Infect Dis (Lond). 2025 Nov 17:1-13. doi: 10.1080/23744235.2025.2584143. Online ahead of print.
ABSTRACT
PURPOSE: The northern part of India is hyperendemic for acute encephalitis syndrome (AES) among children. In a significant proportion of AES cases, the causative agent remained unknown. We prospectively investigated the etiologies in pediatric AES (pAES) cases.
METHODS: The pAES cases hospitalized at the tertiary care center from January 2022 to December 2023 were recruited in this study. Serological and molecular investigation was done, using available cerebrospinal fluid/whole blood/serum samples. Sequencing was done for positive samples.
RESULTS: A total of 557 confirmed AES cases were recruited for the study. A comprehensive investigation for infectious cause identified etiologies in 76.1% (424/557) of pAES cases. In non-JE associated AES, viral infections such as cytomegalovirus (CMV) and herpes simplex virus (HSV-1), along with bacterial infections caused by Orientia tsutsugamushi (OT), Rickettsia, and Leptospira, have emerged as the leading causes in the studied region. About 9.7% (45/463) of cases were fatal. Among fatalities, 62.2% were females; 28.9% were positive for OT, 6.8% for JE, and 2.3% for Leptospira. Either mixed viral or viral-bacterial infections were observed in 13.6% of fatalities. No identifiable causative agent was detected in 48.9% (22/45) of cases. The greatest number of deaths occurred in the post-monsoon season.
CONCLUSION: This research highlights a notable change in the profile of pathogens associated with pAES. Further, findings also suggest that the use of more comprehensive PCR panels can provide in-depth identification of etiologies associated with pAES. Finally, these findings could guide policymakers in updating diagnostic and treatment protocols for better management of pAES cases in India.
PMID:41247776 | DOI:10.1080/23744235.2025.2584143
