Prevalence of Neuroleptospirosis in Pediatric Acute Encephalitis Syndrome Cases: An Experience of Northern India Tertiary Care Centre

Abstract

Background: Acute encephalitis syndrome (AES) is a serious public health problem in Northern India.
Neuroleptospirosis presenting as AES is well documented, so this study was planned to know the
contribution of Neuroleptospirosis in AES, in children. Another gap in leptospirosis research is lack of
studies on confirmed cases in children.
Aims: The aim of this study was to look for contribution of Neuroleptospirosis in Pediatric AES
patients, in this part of the country.
Method: All children with AES-like presentations were included. Detailed history, clinical examination
and appropriate lab investigations were done, to look for the cause of illness. For diagnosis of
Leptospirosis, IgM, polymerase chain reaction (PCR), and Microscopic Agglutination Test (MAT)
Leptospira was done.
Results: Among 100 AES children, 3 were diagnosed as neuroleptospirosis, the rest were 16 Scrub
typhus meningoencephalitis, 20 Japanese, 14 dengue, 2 herpes, and 1 case of chikungunya encephalitis.
44 cases remain undifferentiated. Mean age at presentation for non-leptospirosis AES (NLAES)
and Neuroleptospirosis was 75.4 & 96 months, 43% of NLAES were between 2-5 years while all
neuroleptospirosis cases were older (> 8 years age). All neuroleptospirosis cases were, from a rural
background, presented in rainy / post rainy season and fulfilled Modified Faine’s criteria. Better
Glasgow coma scale score, absence of seizure & focal neurological deficit, hypertonia among clinical
findings, and high serum bilirubin, liver enzymes, and creatinine were other important observations,
though only high serum bilirubin was statistically significant.
Conclusions: Neuroleptospirosis is uncommon but important treatable etiology for AES in children
and should always be considered in differential while evaluating a child with AES.