AES: Clinical Presentation and Dilemmas in Critical Care Management

Acute encephalitis syndrome (AES) is an epidemiological term used for surveillance of encephalitis. Worldwide, reported incidences of encephalitis range from 6.3 to 7.4 per 100,000 for all ages (adults and children) and approximately 10.5-13.8 per 100,000 children. The most common cause of AES is viral but definitive diagnosis remains elusive in most cases. Gorakhpur and adjoining areas have been witnessing seasonal outbreaks since 1978. Over the past few years, the clinical pattern of the epidemics has changed with patients having multisystem involvement rather than isolated neurological involvement. The percentage of Japanese encephalitis positive cases have also declined and few studies have identified Enteroviruses as a possible cause, but the exact aetiology still remains undetermined. The changing clinical presentations have also posed a challenge towards the optimal management of patients of encephalitis. The management of AES does not end with acute illness, but prolonged neurological deficits are common, needing not only medical but educational and vocational support, and physiotherapy as well. Evidence based guidelines for diagnosis and treatment of these cases is required.