Prognosis Related Clinical Feature Of 108 Children With Japanese Encephalitis

Objectives:To analyze the clinical features of children with Japanese encephalitis(JE), evaluate their outcomes, and find out the clinical features which related with the outcome of JE.Methods: 1.Collected and retrospectively analyzed the clinical data of 108 children with JE in Children's Hospital of Chongqing Medical Univer-sity in 2010; 2.The outcomes were graded fromⅠtoⅤwith the Liverpool Outcome Score at least 4 months after discharge from hospi-tal.GradeⅠrepresented death;gradeⅡrepresented severe sequelae, im-pairing function sufficient to make patient dependent;gradeⅢrepresented moderate sequelae mildly affecting function, probably compatible with in-dependent living;gradeⅣrepresented minor sequelae with mild effects on function ,compatible with independent living ;gradeⅤrepresented full re-covery; 3.For the purpose of analyzing,patients with grade I or grade II were considered to have a poor outcome,whereas patients with grades III, IV, and V were considered to have a better outcome,then found out the rela-tionships between the outcome and age,gender,history of JE vaccination, duration of the initial stage, state of consciousness, seizure at-tacks,respiratory failure, upper gastrointestinal bleeding, count of CSF WBC, concentration of CSF protein.Result: All of 108 cases ranged from 2 months to 15 years, with an average 4.25±2.82 years, and patients aged 2~6 years old accounted for most(54.6%). The onset of time was from July to September. Patients from the rural area accouted for 91.7%, and among all 108 patients, only 26 cases had a JE vaccination history.Of the 108 cases, all patients developed fever and disturbance of con-sciousness. Patients with a temperature higher than 39℃accounted for 80.6%.Meanwhile,82(75.9%) patients had at least one seizure attack, 7(6.5%) patients had respiratory failure,24(22.2%) patients had upper gas-trointestinal bleeding.All of 108 cases accepted blood routine examination, count of WBC elevated in 68(63.3%).94 patients accepted lumbar puncture and CSF ex-amination, count of CSF WBC elevated in 60 (63.8%), concentration of CSF protein elevated in 43 (45.7%).The head imaging showing abnormal signal of the area of thalamus and basal ganglia in MRI and CT accounted for 68.9% vs 52.9%, respec-tively. EEG was much more sensitive, withδandθwaves increased in bi-lateral hemisphere in 97.9% of all patients.Of the 72 cases who were successfully followed up, 7(9.7%) died, 4(5.6%) had severe sequelae ,6(8.3%) had moderate sequelae, 13(18.1%) had minor sequelae,42(58.3%) recovered fully. According to our classifica- tion, 11 (15.3%) patients were assigned to a poor-outcome group, 61(84.1%) patients were assigned to a better-outcome group.The analysis showed that duration of the initial stage, state of con-sciousness, seizure attacks,respiratory failure,upper gastrointestinal bleed-ing were related with the outcome.Conclusion:The clinical features of 108 cases were consistent with general clinical features of children with JE.The outcome of the 72 cases who were successfully followed up indicated that the incidence of poor outcome was high(15.3%). The duration of the initial stage, state of con-sciousness, seizure attacks, respiratory failure and upper gastrointestinal bleeding were related with the outcome. Shorter duration of initial stage,deeper consciousness,frequent seizures, having respiratory failure and(or) upper gastrointestinal bleeding usually predicted a poor outcome.