Etiology, Clinical Profiles, and Outcomes of Acute Encephalitis Syndrome Cases Admitted to a Tertiary Care Center in Myanmar in 2023

• Published in: Diagnostics (Basel) Vol. 14; no. 19; p. 2248
• Main Authors: Kyaw, Aung Kyaw, Ohnmar, Win, Zin Nwe, Win, Sai Kyaw, Shwe, Zarni Myint, Show, Kyaw Lwin, Oo, Nan Aye Thida, Win, Mya Thandar, Aung, Khin Zarchi, Naing, Win Pa Pa, Lay, Phyu Phyu, Thu, Hlaing Myat, Htun, Zaw Than
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 09.10.2024; MDPI
• Subjects: Autoimmune diseases; Bacterial infections; Chicken pox; Disease prevention; E coli; Encephalitis; Epilepsy; Etiology; Herpes viruses; Hospitals; Immunocompetence; Infectious diseases; Kidney diseases; Laboratories; Listeria; Medical imaging; Medical research; Meningitis; Microorganisms; Mortality; Neuroimaging; Pathogens; Ribonucleic acid; RNA; Streptococcus infections; Tuberculosis; Germany; Myanmar (Burma)
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics14192248

Background/Objectives: The diagnosis of encephalitis is a challenging problem due to the heterogeneity of clinical presentations. The objective was to determine the etiology, clinical features, laboratory parameters, radiological findings, and in-hospital outcome of acute encephalitis syndrome (AES) cases in Myanmar. Methods: A prospective descriptive study was conducted at the Neuromedical Ward of Yangon General Hospital from March to August 2023. Eighty-one AES cases were enrolled, and cerebrospinal fluid (CSF) samples were collected. A Qiastat ME Panel was used to detect viral, bacterial, and fungal pathogens. Results: Seventeen out of eighty-one (21%) cases were non-encephalitis with alternative definite diagnosis. Among the remaining 64 encephalitis cases, the exact infectious and immune etiologies were identified in 31 of 64 cases (48.4%); 26 of these (83.9%) were due to infectious causes and 5 (16.1%) were immune encephalitis. Among the infectious causes, six Herpes Simplex Virus-1-, one bacteriologically confirmed and seven probable Mycobacterium tuberculosis-, three Haemophilus influenzae-, two Streptococcus pneumoniae-, one Streptococcus pyogenes-, one Varicella-Zoster Virus (Ramsay Hunt Syndrome with meningoencephalitis)-, and two Cryptococcus neoformans-infected patients and rare causes such as Listeria monocytogenes, Burkholdelria cepacia, Sphingomonas paucimobilis, and Aspergillus were identified. One case was a dual infection with Haemophilus influenzae and Cryptococcus neformans. Abnormal protein levels and CSF pleocytosis were significantly higher among bacterial causes (p < 0.05). In total, 6.45% (2/31) of encephalitis patients with identified causes and 12.12% (4/33) of those without an identified organism had poor outcome. Conclusions: Herpes encephalitis and tuberculous meningoencepalitis were the commonest. This study highlighted that molecular testing with a multidisciplinary approach is required to ensure the right treatment on time.