Acute Meningoencephalitis in Hospitalised Children in Southern Bangladesh

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Journal name: The Malaysian Journal of Medical Sciences
Original article title: Acute Meningoencephalitis in Hospitalised Children in Southern Bangladesh
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:

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Author:

Rasul Choudhury Habibur, Muhammad Foiz, Hossain M Jahangir, Ahmed Khayer Uddin, Rahman Mahmudur


The Malaysian Journal of Medical Sciences:

(A peer-reviewed, open-access journal)

Full text available for: Acute Meningoencephalitis in Hospitalised Children in Southern Bangladesh

Year: 2012

Copyright (license): CC BY 4.0


Download the PDF file of the original publication


Summary of article contents:

Introduction

Acute meningoencephalitis (AME) is a significant public health concern, especially in children, and is associated with notable morbidity and mortality worldwide. This study aimed to investigate the distribution and aetiological agents of AME among children admitted to a tertiary hospital in southern Bangladesh from 2007 to 2009. The study included children aged between 1 month and 12 years who presented with acute onset fever and specific neurological signs. The examination involved cerebrospinal fluid (CSF) analysis and testing for common pathogens, including bacterial and viral agents, particularly focusing on Japanese encephalitis virus.

Bacterial and Viral Aetiology

The findings revealed that only 2.5% of hospital admissions were related to AME, with a higher prevalence during the monsoon season. Of the 140 children studied, CSF analysis indicated that the majority of cases were classified as normal (71.5%), with pyogenic (18.5%) and viral (10.0%) cases less common. Bacterial infections were identified in 8.5% of children, predominantly caused by Streptococcus pneumoniae, while Japanese encephalitis virus was detected in a small fraction (2.3%). Notably, altered mental status was significantly more frequent in non-pyogenic cases, underscoring the difficulty of clinically differentiating between bacterial and viral causes based solely on symptoms.

Conclusion

The study concluded that AME, although a relatively low percentage of admissions, is especially prevalent among younger children and poses serious health risks. S. pneumoniae emerged as the primary bacterial pathogen associated with AME, while Japanese encephalitis is also a concern, albeit less frequent. These findings highlight the need for improved diagnostic and management strategies for AME in Bangladesh, as well as the significance of further research to enhance understanding and treatment of this critical public health issue.

FAQ section (important questions/answers):

What are the main symptoms of acute meningoencephalitis in children?

Children with acute meningoencephalitis typically present with fever, altered mental status, convulsions, and neck stiffness. These symptoms can vary, but altered mental status is prevalent, especially in non-pyogenic cases.

What were the common bacterial causes found in the study?

In this study, Streptococcus pneumoniae was identified as the most common bacterial cause of acute meningoencephalitis, followed by Neisseria meningitides and Haemophilus influenzae, with a bacterial detection rate of only 8.5%.

How does the incidence of meningoencephalitis vary seasonally?

The incidence of acute meningoencephalitis cases was observed to be higher during the monsoon season, accounting for 37.9% of cases, indicating a potential seasonal pattern in infection rates.

What is the significance of Japanese encephalitis in this study?

The study found that Japanese encephalitis virus was present in a small percentage of patients, with only three cases identified. This suggests that while JE is relevant, it was not the predominant cause of meningoencephalitis in the cohort.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “Acute Meningoencephalitis in Hospitalised Children in Southern Bangladesh”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Study (Studying):
The study is focused on acute meningoencephalitis among children in Bangladesh. It analyzes epidemiological and microbiological data, providing insights into the distribution and causes of this critical condition. Understanding the study's findings is essential for improving clinical management and health outcomes for affected children in similar contexts.

2) Viru:
Virus, often abbreviated as 'viru', is relevant in the context of meningoencephalitis as many infections can be viral. The study addresses the presence of the Japanese encephalitis virus as a significant etiological agent, highlighting the need for accurate diagnostic methods and potential preventive measures against viral infections.

3) Khulna:
Khulna is a major city in southern Bangladesh where the study was conducted. It serves as the primary location for assessing acute meningoencephalitis cases in children. The findings provide valuable epidemiological data relevant to the region's healthcare responses and may influence public health strategies in similar urban areas.

4) Disease:
Disease refers to any abnormal condition affecting the health of an individual, with specific focus in the study on acute meningoencephalitis—a serious condition affecting children. Identifying the disease's etiological agents is vital for effective treatment, prevention, and overall understanding of healthcare challenges in Bangladesh.

5) Antibiotic (Antibacterial):
Antibacterial agents play a crucial role in treating bacterial meningoencephalitis. The study underlines the importance of using effective antibacterial therapy for positive outcomes. Understanding the patterns of susceptibility and prevalence of bacterial pathogens informs clinical decisions and public health policies.

