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Acute Encephalitis Syndrome (AES) is a group of Clinical neurologic manifestation caused by wide range of viruses, bacteria, fungus, parasites, spirochetes, chemical and toxins. The most common causes of acute viral encephalitis are Japanese encephalitis virus, West Nile virus (WNV), Eastern equine encephalitis virus (EEEV), Western equine encephalitis virus (WEEV), Venezuelan equine encephalitis virus (VEEV), Hendra virus (HeV), enteroviruses (ENV), Chandipura virus (CHPV), Nipah (NiV), Kyasanur forest disease (KFD), St. Louis encephalitis virus, Herpes simplex, poliovirus and measles virus. AES is reported mainly from Assam, Bihar, Karnataka, Uttar Pradesh and Tamil Nadu which contributes approximately 80% of cases. The case fatality and morbidity is very high. Japanese encephalitis (JE) is considered as a main viral aetiology of patients with AES. Infection with Japanese encephalitis virus may cause febrile illness, meningitis, myelitis or encephalitis, and is clinically indistinguishable from other causes of an acute encephalitis syndrome (AES). In the year 2006, West Nile (WN) virus emerged as another cause of acute encephalitis syndrome in India. Leptospirosis and toxoplasmosis is a zoonotic disease and its severe form can cause AES. The causative agent of the AES varies with season and geographical location. The outbreak of AES and JE usually coincides with the monsoon and post monsoon period when the density of mosquitoes increases. Encephalitis due to entero-viruses occurs throughout the year as it is water borne disease. Most of the times, it may be difficult to differentiate Japanese Encephalitis from those caused by other bacteria and viruses, as clinical signs of JE are indistinguishable from other causes of AES. Under such conditions laboratory confirmation is essential for accurate diagnosis of AES. Specific anti-viral drug for AES including Japanese Encephalitis is not available till date and cases are managed symptomatically and supportive treatment plays major role
Acute encephalitis syndrome (AES) is a constellation of clinical signs and/ or symptoms, i.e. acute fever, with an acute change in mental status and/ or new onset of seizures that signifies acute inflammation of brain cells. Although viruses have been identified as the major etiological agents for this syndrome, a range of pathogens including acute bacterial or parasitic infection have also been attributed. In Asia, the major identified cause of acute encephalitis is Japanese Encephalitis (JE) virus. JE affects over 50,000 people annually, leading to 8- 30% mortality and 50- 60% disability, with children bearing the brunt of the disease. These outbreaks affect over 5,000 people annually in India, most of them being children. Many are left permanently disabled and as many as 700 people die each year. The Eastern region of Uttar Pradesh has been especially hard hit with a recurring outbreak in the rainy season each year, the primary cause of which remains uncertain. Although ICMR research institutions like National Institute of Virology (NIV), Enterovirus Research Centre, Mumbai, Vector Control Research Centre (VCRC), National Institute of Epidemiology (NIE), Centre for Research in Medical Entomology (CRME) etc are engaged in research activities dealing with various aspects of the disease, but have achieved limited success in identifying the aetiological agents. Therefore, there is a need to define research priorities in India to conduct focussed research that identifies the etiological agents for better management and treatment of AES cases to help reduce the morbidity as well as mortality associated with AES.
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© Udit Kulshrestha 20XVIII