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the impact of infectious diseases

Acute viral encephalitis in children

Encephalitis is an underreported disease. Despite being a significant clinical problem among young people in Indonesia, limited diagnostic tools mean that accurate incidence statistics are not available.

A decade ago encephalitis was only seen sporadically
This view has changed since 1999 when West Nile virus first spread to the western hemisphere and, over the next few years, extended throughout the United States and Canada. As of November 7, 2006, there had been 3,830 confirmed cases in the United States, 1,339 of which were neuroinvasive, with 119 deaths. Between December 2007 and July 2008 there were 36 encephalitis cases in the pediatric intensive care unit of Cipto Mangunkusumo University Hospital, Jakarta, Indonesia. The average age of the patients was 18.5 months and the mortality rate 22%.

More antiviral agents are urgently needed for accurate virological diagnoses. However, even under the best of diagnostic circumstances, significant percentages of acute encephalitis have remained undiagnosed. Correlating specific aetiology with the clinical signs and course of the disease is important in the early management of encephalitis. Identification of the specific agent is also important for epidemiologic and public health reasons. Etiologic diagnosis of acute viral encephalitis in Indonesia so far has been very limited. One case of enterovirus 71 has been reported from the 15 suspected cases in Jakarta this year.

The acute therapeutic management of encephalitis usually entails cardiopulmonary stabilization, the reduction of raised intracranial pressure and the control of seizures. Recently, several studies have been carried out on secondary neural damage in the field of traumatic brain injury and strokes. The mechanisms of secondary neural damage in acute viral encephalitis have never been elucidated. Understanding the mechanisms of pathophysiological process in acute viral encephalitis may open a new era of therapeutic management and reduce the impact of the disease.

Between 10 and 20% of the children who survive bacterial meningitis have severe or mild sequelae. The most common severe sequelae are hearing impairment, neuromotor disabilities (spasticity, for example) and mental retardation. Among the more subtle sequelae are cognitive impairment, academic and/or behavioral disabilities and minor neuromotor disorders. Very little is known about the sequelae of children in Indonesia who have survived from acute viral encephalitis.

This study will elaborate on the etiologic cause, pathophysiological process, clinical pictures and long-term consequences of children with acute viral encephalitis with a prospective cohort design.

A.M. van Furth, MD, PhD VU Medisch Centrum –Vumc, Vrije Universiteit Amsterdam/Professor Pratiwi Pujilestari Sudarmono, M.D., PhD. Faculty of Medicine, University of Indonesia/Beti Ernawati Dewi, M.Sc. PhD. Department of Microbiology, Faculty of Medicine, University of Indonesia/B.B. Martina, PhD. Erasmus MC, dept. virology/Prof. Dr. A.D.M.E. Osterhaus. Erasmus MC, dept. virology/Antonius H. Pudjiadi, M.D. Department of Child Health, Faculty of Medicine, University of Indonesia/Dwi Putro Widodo, M.D. Department of Child Health, Faculty of Medicine, University of Indonesia/Irawan Mangunatmadja, M.D. Department of Child Health, Faculty of Medicine, University of Indonesia/J.F.P. Wagenaar, M.D. Slotervaart Hospital/E.C.M. van Gorp, M.D. PhD Slotervaart Teaching Hospital and Erasmus MC, dept. virology