Acute Encephalitis Syndrome (AES) is a serious neurological condition characterized by the sudden onset of fever, altered sensorium, and seizures in children. Prompt recognition and appropriate management are vital for ensuring the best possible outcomes. In this article, we will explore the key aspects of AES, including its symptoms, diagnostic procedures, and recommended treatment strategies.
Symptoms and Evaluation:
AES typically manifests with a rapid onset of fever lasting for approximately 5-7 days, accompanied by altered sensorium and seizures (excluding simple febrile seizures). In order to evaluate the condition, several vital signs and general examination parameters are assessed, including temperature, pulse rate, respiratory rate, blood pressure, pallor, petechiae, rash, and icterus. A detailed neurological examination is also conducted, which involves assessing the level of consciousness, abnormal posturing, active seizures, cranial nerve function, focal neurological deficits, and meningeal signs.
To aid in the diagnosis, a series of investigations are performed. Essential tests include complete blood count (CBC), liver and kidney function tests, blood sugar levels, contrast-enhanced computed tomography (CECT) of the brain, and cerebrospinal fluid (CSF) examination. Additional desirable investigations may include magnetic resonance imaging (MRI) of the brain, CSF polymerase chain reaction (PCR) for specific viral encephalitis, serological tests for Japanese encephalitis and dengue, electroencephalography (EEG), and HIV testing.
The management of AES involves several key steps. Rapid assessment and stabilization are prioritized, ensuring the maintenance of airway, ventilation, and circulation. Seizures are promptly treated with benzodiazepines and phenytoin loading. Empirical treatment with intravenous ceftriaxone and acyclovir is initiated in suspected viral encephalitis cases. Supportive care and treatment measures include maintaining euglycemia, hydration, control of fever, and addressing raised intracranial pressure. Rehabilitation and prevention of complications are also integral parts of the management process.
Discharge Criteria and Follow-up:
Before discharge, certain criteria need to be met, including being afebrile, starting to eat and drink orally, and subsiding of seizures. It is essential to provide clear instructions to parents regarding supportive care, physiotherapy, and continued monitoring at home. Additionally, a high threshold for invasive procedures is maintained, with interventions reserved for cases where they are absolutely necessary.
Acute Encephalitis Syndrome (AES) poses a significant health challenge, particularly in children. Early recognition, timely intervention, and appropriate management are essential for improving outcomes. By understanding the symptoms, undergoing relevant diagnostic investigations, and following the recommended treatment protocols, healthcare professionals can provide effective care and support to children with AES.
Disclaimer: The information provided in this article is based on available scientific evidence and expert recommendations. Treatment protocols may vary based on individual circumstances, and it is advised to consult a qualified healthcare professional for personalized diagnosis and treatment.