Authors are-: 
Professor Pranab KumarBhattacharya MD ( university of Calcutta) FIC Path(India) 

Professor Department of Pathology ;Murshidabad Medical college, Berhampore Station Road;
 Berhampore Court ; West Bengal ; India , Dr Arindam Naskar , Dr Sumana Mukherjee ; 
Dr Soma Das; Department of Tropical medicine and Department of Pathology ,
 Calcutta School of Tropical Medicine Kolkata-700073 West Bengal and Rupak Bhattacharya, 
Upasana Bhattacharya, Ritwick Bhattacharya ; Dalia Mukherjee; Ayeshi Mukherjee ,
Hindol Banerjee of residence 7/51 Purbapalli Sodepur 24 parganas(north) Kolkata 110 
West Bengal India

Encephalitis refers to inflammation of the brain parenchyma. It is a neurological emergency 

predominantly affecting children less than 15 years in West Bengal of India and is an important
 cause of mortality and morbidity in them. The Term Acute Encephalitis syndrome (AES) was 
coined by WHO in 2006 for facilitating the syndromic approach to surveillance of Encephalitis .
 AES is a serious Public health Problem in India posing a formidable clinical challenge.
 In the last five years more than 53000 cases and approximately 6500 deaths have been reported 
due to AES by National Vector Borne Disease Control program in India [1] . The most common
 Etiologies 
of AES in India are infectious. The history of AES in India paralleled that of Japanese Encephalitis (JE) 
. Following Introduction of JEV vaccination in 2006 the incidence of J E considered to be declined ; 
although the incidence of AES cases has not altered over the years. This suggested that there is 
etiological agents other than JEV as the cause of AES in India. In India ,Out breaks of AES
 involving thousands of cases are reported annually during the post monsoon season. 
While Japanese Encephalitis Virus has been identified as the main etiological agents
 in 5-35% of reported cases, the causative agents of majority of AES in India remains 
unknown and systematic testing for other pathogens is not routinely performed
In India various laboratory tests have been employed to identify pathogens associated

 with AES. The Virus isolation using cell lines, serological tests like ELISA
 ( for detection of antigen and IgM/ IgG antibodies in Serum/ C S F), Molecular tests like 
Polymerase chain reaction ( for detection of Nucleic acid) ; Bacterial culture to identify 
bacterial pathogens and few microscopic staining techniques ( like Gram's stain, ZN stain and
 Giemsa stain)
 . However a combination of molecular and serological assays are considered as gold standard tests.
 Using the gold standard tests etiological diagnosis of AES can be achieved in 85% cases.
 In a pilot study ( not yet published) on Pediatric patients with AES (N-122 patients) 
Specific etiological agents was achieved in 56% cases using a laboratory testing strategy 
of combining molecular and serological assays . Dengue, Chickengunia and J E V were the
 major pathogens identified in that study and treatable causes of AES were identified
 in approximately 10% patients and these AES were by Orienta Tsutsugamushi ( scrub typhus)
 Streptococcus Pneunoniae, Hemophilus influenzae,HSV-1) apart from the pathogens identified
 other pathogens are Nipha Virus mumps virus, other Ricketssia species and salmonella Species
 and that require using of Multiplex PCR Kit Commercially available. Together the laboratory 
strategy when adopted was able to identify an eitiological agent in 62% cases

In India, Nipah Virus affected humans without any involvement of pigs. The first outbreak was 

observed in Siliguri, West Bengal, in 2001. The second incident also emerged in the Nadia district
 in West Bengal in 2007. Scientists have found that humans often contracted the disease by drinking
 raw date palm sap tapped directly from trees, a sweet treat that fruit bats also enjoy. The third
 outbreak is reported in the 2nd week of May 2018 in the southern Indian state of Kerala's Kozhikode 
district, 
which is on high alert as a deadly virus called Nipah virus claimed nine lives. The fast-spreading virus
 Nipah reported has a mortality rate of 70 per cent . Mites also emerges as key vector in 
Acute Encephalities Syndrome in India particularly in Gorahpur of UP , New Delhi ,
 in some pockets of West Bengal and in Bihar affecting children aged 15 years and 
under during the monsoon . Srub typhus is itselfan infectious disease characterised
 by fever, headache, muscle pain, rashes. According to CDC US infected larval mites
 commonly known as “Chiggers” and of Primarily of genus Lepofrombidium can transmit 
the bacterial pathogen of Orienta Tsutsugamushi and treatment of choice remains Doxycycline there.
So the algorithm of all Serum and CSF specimens should be initially evaluated for JEV IgM 

antibodies.
 The JEV IgM negative serum samples are next to be tested for IgM antibodies to Scrub typhus, 
Dengue virus , West Nile Virus; Nipha Virus, ChickenGunia and leptospirosis. And JEV Negative
 CSF samples should be tested by PCR for S pneumoniae, N meningitidies, H influenze 
, Herpis Simplex Virus-1; entetrovirus and Zika virus Nucleic acid in that order of Priority

References 
1] Directorate of national Vector Borne Disease Control Programe- Delhi state wise number

 of AES/JE cases and deaths from 2010-2016 Available from 
http:// nvbdep.gov.in/Doc/je-aes.pdf. accessed on 29/10/2018
No competing interests declared.

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 Aetiology of Acute Encephalitis syndrome in India: the Changing Epidemiology   
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