Epidemiological Profile of Acute Viral Encephalitis in a Sample of Egyptian Children

  • Bassant Meligy Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo
  • Dalia Kadry Department of Microbiology, Faculty of Medicine, Cairo University, Cairo
  • Iman H. Draz Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo
  • Huda Marzouk Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo
  • Nevine R. El Baroudy Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo
  • Amira Sayed El Rifay Departments of Child Health, National Research Centre, Cairo
Keywords: Viral encephalitis, Pediatric, PCR, Outcome


INTRODUCTION: Acute encephalitis syndrome (AES) is a considerable public health problem.

AIM: This study was designed to describe the aetiology, demographic features, clinical picture, short-term outcome and risk factors of mortality of children with viral encephalitis in Egyptian children.

METHODS: PCR detection of viruses in the CSF of pediatric patients admitted to the pediatric unit or ICU Cairo University Pediatric hospital presenting with encephalitis syndrome.

RESULTS: Of the 96 patients included in the study, viral etiological agents were detected in 20 cases (20.8%), while 76 patients (79.2%) had no definite viral aetiology. The most abundant virus detected was Enterovirus (EV) in fourteen (14.5%), two (2.1%) were positive for human herpes simplex virus 6 (HSV-6), one (1.0%), human herpes simplex virus1 (HSV-1), one (1.0%) Epstein Barr virus (EBV), one (1.0%), cytomegalovirus (CMV) and one (1.0%) with varicella-zoster virus (VZV). On the short term outcome, 22 (22.9) patients died, and 74 (77.1%) survived. Severity outcome among survival was vegetative in three cases (4%) severe in 9 (12.16%), moderate in 14 (18.9%), mild in 29 (39.2%) and full recovery in 19 (25.6%). Mortality risk factors for younger age, the presence of apnea, the need for mechanical ventilation and the presence of abnormal CT findings were all significantly associated with fatal outcome (p < 0.05).

CONCLUSION: Enterovirus was the most common cause of encephalitis among Egyptian children. Mortality was correlated with younger age and disease severity at admission. Sequelae were high among infected children.


Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


Tack DM, Holman RC, Folkema AM, Mehal JM, Blanton JD, Sejvar JJ. Trends in encephalitis-associated deaths in the United States, 1999-2008. Neuroepidemiology. 2014; 43(1): 1-8. https://doi.org/10.1159/000362688 PMid:24968857

Said S, Kang M, Encephalitis, Viral, in StatPearls. Stat Pearls Publishing Stat Pearls Publishing LLC.: Treasure Island, 2017.

Hajjeh RA, Relman D, Cieslak PR, Sofair AN, Passaro D, Flood J, et al. Surveillance for unexplained deaths and critical illnesses due to possibly infectious causes, United States, 1995-1998. Emerg Infect Dis. 2002; 8(2): 145-53. https://doi.org/10.3201/eid0802.010165 PMid:11897065 PMCid:PMC2732455

Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH. Beyond viruses: clinical profiles and etiologies associated with encephalitis. Clinical Infectious Diseases. 2006; 43(12):1565-77. https://doi.org/10.1086/509330 PMid:17109290

Alexandra Mailles J-PS. Infectious Encephalitis in France in 2007: A National Prospective Study. Clinical Infectious Diseases. 2009; 49(12): 1838–1847. https://doi.org/10.1086/648419 PMid:19929384

Beig FK, Malik A, Rizvi M, Acharya D, Khare S. Etiology and clinico-epidemiological profile of acute viral encephalitis in children of western Uttar Pradesh, India. International Journal of Infectious Diseases. 2010; 14(2): e141-e146. https://doi.org/10.1016/j.ijid.2009.03.035 PMid:20106698

Rozenberg F, Chapter 122 - Acute viral encephalitis, in Handbook of Clinical Neurology, O. Dulac, M. Lassonde, and H.B. Sarnat, Editors. Elsevier, 2013:1171-1181. https://doi.org/10.1016/B978-0-444-52910-7.00038-6

Chaudhuri A, Kennedy PG. Diagnosis and treatment of viral encephalitis. Postgrad Med J. 2002; 78(924): 575-83. https://doi.org/10.1136/pmj.78.924.575 PMid:12415078 PMCid:PMC1742520

Solomon T, Michael BD, Smith PE, Sanderson F, Davies NW, Hart IJ, et al. Management of suspected viral encephalitis in adults--Association of British Neurologists and British Infection Association National Guidelines. J Infect. 2012; 64(4): 347-73. https://doi.org/10.1016/j.jinf.2011.11.014 PMid:22120595

Quan PL, Wagner TA, Briese T, Torgerson TR, Hornig M, Tashmukhamedova A, et al. Astrovirus encephalitis in boy with X-linked agammaglobulinemia. Emerg Infect Dis. 2010; 16(6): 918-25. https://doi.org/10.3201/eid1606.091536 PMid:20507741 PMCid:PMC4102142

Shaheen N, Mussai F. Enteroviral Encephalitis in a Child With CNS Relapse of Burkitt Leukemia Treated With Rituximab. J Pediatr Hematol Oncol. 2018; 2018.

