JAPANESE ENCEPHALITIS IN CHILDREN IN BELLARY KARNATAKA: CLINICAL PROFILE AND SEQUELAE
The predominant age group was 5 to 12 years. Male: female ratio was 1.3:1. Fever (94.84%), seizures (73.39%) and altered sensorium(91.84%) were the important presenting symptoms. The onset of illness was acute in 28.32% and subacute in 38.62% .CSF analysis showed lymphocytosis and 45.06% had cell count between 6-50/cmm and in majority it was <200/cmm. Proteins were 21-50mg/dl in 74.67% and sugar was normal in 89.6%. 55.36% patients were positive for JE. Mortality was 22.74% with average duration of onset of symptoms to death was 8.19 days. Deeper level of coma (p<0.001), respiratory irregularities (p<0.001) and meningeal signs (p<0.05) were associated with mortality. Of the 147 patients who survived the acute attack; 40.85% completely recovered. Speech disturbance (47.61%), motor deficits (36.73%), behavioural disturbance (14.96%), involuntary movements (12.24%) and seizures (1.36%) were the morbidities. The deficits found to be gradually improving. Motor deficits and speech disturbances were found in 25.68% and 22.01% respectively at one year follow up.
JE is predominately a disease of low socioeconomic group of rural origin. The characteristic clinical features include fever, seizure, altered sensorium, aphasia, relative absence of cranial nerve involvement and irregular and rapidly changing motor and tone abnormality. Deeper level of coma, respiratory abnormalities and meningeal signs were associated with mortality. Speech disturbance and motor deficits were frequently encountered sequelae at discharge and remained the most significant cause of handicap over a period of one year follow up.
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