Clinical profile and outcome of patients with meningoencephalitis in a tertiary care hospital

Monika N.; Rohith M. G.; Ravi K.; Someshwar A. Kandagal

doi:10.18203/2320-6012.ijrms20230591

Authors

Monika N. Department of Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
Rohith M. G. Department of Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
Ravi K. Department of Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
Someshwar A. Kandagal Department of Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20230591

Keywords:

Meningoencephalitis, Syndromic approach, Mortality

Abstract

Background: Encephalitis is an important cause of morbidity, mortality, and permanent neurologic sequelae globally. Causes are diverse and include viral and non-viral infections. In the emergency setting differentiating the bacterial from other causes such as viral, fungal, tubercular, toxic or autoimmune causes is extremely difficult. Although plenty of literature is available on meningitis, the clinic-etiological profile and outcome with meningoencephalitis remains not that well studied, except for in paediatric population.

Methods: The present prospective observational study included 75 patients who presented with acute encephalitis syndrome in tertiary care hospital, Bengaluru. All patients were subjected to complete clinical evaluation and appropriate investigations to study the etiology, clinical profile and outcome in them.

Results: Among 75 patients, majority of them were <60 years constituting about 73.2%, mean age being 49.14 years with female preponderance. 30 (40%) patients had viral meningoencephalitis where aetiology was confirmed in 15 patients, remaining were presumed to be of viral aetiology. 12 (16%) had tubercular meningitis and 8 (10.6%) had bacterial meningitis followed by cryptococcal meningitis 7 (9.3%). In about 18 (24%) patients, aetiology was not identified and were treated based on syndromic approach. The most common presentation was fever and altered sensorium. Thrombocytopenia was common among viral and bacterial aetiologies and those in unspecified etiological group. Mortality was highest among cryptococcal meningitis (71.4%) followed by tubercular (66.7%) and bacterial meningitis (62.5%).

Conclusions: A large number of number of cases where aetiology cannot be identified maybe benefited by a syndromic approach and better diagnostic modalities.

Metrics

Metrics Loading ...

References

Ginsberg L, Kidd D. Chronic and recurrent meningitis. Pract Neurol. 2008;8(6):348-61.

Bloch KC, Glaser C. Diagnostic approaches for patients with suspected encephalitis. Curr Infect Dis Rep. 2007;9(4):315-22.

Khajeh A, Sharifi-Mood B, Soleimani GR. Pediatric meningoencephalitis; a research on patients hospitalized in Zahedan, Southeastern Iran. Int J Infect. 2015 Apr 30;2(2).

Thinyane KH, Motsemme KM, Cooper VJ. Clinical Presentation, Aetiology, and Outcomes of Meningitis in a Setting of High HIV and TB Prevalence. J Trop Med. 2015;423161.

Joshi R, Mishra PK, Joshi D, Santhosh SR, Parida MM, Desikan P, et al. Clinical presentation, etiology, and survival in adult acute encephalitis syndrome in rural Central India. Clin Neurol Neurosurg. 2013;115(9):1753-61.

Roy DB, Khatri HV. Study of Demographic Profile, Etiology, and Clinical Outcome in Patients Admitted With Acute Encephalitis Syndrome From the Western Part of India. Cureus. 2022;14(3):e23085.

Bhattacharjee C, Bhowmik D. Acute Encephalitis Syndrome-The Socio-economic Burden in India. Pharm Biosci J. 2019;18-23.

Poley M, Koubek R, Walsh L, McGillen B. Cryptococcal meningitis in an apparent immunocompetent patient. J Investig Med High Impact Case Rep. 2019;7:2324709619834578.

Petchiappan V, Pedireddy D, Manickam S, Kuppusamy J. A prospective study on the clinical profile and outcome of meningoencephalitis in adults in a South Indian tertiary care centre. J R Coll Physicians Edinb. 2019;49(4):282-6.

Thejaswini HS, Tejashree A. Detection of Arboviral Infections in Acute Febrile Patients with Thrombocytopenia–A Serological Study. Med Res Publications. 2020;2(1).

Zhang C, Tan Z, Tian F. Impaired consciousness and decreased glucose concentration of CSF as prognostic factors in immunocompetent patients with cryptococcal meningitis. BMC Infect Dis. 2020;20(1):69.

Misra UK, Mani VE, Kalita J. A Cost-Effective Approach to the Diagnosis and Management of Acute Infectious Encephalitis. Eur Neurol. 2017;77(1-2):66-74.