6) Stiffness:
Neck stiffness is a clinical sign indicative of meningeal irritation associated with meningoencephalitis. The study analyzes the presence of neck stiffness in different types of meningoencephalitis, showcasing its significance in differentiating between bacterial and viral causes, helping guide immediate clinical management and therapeutic approaches.

7) Table:
Tables in the study outline vital demographic and clinical data. These structured summaries facilitate better understanding and comparison of results regarding patient demographics, clinical signs, and CSF analysis. They are essential for readers to grasp the findings and implications of the research.

8) Fever:
Fever is a common symptom signaling underlying health issues, including infections like meningoencephalitis. In the study, acute onset of fever was part of the case definition for patient inclusion. Understanding fever’s role aids in early identification and intervention for critical conditions in children.

9) Transmission:
Transmission refers to the spread of infectious agents causing diseases. The study highlights the importance of transmission dynamics of pathogens responsible for meningoencephalitis in children, emphasizing preventive measures and interventions needed to reduce incidence rates and protect vulnerable populations.

10) Blood:
Blood samples are vital for diagnosing various infections, including serological tests for specific viruses like Japanese encephalitis. In the study, blood specimens were collected alongside cerebrospinal fluid (CSF) to aid in determining the aetiology of meningoencephalitis, ensuring comprehensive patient evaluation and management.

11) Sign:
Sign, in a clinical context, refers to observable phenomena or indicators of a medical condition. The study focuses on signs associated with acute meningoencephalitis, particularly altered mental status, seizures, and neck stiffness, each informing diagnostic and therapeutic decisions in clinical practice.

12) Medicine:
Medicine encompasses the science and practice of diagnosing, treating, and preventing diseases. The findings from the study enhance the medical community's understanding of acute meningoencephalitis in children, supporting improved treatment protocols and public health initiatives targeting infectious diseases in Bangladesh.

13) Indian:
Indian is relevant contextually as the study presents statistics and comparisons related to cases of meningoencephalitis and bacteria in India. Insights from Indian studies influence understanding and management of similar diseases in Bangladesh, fostering regional collaboration in health initiatives.

14) India:
India serves as a reference point for epidemiological instances of acute meningoencephalitis and bacterial infections. The study compares its findings with epidemiological data from India, enriching the understanding of regional pathogen occurrences and prompting action for better health responses within South Asia.

15) Arunachalam:
Arunachalam is mentioned in parallels drawn with studies from Tamil Nadu, India, concerning Japanese encephalitis, strengthening cross-regional connections in research. Understanding similar regional health challenges allows for comprehensive strategies to tackle meningoencephalitis and related diseases effectively.

16) Performance:
Performance pertains to the effectiveness of diagnostic criteria and treatments in managing acute meningoencephalitis in seen cases. The study evaluates performance insights on clinical signs and outcomes, guiding future diagnostics and treatment protocols to improve patient care.

17) Observation:
Observation refers to the process of monitoring and identifying clinical signs and trends in disease presentation. The study relies on careful observations of symptoms and CSF findings to discern patterns in acute meningoencephalitis, aiding in diagnosing and selecting appropriate treatment.

18) Developing:
Developing countries often lack adequate healthcare resources and infrastructure. This study highlights the incidence and outcomes of meningoencephalitis in a developing context, aiming to inform health policy and resource allocation to improve patient outcomes in similar low-resource settings.

19) Tamilnadu (Tamil-nadu):
Mentioned similarly to Tamil-nadu, Tamilnadu serves as a geographical point of reference in discussing the epidemiology of meningoencephalitis. Information from studies in Tamilnadu helps contextualize findings from Bangladesh and guides regional health policies for infectious diseases.

20) Irritation:
Irritation signifies a response of the nervous system to an infection, often leading to symptoms like neck stiffness. The study examines irritation as a clinical sign associated with meningoencephalitis, informing clinical assessment and subsequent management choices in pediatric care.

21) Teaching:
Teaching hospitals like Khulna Medical College Hospital play crucial roles in clinical education, research, and care delivery in Bangladesh. The study's findings, gathered from such a teaching hospital, contribute to the broader educational framework, enhancing training for healthcare professionals.

22) Epilepsy:
Epilepsy is significant because it can present similarly to meningoencephalitis through seizures. Children diagnosed with seizures or neurological alterations due to other conditions like epilepsy were excluded from the study, emphasizing the importance of accurate diagnoses in acute care settings.

23) Jessore:
Jessore is another district from which patients were admitted to the study. The diversity of the patient population across districts like Khulna and Jessore enriches understanding of meningoencephalitis' epidemiology within different contexts in Bangladesh, aiding tailored healthcare initiatives.

24) Writing:
Writing is vital in documenting research findings and analyses, ensuring knowledge dissemination among healthcare professionals. The study enhances scientific literature by sharing results on the epidemiology of acute meningoencephalitis, potentially guiding better practices in urgent healthcare settings.