Kumar R, Kumar P, Singh MK, Agarwal D, Jamir B, Khare S, et al. Epidemiological Profile of Acute Viral Encephalitis. Indian J Pediatr. 2017; 2017.

Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar J, Bitnun A, et al. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis. 2013; 57(8):1114-28. https://doi.org/10.1093/cid/cit458 PMid:23861361 PMCid:PMC3783060

Sejvar JJ, Kohl KS, Bilynsky R, Blumberg D, Cvetkovich T, Galama J, et al. Encephalitis, myelitis, and acute disseminated encephalomyelitis (ADEM): case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine. 2007; 25(31): 5771-92. https://doi.org/10.1016/j.vaccine.2007.04.060 PMid:17570566

Olsen SJ, Campbell AP, Supawat K, Liamsuwan S, Chotpitayasunondh T, Laptikulthum S, et al. Infectious causes of encephalitis and meningoencephalitis in Thailand, 2003-2005. Emerg Infect Dis. 2015; 21(2):280-9. https://doi.org/10.3201/eid2102.140291 PMid:25627940 PMCid:PMC4313633

Debiasi RL, Tyler KL. Molecular methods for diagnosis of viral encephalitis. Clin Microbiol Rev. 2004; 17(4):903-25. https://doi.org/10.1128/CMR.17.4.903-925.2004 PMid:15489354 PMCid:PMC523566

Fillatre P, Crabol Y, Morand P, Piroth L, Honnorat J, Stahl JP, et al. Infectious encephalitis: Management without etiological diagnosis 48hours after onset. Médecine et Maladies Infectieuses. 2017; 47(3):236-251. https://doi.org/10.1016/j.medmal.2017.02.004 PMid:28314470

World Medical Association Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. medical Ethics 2018 [cited 2018 january]; Available from: https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/.

Fiser DH. Assessing the outcome of pediatric intensive care. J Pediatr. 1992; 121(1):68-74. https://doi.org/10.1016/S0022-3476(05)82544-2

Chan YH. Biostatistics 102: quantitative data--parametric & non-parametric tests. Singapore Med J. 2003; 44(8): 391-6. PMid:14700417

Chan YH. Biostatistics 104: correlational analysis. Singapore Med J. 2003; 44(12): 614-9. PMid:14770254

Deigendesch N, Stenzel W. Acute and chronic viral infections. Handb Clin Neurol. 2017; 145: 227-243. https://doi.org/10.1016/B978-0-12-802395-2.00017-1 PMid:28987172

Mailles A, Stahl JP. Infectious encephalitis in france in 2007: a national prospective study. Clin Infect Dis. 2009; 49(12): 1838-47. https://doi.org/10.1086/648419 PMid:19929384

Ambrose HE, Granerod J, Clewley JP, Davies NW, Keir G, Cunningham R, et al. Diagnostic strategy used to establish etiologies of encephalitis in a prospective cohort of patients in England. J Clin Microbiol. 2011; 49(10): 3576-83. https://doi.org/10.1128/JCM.00862-11 PMid:21865429 PMCid:PMC3187347

Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010; 10(12): 835-44. https://doi.org/10.1016/S1473-3099(10)70222-X

Leber AL, Everhart K, Balada-Llasat JM, Cullison J, Daly J, Holt S, et al. Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens. J Clin Microbiol. 2016; 54(9): 2251-61. https://doi.org/10.1128/JCM.00730-16 PMid:27335149 PMCid:PMC5005480

Vial C, Pozzetto B, Essid A, Stephan JL, Chabrier S. [Acute encephalitis: report on 32 consecutive pediatric cases observed in one hospital]. Med Mal Infect. 2007; 37(4): 208-14. https://doi.org/10.1016/j.medmal.2007.01.008 PMid:17368784

Le VT, Phan TQ, Do QH, Nguyen BH, Lam QB, Bach V, et al. Viral etiology of encephalitis in children in southern Vietnam: results of a one-year prospective descriptive study. PLoS Negl Trop Dis. 2010; 4(10): e854. https://doi.org/10.1371/journal.pntd.0000854 PMid:21049060 PMCid:PMC2964288

Solomon T, Dung NM, Kneen R, Thao le TT, Gainsborough M, Nisalak A, et al. Seizures and raised intracranial pressure in Vietnamese patients with Japanese encephalitis. Brain. 2002; 125(Pt 5): 1084-93. https://doi.org/10.1093/brain/awf116 PMid:11960897

