ENCEPHALITES AIGUES INFECTIEUSES CHEZ LENFANT, EXPERIENCE DU SERVICE DES MALADIES INFECTIEUSES DE LHOPITAL DENFANT DE RABAT

Acute infectious encephalitis is a rare neurological pathology with a varied etiology and a serious prognosis. The purpose of this work is to report the experience of the pediatric infectious diseases department of the Childrens Hospital of Rabat in the management of this condition in order to identify the clinical, paraclinical, etiological, therapeutic and evolutionary and to determine the prognostic factors. Materials and Methods: This is a retro-prospective monocentric study, conducted from January 2014 to March 2019. Included in the study are children under 15 years of age, hospitalized for acute infectious encephalitis, confirmed or retained on presumption criteria. An operating sheet has been prepared for each file collecting epidemiological, clinical, paraclinical, therapeutic and progressive data and reported in an Excel sheet. Results : 60 cases have been collected. The average age of the patients is 4 years, the sex ratio M/F is 1.14. The onset of symptoms was acute in 77% of patients. The reason for consultation was fever (78%), convulsions (63%) and febrile disturbances of consciousness (13%). On admission, functional signs were dominated by fever (90%), disturbance of consciousness (53%), immediate coma (20% of cases) and convulsions (75%). The clinical examination found signs of deficit (43.33%), meningeal syndrome (20%), gait disturbances (16.6%), aphasia (2 cases), cerebellar syndrome (2 cases) and hypotonia (3 cases). Brain CT was instrumental in the diagnosis of encephalitis (26.4%), brain MRI (70%) and EEG (51%). The CSF analysis was pathological in 46% of the cases with a positive direct examination (1 case) and positive culture at MNO (1 case). PCR on CSF was positive in 25.6% of cases (HSV1: 5cases, EBV: 1 case, TB: 4cases). The etiology found was viral (50 cases: unknown germ (42 cases), HSV1 (5 cases), chickenpox (1 case), mumps virus (1 case), EBV (1 case)) and bacterial (10 cases: unknown germ (2 cases), MNO (2 cases), PNO (1 case) BK (5 cases)). Treatment was based on the etiology. Corticotherapy was recommended for 25 children and anticonvulsant treatment in all cases. Discussion: Despite its mono-centric nature and its time limitation, this series highlight the severity of acute infectious encephalitis in children. Viral encephalitis is the most common including herpetic encephalitis. The diagnostic difficulties are significant due to the routine unavailability of cerebral MRI and PCR in the CSF. However, a probabilistic treatment must be started without delay, the time to have more elements for the etiological orientation. Physicians awareness and the availability of these examinations remain essential for obtaining better results.