Infectious causes of acute encephalitis syndrome hospitalizations in Central India, 2018-20.

BACKGROUND: We enhanced surveillance of hospitalizations of all ages for acute encephalitis syndrome (AES) along with infectious aetiologies, including the Japanese encephalitis virus (JEV). METHODS: From October 2018 to September 2020, we screened neurological patients for AES in all age groups in Maharashtra and Telangana States. AES cases were enrolled at study hospitals along with other referrals and sampled with cerebrospinal fluid, acute and convalescent sera. We tested specimens for non-viral aetiologies viz. leptospirosis, typhoid, scrub typhus, malaria and acute bacterial meningitis, along with viruses - JEV, Dengue virus (DENV), Chikungunya virus (CHIKV), Chandipura virus (CHPV) and Herpes simplex virus (HSV). RESULTS: Among 4977 neurological hospitalizations at three study site hospitals over two years period, 857 (17.2%) were AES. However, only 287 (33.5%) AES cases were eligible. Among 278 (96.9%) enrolled AES cases, infectious aetiologies were identified in 115 (41.4%) cases, including non-viral in 17 (6.1%) cases - leptospirosis (8), scrub-typhus (3) and typhoid (6); and viral in 98 (35.3%) cases - JEV (58, 20.9%), HSV (22, 7.9%), DENV (15, 5.4%) and CHPV (3, 1.1%). JEV confirmation was significantly higher in enrolled cases than referred cases (10.2%) (p < 0.05). However, the contribution of JEV in AES cases was similar in both children and adults. JE was reported year-round and from adjacent non-endemic districts. CONCLUSIONS: The Japanese encephalitis virus continues to be the leading cause of acute encephalitis syndrome in central India despite vaccination among children. Surveillance needs to be strengthened along with advanced diagnostic testing for assessing the impact of vaccination.

Clinical Profile and Treatment Outcome in Scrub Typhus Patients in Central India.

BACKGROUND: Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. It is known from various parts of India. However Central India was naive to any epidemics of scrub typhus with occasional and sporadic occurrence now and then. This part of India witnessed an outbreak of scrub typhus in the months of August and September 2018. Therefore present research was carried out with an objective to study the clinical profile and treatment outcome in scrub typhus patients in central India. METHOD: In this study, total 140 patients with an acute febrile illness diagnosed as scrub typhus by positive IgM antibodies against O. tsutsugamushi were enrolled, over a period of two months (August to October 2018). All relevant data were recorded and analyzed. RESULTS: Among 140 cases, 52.14% patients reported from urban area and 47.85% patients from rural area. The mean age of patients was 43.75±16.82 years, ranged from 12-83 years with female predominance (male: female-1:1.37). Fever (100%), cough (38.57%) breathlessness (27.85%), altered sensorium (9.28%) and headache (7.85%) were the predominant clinical features. Eschar was seen in 33 patients (23.57 %). Renal (73; 52.14%) and hepatic dysfunction (68; 48.57%) was the commonest followed by respiratory dysfunction (59; 42.14%). All patients (except pregnant patients) were treated with oral or inj doxycycline. Seventeen patients needed mechanical ventilation and five patients required dialysis. Total 24 (17.14%) patients died during the study period. CONCLUSION: Scrub typhus has become a leading infectious disease in central India and an important cause of infectious fever. An increasing awareness of this disease coupled with prompt management will go a long way in reducing both morbidity and mortality from this disease.

Clinical predictors of acute kidney injury following snake bite envenomation.

BACKGROUND: Snake bite envenomation is a major public health concern in developing countries. Acute kidney injury (AKI) is as important cause of mortality in patients with vasculotoxic snake bite. AIMS: This study was to evaluate the clinical profile of snake bite patients and to determine the predictors of developing AKI following snake bite. MATERIALS AND METHODS: Two hundred and eighty-one patients with snake envenomation were included. Eighty-seven patients developed AKI (Group A) and 194 (Group B) did not. History, examination findings and investigations results were recorded and compared between the two groups. RESULTS: In group A, 61 (70.11%) patients were male and in group B, 117 (60.30%) patients were male. Out of 281 patients, 232 had cellulitis, 113 had bleeding tendencies, 87 had oliguria, 76 had neuroparalysis, and 23 had hypotension at presentation. After multivariate analysis, bite to hospital time (P = 0.016), hypotension (P = 0.000), albuminuria (P = 0.000), bleeding time (P = 0.000), prothrombin time (P = 0.000), hemoglobin (P = 0.000) and total bilirubin (P = 0.010) were significant independent predictors of AKI. CONCLUSIONS: AKI developed in 30.96% of patients with snake bite, leading to mortality in 39.08% patients. Factors associated with AKI are bite to hospital time, hypotension, albuminuria, prolonged bleeding time, prolonged prothrombin time, low hemoglobin and a high total bilirubin.