Factors associated with outcome of acute encephalitis in children: a retrospective study of three referral hospitals

  • Lucyana Alim Santoso Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Dwi Putro Widodo Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Zakiudin Munasir Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Keywords: child, encephalitis, risk factors, seizures


BACKGROUND Encephalitis is more frequent in children and has a poor outcome. There was no data on encephalitis in children in Indonesia, so this study was aimed to evaluate clinical presentation and diagnostic examination of children with acute encephalitis, and factors related to outcome.

METHODS This was a retrospective study of medical records between 2014 and 2018 in three referral hospitals in Jakarta and Tangerang. Clinical presentation at admission, cerebrospinal fluid analysis, neuroimaging, and electroencephalography (EEG) were documented. Outcome was determined at hospital discharge and classified as poor for severe neurological abnormalities at discharge or died. Logistic regression was used to evaluate associated factors with the outcome.

RESULTS A total of 190 children were included and most were age >1 year (71%). Most subjects presented with fever (90%) and seizures (87%). Of those who had seizures, 80% experienced generalized seizures. Focal neurological deficit was seen in 90 patients (47%). EEG was positive in 90% subjects (n = 27/30). Probable cases were found in 51% of all subjects. The mortality was 23%. Focal seizures (odds ratio [OR] = 3.305, 95% confidence interval [CI] = 1.122–9.742) and age >1 year (OR = 3.076, 95% CI = 1.388–6.803) were risk factors for a poor outcome.

CONCLUSIONS Acute encephalitis occurred most often in children aged >1 year. Fever and seizures were the most common symptoms. EEG was better than other examinations for confirming diagnosis of encephalitis. Focal seizures and age >1 year were associated with a three-fold increased risk for a poor outcome.


Falchek SJ. Encephalitis in the pediatric population. Pediatr Rev. 2012;33(3):122-33. https://doi.org/10.1542/pir.33-3-122

Messacar K, Fischer M, Dominguez SR, Tyler KL, Abzug MJ. Encephalitis in US children. Infect Dis Clin North Am. 2018;32(1):145-62. https://doi.org/10.1016/j.idc.2017.10.007

Chokephaibulkit K, Kankirawatana P, Apintanapong S, Pongthapisit V, Yoksan S, Kositanont U, et al. Viral etiologies of encephalitis in Thai children. Pediatr Infect Dis J. 2001;20(2):216-8. https://doi.org/10.1097/00006454-200102000-00020

Xu Y, Zhaori G, Vene S, Shen K, Zhou Y, Magnius LO, et al. Viral etiology of acute childhood encephalitis in Beijing diagnosed by analysis of single samples. Pediatr Infect Dis J. 1996;15(11):1018-24. https://doi.org/10.1097/00006454-199611000-00017

Klein SK, Hom DL, Anderson MR, Latrizza AT, Toltzis P. Predictive factors of short-term neurologic outcome in children with encephalitis. Pediatr Neurol. 1994;11(4):308-12. https://doi.org/10.1016/0887-8994(94)90007-8

Ai J, Xie Z, Liu G, Chen Z, Yang Y, Li Y, et al. Etiology and prognosis of acute viral encephalitis and meningitis in Chinese children: a multicentre prospective study. BMC Infect Dis. 2017;17(1):494. https://doi.org/10.1186/s12879-017-2572-9

Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar J, Bitnun A, et al. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis. 2013;57(8):1114-28. https://doi.org/10.1093/cid/cit458

Fowler A, Stödberg T, Eriksson M, Wickström R. Childhood encephalitis in Sweden: etiology, clinical presentation and outcome. Eur J Paediatr Neurol. 2008;12(6):484–90.

Fowler A, Stödberg T, Eriksson M, Wickström R. Long-term outcomes of acute encephalitis in childhood. Pediatrics. 2010;126(4):e828–35.

Rao S, Elkon B, Flett KB, Moss AF, Bernard TJ, Stroud B, et al. Long-term outcomes and risk factors associated with acute encephalitis in children. J Pediatric Infect Dis Soc. 2017;6(1):20-7. https://doi.org/10.1093/jpids/piv075

Khandaker G, Jung J, Britton PN, King C, Yin JK, Jones CA. Long-term outcomes of infective encephalitis in children: a systematic review and meta-analysis. Dev Med Child Neurol. 2016;58(11):1108-15. https://doi.org/10.1111/dmcn.13197

Michaeli O, Kassis I, Shachor-Meyouhas Y, Shahar E, Ravid S. Long-term motor and cognitive outcome of acute encephalitis. Pediatrics. 2014;133(3):e546-52. https://doi.org/10.1542/peds.2013-3010

Sasaki J, Chegondi M, Raszynski A, Totapally BR. Outcome of children with acute encephalitis and refractory status epilepticus. J Child Neurol. 2014;29(12):1638-44. https://doi.org/10.1177/0883073813513069

