Abstract
Encephalitis, a severe central nervous system infection, poses significant morbidity
and mortality risks. Etiologically, this condition can arise from infections or immune-mediated
mechanisms, with varying causative agents across regions. Despite limited studies
on pediatric encephalitis in Thailand, our retrospective cohort study aimed to discern
the characteristics, outcomes, and prognostic factors influencing clinical results.
We examined patients under 15 years of age admitted to Maharat Nakhon Ratchasima Hospital
from January 1, 2007 to December 31, 2022, recording baseline data encompassing clinical
manifestations, etiology, investigations, and treatments. The study defined outcomes
in terms of morbidity, subsequent epilepsy incidence, and mortality rates evaluated
via the modified Rankin Scale. Among 183 enrolled patients (age range 5 days to 15
years, mean age 7.4 years), males comprised 54.1%. Viral encephalitis (35.52%) and
immune-mediated encephalitis (22.4%) emerged as the prevailing etiologies, with herpes
simplex, dengue, and influenza virus as prominent viral pathogens. Anti-N-methyl-D-aspartame
receptor encephalitis (56.1%) led among immune-mediated cases. Initially, 94.53% of
patients displayed moderate-to-severe disability, while 45.7% exhibited clinical improvement
within 6 months. Subsequent epilepsy ensued in 38.8% of cases, with an overall mortality
rate of 19%, notably higher in viral encephalitis instances. Our findings underscore
a predilection for viral pathogens in pediatric encephalitis cases, contributing to
inferior prognoses. This study accentuates the necessity of understanding etiological
patterns and prognostic markers to enhance clinical outcomes in this vulnerable population
segment.
Keywords
pediatric encephalitis - etiology - outcome - prognostic factors
