Clinico-etiological profile and prognostic factors of acute febrile encephalopathy in children: a prospective study from Indian subcontinent

Acute febrile encephalopathy (AFE) is a common neurological emergency in all age groups. In tropical regions, long-standing infections such as Japanese encephalitis and bacterial meningitis continue to be major causes of AFE, while changing presentations of familiar infections and newly emerged diseases like COVID-19 are also becoming increasingly notable. To describe various clinical presentations, etiology and mortality of AFE in pediatric age group. This prospective observational study was undertaken in a tertiary care institute of Northern India from April 2022 to April 2023. Children aged 1 month to 18 years presenting to the pediatric emergency department with fever of <2 weeks duration and altered sensorium lasting >24 hours were eligible for inclusion. A total of 100 patients (49% males) with AFE were enrolled. The mean (SD) duration of encephalopathy was 1.39 (0.69) days. The most frequent etiologies were viral encephalitis (17%), dengue encephalopathy (12%), and hepatic encephalopathy (9%). The peak incidence occurred between August and November. The overall case fatality rate was 33%. Under-5 children with severe acute malnutrition (SAM) had the highest fatality rate (56%, 9/16). Among survivors, 16% (11/67) had poor functional outcomes. Higher odds of mortality were observed in patients with a Glasgow coma scale score <8, hypoglycemia at admission, requirement for mechanical ventilation or inotropic support, and presence of multiorgan dysfunction. AFE demonstrates a predictable seasonal pattern and is associated with high mortality and morbidity, particularly in under-5 children with SAM, who represent the most vulnerable group.