Comparison of Viral and Non-Viral Acute Encephalitis Syndrome in Children: Etiological Profile and Clinical Outcomes

Abstract

Background: Acute encephalitis syndrome (AES) in children comprises a heterogeneous group of infectious neurological disorders with considerable morbidity and mortality. Differentiating viral from non-viral AES may facilitate etiological evaluation and appropriate management.

Methods: This prospective cross-sectional study included 143 children aged 6 months to <12 years admitted with AES to the Paediatric Intensive Care Unit of Mahaveer Institute of Medical Sciences. Patients underwent detailed clinical evaluation and laboratory investigations, including cerebrospinal fluid analysis. Cases were categorized as viral or non-viral AES based on CSF characteristics and etiological assessment.

Results: Of 143 children, 80 (55.9%) had viral AES and 63 (44.1%) had non-viral AES. Viral AES was predominantly associated with rash, extrapyramidal manifestations, decreased total leukocyte count, and thrombocytopenia, whereas vomiting, undernutrition, meningeal signs, cranial nerve palsy, increased leukocyte count, and hyponatremia were more prominent in non-viral AES. Inotropic support was required in 67 (46.9%) patients and ventilatory support in 44 (30.8%). Overall, 28 (19.6%) children died. Dengue was the leading identified viral etiology, while pyogenic and tubercular meningitis were important non-viral causes.

Conclusion: Viral AES constituted the larger etiological group. Viral and non-viral AES demonstrated differing clinical and laboratory patterns, while substantial mortality was observed across the overall AES cohort. Early etiological evaluation and recognition of characteristic clinical patterns may support timely management.