Review articleTropical febrile encephalopathy
Section snippets
INTRODUCTION
Infections are the biggest cause of morbidity and mortality, within the tropics. Thickly populated and overcrowded areas, cause increased risk of respiratory and gastrointestinal infections. Malnutrition, on the other hand, can cause impaired defense against infections. Many countries in the tropics, have less developed physical infrastructure; some parasitic infestations tend to occur specifically in a tropical climate. Parasites have a life cycle, that will be interrupted, should the ambient
Mechanisms and pathophysiology
Encephalopathy is a diffuse disease of the brain that alters its structure or function. It may be caused by a variety of infective, metabolic, toxic, ischemic–hypoxic, nutritional causes or trauma [4]. In febrile illnesses, encephalopathy may result from pathogenic mechanisms affecting the nervous system directly or because of systemic complications like hypoglycemia, hypovolemia, hyperpyrexia, hypoxia, anaemia, hepatic insufficiency, renal injury and bleeding contributing individually and in
Investigations
The standard tests for febrile encephalopathy are fourfold:
- 1.
Blood counts and tests to identify the presence of organisms- bacteria, virus, parasite, rickettsia, fungi. Cultures, Serology −Immunologic (Antigen/antibody detection), DNA detection by PCR/RNA detection by RT PCR. The battery of tests available, is to be interpreted properly, at several different phases of the illness.
- 2.
Cerebro spinal fluid examination, biochemical, microbiologic and serologic aspects.
- 3.
Imaging. Brain CT scan/MRI can now
Clinical approach
A properly conducted clinical examination, linked with a methodical history and evolution of illness, in conjunction with available laboratory/imaging reports, can throw sufficient light on the diagnosis, for treatment to be initiated, by a clinician with a reasonable exposure. Yet over and above initial measures, to control high fever, maintaining hydration, cardiorespiratory support to maintain/improve vital parameters/function, empirical treatment in early stages, may be called for as
Conflict of interest
The authors have none to declare.
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