Volume-1 Issue-1, 2020
Assessment of Diagnostic Approach and Management of Suspected Encephalitic Patients at Omdurman Teaching Hospital
Mohammed Eltahier Abdalla Omer
Final year medical student, Gadarif University,faculty of medicine and health sciences
Suggested Citation :
Mohammed Eltahier Abdalla Omer, Mohamed Alebeed, Khalid Mohammed Ali (2020) Assessment of Diagnostic Approach and Management of Suspected Encephalitic Patients at Omdurman Teaching Hospital , Tryaksh International Journal of Infection Disease (TIJID), Volume 1 Issue 1: Tryaksh. 1(1): 1-6.
Objectives: The objectives of this study were to assess the approach and management of suspected encephalitis cases in Omdurman Teaching Hospital.
Methods: This study was a descriptive cross-sectional study over 6 months (May to October 2019). The study included 84 patients with suspected encephalitis, selected by convenience sampling. A standardised questionnaire was used to interview patients and the collected data was analysed by SPSS version 27.0.
Results: Themost common presenting symptoms among the study participants were fever and headache (100%), seizures (36.9%) and agitation (28.6%). Neurological examinations showed hemiparesis in 13.1% of patients. Complete blood counts showed lymphocyte predominance in all patients. 65.5% of patients made a full recovery, whereas 26.2% of cases culminated in motor deficit.
Conclusion: The patients’ outcome was poor as below two-thirds of suspected encephalitis cases recovered fully. The NICE criteria for diagnosis had not been adequately followed, as only a minority of patients had undergone CSF and MRI investigations.
Recommendations: Greater adherence to NICE diagnostic criteria must be observed. Documentation of specific reasons is also necessary if neurological imaging is not used. The exact etiology must be identified and targeted antimicrobial treatment must be initiated. If CSF results cannot be obtained in cases of suspected encephalitis, rapid administration of intravenous acyclovir should be included as part of empirical antimicrobial therapy.
Encephalitis, which refers to the diffused inflammation of the brain, is considered as a neurological emergency which can cause permanent brain damage or even death.(1) Encephalitis can be classified according to the underlying cause into three categories: encephalitis which caused by direct infection to the nervous system, post-infectious or para-infectious encephalitis and encephalitis of non-infectious causes.(2) Herpes simplex virus is considered the most common cause of encephalitis.(3)
Presentation of encephalitis is characterized by fever, headache, clouding of consciousness and focal neurological defects.(3) However these symptoms make differentiation between encephalitis and other neurological diseases such as metabolic encephalopathy pretty challenging physicians. Also differentiation between the various underlying etiologies of encephalitis is quite hart.
According to the National Institute for Health and CareExcellence (NICE)(4), every patient presented with altered consciousness or changed behavior should raise the possibility of encephalitis and hence a diagnostic approach for encephalitis should be started. The diagnosis must include cerebrospinal fluid (CSF) investigation for opening pressure ,antigens and antibodies, neurological imaging (MRI) with or without performing an EEG. If neurological imaging is not used, the medical record should include documentation of the specific reasons. If lumbar puncture is contraindicated, CSF analysis should be replaced by computed tomography as soon as possible.
Management of acute encephalitis includes administration of acyclovir during the first six hours of admission even if the CSF investigations are incomplete.(5)
In 2010, the worldwide incidence of encephalitis was estimated to be between 3.5 to 7.4 patients per 100000 per year.(6) Also, an incidence of 103 was reported in 2016.(7) In Sudan, no exact data estimated the statistics of encephalitis, but a World Health Organization report estimated that deaths due to encephalitis in Sudan reached 310 or 0.12% of the total deaths in 2018.(8) Moreover, information about medical personnel practice regarding acute encephalitis management in Sudan hospitals is also lacking. Therefore, we aim in this study to investigate the presentation, diagnosis, management plan and prognosis of patients suspected to have acute encephalitis in Omdurman teaching hospital and compare it with the standard guidelines.
This was a descriptive cross-sectional hospital base study conducted over a period of six months from May to October 2019 in Omdurman TeachingHospital, which is located in Khartoum state the capital of Sudan.
Inclusion criteria: all patients admitted to the neurology department in Omdurman teaching hospital and suspected to have encephalitis.
Exclusion criteria: patients who refused to participate.
Data collection: Clinical history and neurological examination was done for all participants after gathering their consent to assess if they are suspected case of acute encephalitis. All eligible participants werefollowed up during their stay in Omdurman teaching hospital and after refer or discharge. All patients’ investigations, complications and clinical outcome data were collected.
Data analysis: SPSS version 26 was used to manage and describe the data.
Ethical consideration: Ethical approval was obtained from the research committee of Omdurman TeachingHospital. Also, written informed consent was taken from all study participants.
A total of 84 patients have participated in this study. More than 66% of the participants were between 21 – 40 years old, while only 3.6% of them were above 60 years old. Females represented the majority of the cases (84.8%). More than half of the participants (58.3%) were residing in the Khartoum state. More details about demographic data are demonstrated in Table 1.
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