Potula R, Badrinath S, Srinivasan S. Japanese encephalitis in and around Pondicherry, South India: a clinical appraisal and prognostic indicators for the outcome. J Trop Pediatr. 2003; 49(1): 48-53. https://doi.org/10.1093/tropej/49.1.48 PMid:12630721

Fowlkes AL, Honarmand S, Glaser C, Yagi S, Schnurr D, Oberste MS, et al. Enterovirus-associated encephalitis in the California encephalitis project, 1998-2005. J Infect Dis. 2008; 198(11):1685-91. https://doi.org/10.1086/592988 PMid:18959496

Fowler A, Stodberg T, Eriksson M, Wickstrom R. Childhood encephalitis in Sweden: etiology, clinical presentation and outcome. Eur J Paediatr Neurol. 2008; 12(6):484-90. https://doi.org/10.1016/j.ejpn.2007.12.009 PMid:18313340

Xu Y, Zhaori G, Vene S, Shen K, Zhou Y, Magnius LO, et al. Viral etiology of acute childhood encephalitis in Beijing diagnosed by analysis of single samples. Pediatr Infect Dis J. 1996; 15(11):1018-24. https://doi.org/10.1097/00006454-199611000-00017 PMid:8933552

Chokephaibulkit K, Kankirawatana P, Apintanapong S, Pongthapisit V, Yoksan S, Kositanont U, et al. Viral etiologies of encephalitis in Thai children. Pediatr Infect Dis J. 2001; 20(2):216-8. https://doi.org/10.1097/00006454-200102000-00020 PMid:11224846

Flores-Gonzalez JC, Jordan-Garcia I, Turon-Vinas E, Montero-Valladares C, Tellez-Gonzalez C, Fernandez-Carrion F, et al. [Etiology, clinical presentation and outcome of severe viral acute childhood encephalitis (ECOVE study)]. Rev Neurol. 2015; 61(1): 7-13. PMid:26108903

Galanakis E, Tzoufi M, Katragkou A, Nakou I, Roilides E. A prospective multicenter study of childhood encephalitis in Greece. Pediatr Infect Dis J. 2009; 28(8): 740-2. https://doi.org/10.1097/INF.0b013e318199eff9 PMid:19633519

Fodor PA, Levin MJ, Weinberg A, Sandberg E, Sylman J, Tyler KL. Atypical herpes simplex virus encephalitis diagnosed by PCR amplification of viral DNA from CSF. Neurology. 1998; 51(2): 554-9. https://doi.org/10.1212/WNL.51.2.554 PMid:9710034

Weil AA, Glaser CA, Amad Z, Forghani B. Patients with suspected herpes simplex encephalitis: rethinking an initial negative polymerase chain reaction result. Clin Infect Dis. 2002; 34(8): 1154-7. https://doi.org/10.1086/339550 PMid:11915008

Rantala H, Uhari M. Occurrence of childhood encephalitis: a population-based study. Pediatr Infect Dis J. 1989; 8(7):426-30. https://doi.org/10.1097/00006454-198907000-00004 PMid:2755753

Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, et al. Beyond viruses: clinical profiles and etiologies associated with encephalitis. Clin Infect Dis. 2006; 43(12):1565-77. https://doi.org/10.1086/509330 PMid:17109290

Wang IJ, Lee PI, Huang LM, Chen CJ, Chen CL, Lee WT. The correlation between neurological evaluations and neurological outcome in acute encephalitis: a hospital-based study. Eur J Paediatr Neurol. 2007; 11(2):63-9. https://doi.org/10.1016/j.ejpn.2006.09.010 PMid:17240177

Granerod J, Tam CC, Crowcroft NS, Davies NW, Borchert M, Thomas SL. Challenge of the unknown. A systematic review of acute encephalitis in non-outbreak situations. Neurology. 2010; 75(10): 924-32. https://doi.org/10.1212/WNL.0b013e3181f11d65 PMid:20820004

Rautonen J, Koskiniemi M, Vaheri A. Prognostic factors in childhood acute encephalitis. Pediatr Infect Dis J. 1991; 10(6):441-6. https://doi.org/10.1097/00006454-199106000-00005 PMid:1906597

How to Cite
Meligy B, Kadry D, Draz IH, Marzouk H, El Baroudy NR, El Rifay AS. Epidemiological Profile of Acute Viral Encephalitis in a Sample of Egyptian Children. Open Access Maced J Med Sci [Internet]. 2018Feb.14 [cited 2020Dec.2];6(2):423-9. Available from: https://www.id-press.eu/mjms/article/view/oamjms.2018.103
E - Public Health

Most read articles by the same author(s)