Background and Aims Encephalitis is a relatively rare but potentially devastating condition1. Our study investigated the presentation and management of children with encephalitis presenting to a tertiary UK hospital.
Methods Cases of encephalitis presenting during 2001 – 2009 were identified using clinical coding records and a clinical database maintained by the paediatric infectious diseases team. Inclusion criteria were children between the ages of 3 months to 16 years who presented with an acute encephalopathy. A retrospective case notes review was performed and management compared to local infectious disease guidelines for children with an unexplained acute encephalopathy.
Results 71 cases were identified and notes were found in 58 cases. 29 cases met the study criteria.
The commonest presenting features were confusion (86%), fever (69%), seizures (62%) and headache (60% in those aged over 5 years).
Microbiological and metabolic workup was inconsistent in relation to the local hospital guidelines. In particular exclusion of metabolic causes of acute encephalopathy was fully undertaken in only 28% of children. Confirmed or probable infectious aetiologies were identified in 21 cases (72%) with HSV (17%), VZV (10%) and EBV (7%) being the most commonly identified pathogens. Other final diagnoses included Acute Disseminated Encephalomyelitis (14%).
With regards to treatment, 97% of children were started empirically on aciclovir although 43% were prescribed half or less of the recommended dose for encephalitis. Anti-microbial use was also inconsistent between cases: ceftriaxone was started in 76%, azithromycin in 34% and amoxicillin in 12%.
Conclusion The initial investigation and management of children with an acute encephalopathy who are subsequently diagnosed with encephalitis did not fully follow the guideline in 76% of cases. The most important finding was the high incidence of inadequate aciclovir dosing in the empirical treatment of children with suspected encephalitis. Recently published guidance highlights the importance of a full clinical, microbiological and metabolic work up and emphasises the correct aciclovir dose1. Although encephalitis is an uncommon condition, awareness of its management is vital to prevent the high morbidity associated with the disease.
Thompson C, Kneen R, Riordan A, Kelly D, Pollard AJ. Encephalitis in children. Arch Dis Child. 2012 Feb; 97(2):150–61.