Wang IJ, Lee PI, Huang LM, Chen CJ, Chen CL, Lee WT. The correlation between neurological evaluations and neurological outcome in acute encephalitis: a hospital-based study. Eur J Paediatr Neurol. 2007;11(12):63-9. https://doi.org/10.1016/j.ejpn.2006.09.010

DuBray K, Anglemyer A, LaBeaud AD, Flori H, Bloch K, Joaquin KS, et al. Epidemiology, outcomes, and predictors of recovery in childhood encephalitis: a hospital-based study. Pediatr Infect Dis J. 2013;32(8):839-44. https://doi.org/10.1097/INF.0b013e318290614f

Lee WT, Yu TW, Chang WC, Shau WY. Risk factors for postencephalitic epilepsy in children: a hospital-based study in Taiwan. Eur J Paediatr Neurol. 2007;11(5):302-9. https://doi.org/10.1016/j.ejpn.2007.02.011

Rautonen J, Koskiniemi M, Vaheri A. Prognostic factors in childhood acute encephalitis. Pediatr Infect Dis J. 1991;10(6):441-6. https://doi.org/10.1097/00006454-199106000-00005

Misra UK, Kalita J. Seizures in encephalitis: predictors and outcome. Seizure. 2009;18(8):583-7. https://doi.org/10.1016/j.seizure.2009.06.003

Caruso JM, Tung GA, Gascon GG, Rogg J, Davis L, Brown WD. Persistent preceding focal neurologic deficits in children with chronic Epstein-Barr virus encephalitis. J Child Neurol. 2000;15(12):791-6. https://doi.org/10.1177/088307380001501204

Pillai SC, Hacohen Y, Tantsis E, Prelog K, Merheb V, Kesson A, et al. Infectious and autoantibody-associated encephalitis: clinical features and long-term outcome. Pediatrics. 2015;135(4):e974-84. https://doi.org/10.1542/peds.2014-2702

Kolski H, Ford-Jones EL, Richardson S, Petric M, Nelson S, Jamieson F, et al. Etiology of acute childhood encephalitis at The Hospital for Sick Children, Toronto, 1994-1995. Clin Infect Dis. 1998;26(2):398-409. https://doi.org/10.1086/516301

Rismanchi N, Gold JJ, Sattar S, Glaser C, Sheriff H, Proudfoot J, et al. Neurological outcomes after presumed childhood encephalitis. Pediatr Neurol. 2015;53:200-6. https://doi.org/10.1016/j.pediatrneurol.2015.05.017

Bykowski J, Kruk P, Gold JJ, Glaser CA, Sheriff H, Crawford JR. Acute pediatric encephalitis neuroimaging: single-institution series as part of the California encephalitis project. Pediatr Neurol. 2015;52(6):606-14. https://doi.org/10.1016/j.pediatrneurol.2015.02.024

Le VT, Phan TQ, Do QH, Nguyen BH, Lam QB, Bach V, et al. Viral etiology of encephalitis in children in southern Vietnam: results of a one-year prospective descriptive study. PLoS Negl Trop Dis. 2010;4(10):e854. https://doi.org/10.1371/journal.pntd.0000854

George BP, Schneider EB, Venkatesan A. Encephalitis hospitalization rates and inpatient mortality in the United States, 2000-2010. PLoS One. 2014;9(9):e104169. https://doi.org/10.1371/journal.pone.0104169

Bagdure D, Custer JW, Rao S, Messacar K, Dominguez S, Beam BW, et al. Hospitalized children with encephalitis in the United States: apediatric health information system database study. Pediatr Neurol. 2016;61:58-62. https://doi.org/10.1016/j.pediatrneurol.2016.04.014

Oba C, Kashiwagi M, Tanabe T, Nomura S, Ogino M, Matsuda T, et al. Prognostic factors in the early phase of acute encephalopathy. Pediatr Int. 2018;60(3):270-5. https://doi.org/10.1111/ped.13492

Daxboeck F, Blacky A, Seidl R, Krause R, Assadian O. Diagnosis, treatment, and prognosis of Mycoplasma pneumoniae childhood encephalitis: systematic review of 58 cases. J Child Neurol. 2004;19(11):865-71. https://doi.org/10.1177/08830738040190110401

Ilias A, Galanakis E, Raissaki M, Kalmanti M. Childhood encephalitis in Crete, Greece. J Child Neurol. 2006;21(10):910-2. https://doi.org/10.1177/08830738060210101701

How to Cite
Santoso LA, Widodo DP, Munasir Z. Factors associated with outcome of acute encephalitis in children: a retrospective study of three referral hospitals. Med J Indones [Internet]. 2020Jul.1 [cited 2024Feb.25];29(2):154-63. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/3651
Clinical Research