium were the most common symptoms (100%). CNS infections were the leading etiology, with scrub encephalitis being the most common cause (15.8%), followed by viral meningoencephalitis (14.4%), and tubercular meningitis (11.5%). The case fatality rate for AFE was 26%, with AFE contributing to 13.7% of the overall PICU mortality. Late presentation, low Glasgow Coma Scale scores, and the presence of multiple organ dysfunction syndrome (MODS) were identified as significant risk factors for mortality. Conclusion: AFE remains a major cause of pediatric morbidity and mortality, particularly in regions where infectious diseases such as scrub typhus are prevalent. Early diagnosis and timely intervention are critical in reducing mortality. The study emphasizes the need for region-specific management protocols and improved diagnostic capabilities, especially during peak seasons like the post-monsoon period when scrub typhus incidence is high.

Keywords: Acute Febrile Encephalopathy, CNS Infections, Scrub Typhus, Pediatric Intensive Care Unit, Mortality, Himachal Pradesh, Viral Encephalitis.