病因不明的急性脑炎综合征-一个病例系列

Ancy Jenilet Rajendran, Preethi Tamilarasan, A. Arunagirinathan
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摘要

急性脑炎综合征(AES)是危及生命的重要症状之一,病死率为12.6%。印度最常见的病因是病毒性脑炎。然而,一种新出现但可治疗的病因是丛林斑疹伤寒,它在印度许多地区流行,包括泰米尔纳德邦和普杜切里。它是一种媒介传播的疾病,有无数的表现,其中之一是AES。这是2022年前6个月记录的四个此类病例的系列病例。所有患者均有发热、感觉改变等症状,无癫痫发作。检查发现全身淋巴结病变,肝脾肿大,中枢神经系统异常。经过彻底的检查,发现所有病例都有典型的焦痂。根据检查结果,所有患者均开始口服强力霉素并给予支持治疗,等待结果,结果后来显示为擦洗ELISA阳性。48 h后,由于退热不足和感觉改善,2例患者加用静脉阿奇霉素,另外2例患者改用口服强力霉素注射。所有患者均痊愈,无并发症和后遗症。早期识别和开始使用适当的抗生素对于取得积极结果至关重要。在流行地区,应彻底检查发生AES的儿童是否有恙虫病的迹象,包括焦痂。在我们的患者中,发现肠外注射强力霉素或阿奇霉素在解决发烧和神经异常方面比口服强力霉素更有效。如果怀疑AES是由恙虫病引起的,肠外治疗可能优于口服治疗。
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Acute encephalitis syndrome with the cause hidden in plain sight – A case series
Acute encephalitis syndrome (AES) is one of the important life-threatening presentations in children with a case fatality rate of 12.6%. The most common etiology in India is viral encephalitis. However, one of the emerging yet treatable causes is scrub typhus, which is endemic in many parts of India including Tamil Nadu and Puducherry. It is a vector borne disease which has myriad presentations, one among those being AES. This is a case series of four such cases noted over the first 6 months of 2022. All the patients presented with symptoms of fever and alteration of sensorium without any seizures. Examination revealed generalized lymphadenopathy, hepatosplenomegaly, and abnormal central nervous system findings. A thorough examination revealed the classical eschar in all the cases. Based on the examination findings, oral doxycycline was started in all the patients along with supportive treatment while awaiting results, which later revealed to be scrub ELISA positive. After 48 h, due to inadequate defervescence and improvement in sensorium, IV azithromycin was added in two patients and oral doxycycline was changed to injectable in other two patients. All of them recovered without any complications or sequelae. Early identification and initiation of appropriate antibiotics are essential for a positive outcome. In endemic areas, children with AES should be thoroughly examined for signs of scrub typhus including eschar. In our patients, parenteral doxycycline or azithromycin was found to be more effective than oral doxycycline in resolution of fever and neurological abnormalities. If AES is suspected to be due to scrub typhus, parenteral therapy may be preferred over oral.
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