Acute Encephalitis Syndrome with an Unusual Diagnosis

Death in children with influenza A (H3N2) virus infection-associated encephalopathy: two case reports

We herein report two cases involving children who died of influenza A (H3N2) virus infection-associated encephalopathy/encephalitis (IAE). Both children developed convulsions and impaired consciousness within a relatively short period and eventually died of brainstem failure. Patient 1 presented with high fever, vomiting, and diarrhea. Laboratory tests indicated persistently high lactate, alanine aminotransferase, and urea nitrogen concentrations in the blood as well as a high protein concentration in the cerebrospinal fluid. Patient 2 presented with persistent hyperthermia and progressive disturbance of consciousness, but the cerebrospinal fluid remained normal during the disease course. Both patients were actively given oseltamivir antiviral treatment after diagnosis of influenza virus infection. However, the disease progressed and invasive mechanical ventilation was performed. Both children's condition quickly progressed to IAE, and they eventually died. IAE is a rare complication of influenza virus infection with high mortality, and its pathogenesis remains unclear. The purpose of this report is to draw attention to the serious central nervous system complications of influenza infection and raise awareness of the fatal consequences of this disease among pediatricians.

Acute encephalitis syndrome and Bihar health profile: Urgent need to revitalize primary health care

Acute encephalitis syndrome(AES) represents long term public health challenge with recurrent seasonal outbreak in many districts of Bihar for the past two decades. Multiple hypothesis has been postulated linking it as cause of acute encephalitis syndrome. Agrochemicals, lychee toxins, heat stroke, infectious causes and environmental factors have been postulated as AES cause. Although association have been found but no definite causation ascertained yet. Bihar heath performance on various indicators have been poor for past many years. Health index 2019 released by Niti Ayog with ministry of health and family welfare ranked Bihar on 20th place out of 21 large states based on various health indicators. Early access to nearest PHC may significantly improve outcome. As most of the children are from rural areas it's imperative to strengthen rural health care. Rural urban disparity and inequitable distribution of resources, lack of well-trained health workforce has been widely reported. Primary healthcare is the essential foundation of emergencies outbreaks. PHC is the best strategy and most cost-effective investment to provide high quality care ensuring equitable access to all. PHC reduces morbidity and makes public health system resilient to absorb sudden increase in number of cases, rising health demands putting health workforce at stress and strain to available resources.