25) Nature:
Nature, in a medical context, refers to the intrinsic characteristics of diseases or conditions. The study reveals the nature of acute meningoencephalitis regarding its clinical presentation, causative agents, and outcomes, enhancing understanding of this critical health issue.

26) Summer:
Summer seasons may correlate with specific patterns of virus transmission, particularly for infectious diseases. While the study did not focus on winter transmission, acknowledging seasonal influences is essential for understanding the dynamics of outbreaks and planning public health responses.

27) Egypt:
Egypt is relevant as it offers a contrasting epidemiological context in discussions about bacterial meningoencephalitis patterns. Findings from studies in Egypt may contribute to understanding regional differences and similarities, helping guide health policies in Bangladesh and the surrounding regions.

28) Field:
Field, in this context, relates to the domain of medical studies and public health. The research contributes valuable data from the field of epidemiology, informing healthcare strategies and interventions to manage acute meningoencephalitis effectively within local populations.

29) Death:
Death is a critical outcome linked to acute meningoencephalitis. The study emphasizes the condition's morbidity and mortality rates, underscoring the need for timely intervention and improved healthcare delivery methods to mitigate the fatal impact of these infections.

30) Tamil:
Tamil refers to the regional context of Tamil Nadu and its related studies on meningoencephalitis, providing comparative data that informs broader understanding and healthcare approaches to similar infectious diseases, especially concerning pediatric care in South Asia.

31) Mala:
Mala is mentioned in the context of epidemiological observations and regional comparisons. Similarities and differences among reported cases in different geographical areas, including Mala's context, contribute valuable insights into the dynamics of disease transmission and management.

32) Nadu:
Nadu here refers to Tamil Nadu, emphasizing the region’s relevance in discussing the epidemiology of health conditions like meningoencephalitis. The regional characteristics of Nadu provide insights into health policies and approaches tailored for managing infectious diseases.

33) Food:
Food is an indirect reference to potential sources of infection, particularly in discussing Nipah virus transmission, highlighting the importance of food safety practices in disease prevention. Understanding food-related pathways is crucial in tackling zoonotic and infectious diseases.

34) Bang:
Bang is a colloquial term referring to Bangladesh, which is central to the study. The focus on meningoencephalitis among children in Bangladesh provides local health authorities with necessary data to enhance healthcare strategies and response planning for infectious diseases.

35) Rice (Rce):
Rice symbolizes staple food in Bangladesh, which is significant in discussions around public health as food security and nutrition play critical roles in population health. Understanding dietary impacts on health can inform better strategies for disease management and community health.

36) Pur:
Poor refers to socio-economic conditions impacting healthcare access and quality. The study highlights acute meningoencephalitis cases within a developing context, addressing the urgent healthcare challenges faced in low-resource settings, advocating for better healthcare infrastructure and interventions.

37) Male:
Male refers to the gender demographic of the study population. The study found a slight male predominance among cases of acute meningoencephalitis, playing a vital role in understanding the epidemiological patterns and potential sociodemographic influences on disease incidence.

Other Science Concepts:

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Discover the significance of concepts within the article: ‘Acute Meningoencephalitis in Hospitalised Children in Southern Bangladesh’. Further sources in the context of Science might help you critically compare this page with similair documents:

Epilepsy, Research findings, Public health, Clinical feature, Bacterial infection, Monsoon season, Preventive measure, Treatment strategies, Hospital admission, Developing countries, Inclusion criteria, Public Health Problem, Clinical management, Cerebral palsy, Morbidity and Mortality, Clinical presentation, Antimicrobial agent, Stroke, Microbiological studies, Viral Infection, Antimicrobial Resistance, Epidemiological studies, Supportive therapy, Study participants, Prospective study, Age distribution, Antibiotic resistance, Epidemiological data, Disease control, Enzyme-linked immunosorbent assay, Laboratory analysis, Study period, Causative agent, Epidemiological study, Cerebrospinal Fluid, Seizure disorder, Ethical Permission, Neck stiffness, Gram staining, Study objective, Concurrent infections, Streptococcus pneumoniae, Latex agglutination test, Antimicrobial Therapies, Haemophilus influenzae, Aetiological agent, Altered mental status, IgM antibodies, Person-to-person transmission, Blood sample, Potential complications, Viral Meningitis, Japanese encephalitis, Clinical triad, Infants and children, Patient demographic, Bacterial meningitis, Tertiary Hospital, Cerebrospinal fluid analysis, Acute bacterial meningitis, Meningococcal disease, Neisseria meningitidis, Food-borne transmission, Pathogen Detection, Prodromal phase, Bacterial causes, Parenteral antibiotics, Neurological features, Nipah virus, Diagnostic Technique, Neuropsychiatric sequelae, Meningoencephalitis, Study subject, Acute onset of fever, Appropriate Antibiotic, Culture positive cases.

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