Author(s): Bhaskar Brahma 1 , Abdul Barik Ahmed 2 , Tribeni Sarma 3 , Debabrata Goswami 4 , Pankaj Patowary 5
BACKGROUND Japanese Encephalitis is one of the most common causes of Acute Encephalitic Syndrome in Asia. During the period of June to August in 2014 an epidemic occurred in Assam, a northestern state of India. METHODS Patients admitted in the Medicine Department in Gauhati Medical College and Hospital (GMCH), Guwahati, Assam, India, with clinical features of Acute Encephalitic Syndrome (AES) i.e. acute onset fever and a change in mental status (including symptoms such as confusion, disorientation, coma, or inability to talk) and/or new onset seizures (excluding simple febrile seizures) from June to August 2014 underwent ELISA for Japanese Encephalitis Immunoglobulin M in cerebrospinal fluid (CSF) at the time of admission. Clinical features, demographic profile and laboratory investigations were recorded in positive patients. RESULTS 226 AES patients were admitted in 6 different units of Medicine ward in GMCH, out of which 76 patients were diagnosed to be JE positive with CSF IgM ESLIA, coming from 17 districts of Assam. Out of 76 patients, 69 patients were from rural area, only 7 patients were from urban area. 59 (77.63%) patients were farmers or daily labourers by occupation and 23 (30.26%) patients were illiterate. Mean age of patients was 47.7 years and male to female ratio was 1.7:1. Mean duration of fever was 6.5 days, convulsion was found in 13.15% patients, out of which most common was generalised seizure (9.2%). 55.2% patients had meningeal signs, 23.68% patients had focal neurological deficits in the form of hemiparesis and monoparesis and mean GCS score was 9.28. Extra pyramidal features present in patients were rigidity (23.68%), abnormal posturing (15.78%) and abnormal movements (23.68%). 23.68% patients had Leukocytosis and Thrombocytopenia was found in 21 (27.6%) patients. Mean CSF cell count was 34.34 cells/mm3 with mean 29.67% polymorphs, mean CSF protein and sugar was 56.15 mg/dl and 66.92 mg/dl respectively. Serum bilirubin level was normal however elevated liver enzymes were present in 63.15% of patients. CT scan brain was done in 52 JE positive patients, cerebral oedema was found in 19 (36.52%) patients and hypodensities in thalamus, midbrain and basal ganglia was found in 16 (30.65%) patients. CONCLUSION One of the important findings of the present study is Thrombocytopenia and elevation of liver enzymes in JE patients which were not reported in previous studies except one study in Thailand and another in India in Paediatrics patients. Though the study was small it needs further studies to prove that thrombocytopenia and elevated liver enzymes may be an important complication of Japanese Encephalitis and should not be overlooked.