Infectious diseases (London, England) · 2025
Molecular and serological investigations of pathogens associated with acute encephalitis syndrome among children in Northern India.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Bhardwaj Pooja, Gulafshan Shahzadi, Yadav Vishal, Dhangur Preeti, Singh Ankur Kumar, Sah Kamlesh, Singh Ravi S, Suyal Tanya, Sharma Bhoopendra, Dwivedi Gaurav Raj, Behera Sthita Pragnya, Singh Amresh Kumar, Joshi Hari Shanker, Singh Rajeev
Аннотация
PURPOSE: The northern part of India is hyperendemic for acute encephalitis syndrome (AES) among children. In a significant proportion of AES cases, the causative agent remained unknown. We prospectively investigated the etiologies in pediatric AES (pAES) cases.
METHODS: The pAES cases hospitalized at the tertiary care center from January 2022 to December 2023 were recruited in this study. Serological and molecular investigation was done, using available cerebrospinal fluid/whole blood/serum samples. Sequencing was done for positive samples.
RESULTS: A total of 557 confirmed AES cases were recruited for the study. A comprehensive investigation for infectious cause identified etiologies in 76.1% (424/557) of pAES cases. In non-JE associated AES, viral infections such as cytomegalovirus (CMV) and herpes simplex virus (HSV-1), along with bacterial infections caused by Orientia tsutsugamushi (OT), Rickettsia, and Leptospira, have emerged as the leading causes in the studied region. About 9.7% (45/463) of cases were fatal. Among fatalities, 62.2% were females; 28.9% were positive for OT, 6.8% for JE, and 2.3% for Leptospira. Either mixed viral or viral-bacterial infections were observed in 13.6% of fatalities. No identifiable causative agent was detected in 48.9% (22/45) of cases. The greatest number of deaths occurred in the post-monsoon season.
CONCLUSION: This research highlights a notable change in the profile of pathogens associated with pAES. Further, findings also suggest that the use of more comprehensive PCR panels can provide in-depth identification of etiologies associated with pAES. Finally, these findings could guide policymakers in updating diagnostic and treatment protocols for better management of pAES cases in India.
METHODS: The pAES cases hospitalized at the tertiary care center from January 2022 to December 2023 were recruited in this study. Serological and molecular investigation was done, using available cerebrospinal fluid/whole blood/serum samples. Sequencing was done for positive samples.
RESULTS: A total of 557 confirmed AES cases were recruited for the study. A comprehensive investigation for infectious cause identified etiologies in 76.1% (424/557) of pAES cases. In non-JE associated AES, viral infections such as cytomegalovirus (CMV) and herpes simplex virus (HSV-1), along with bacterial infections caused by Orientia tsutsugamushi (OT), Rickettsia, and Leptospira, have emerged as the leading causes in the studied region. About 9.7% (45/463) of cases were fatal. Among fatalities, 62.2% were females; 28.9% were positive for OT, 6.8% for JE, and 2.3% for Leptospira. Either mixed viral or viral-bacterial infections were observed in 13.6% of fatalities. No identifiable causative agent was detected in 48.9% (22/45) of cases. The greatest number of deaths occurred in the post-monsoon season.
CONCLUSION: This research highlights a notable change in the profile of pathogens associated with pAES. Further, findings also suggest that the use of more comprehensive PCR panels can provide in-depth identification of etiologies associated with pAES. Finally, these findings could guide policymakers in updating diagnostic and treatment protocols for better management of pAES cases in India.