Acute Febrile Encephalopathy in Adults; a Review of 3 Prospective Trials

Document Type : Review Article


Patient Safety Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: Acute Febrile Encephalopathy (AFE) is a heterogeneous clinical syndrome that refers to fever associated or followed by mental deterioration with or without other neurologic manifestations, including seizure and sensory motor deficits. The emergency nature of AFE necessitates high levels of knowledge and skill for the physician to provide correct diagnostic plan(s) among a wide range of etiologies. Fever accompanying shortens the list of differential diagnosis to mainly infectious agents.
Materials and Methods: Based on a digital search in Pubmed looking for the terms mental alteration, fever, adult, elderly and topical countries, and infectious diseases, three prospective trials which met the inclusive criteria were selected and reviewed.
Results:A total of 430 adult and elderly patients with a mean age of 30 years old admitted to different hospitals of India and diagnosed with AFE were investigated for the most common causes of AFE and other clinical outcomes. In this review, primary CNS infections including pyogenic meningitis (PM) and viral encephalitis various in the most common viral agent in different studies were the main causes responsible for AFE in adults, followed by sepsis associated encephalopathy (SAE) and cerebral malaria (CM). Poor prognostic and protective factors were listed based on the findings and by considering other studies. