Need for a diagnostic algorithm for acute encephalitis syndrome: An approach to changing paradigm

Abstract

Introduction: Acute encephalitis syndrome (AES) refers to a symptom complex that may be caused due to a wide range of etiologies. Outbreaks of AES have occurred in the recent past contributing to significant morbidity and mortality. Identification of the etiology of AES will help in early treatment and containment of outbreaks. Objective: To assess the need for a diagnostic algorithm for AES and to develop a prototype algorithm for AES to be used in the region. Materials and Methods: Secondary data regarding AES from the surveillance unit of our institution was used. In addition, focus group discussion with stakeholders involved in the diagnosis, treatment, and surveillance of AES was done to identify the challenges in diagnosis and develop an algorithm for AES to be used in the region. Results and Discussion: Of the 767 AES cases reported during the study period, only 38% had a confirmatory diagnosis. Common viral etiologies included herpes simplex virus and adenovirus. Rare etiologies viz Nipah and West Nile were also documented. The varied etiologies pose challenges in diagnosis as multiple tests are required. A diagnostic algorithm was developed, taking into consideration the facilities available. Challenges in diagnosis are due to infrastructural shortcomings like lack of point-of-care tests and the nonavailability of viral panels for simultaneous testing for pathogens. Conclusion: Region-specific diagnostic algorithm may be developed taking into consideration of the common etiological agents in the region, which will help in the early identification of outbreaks and help in the institution of containment measures.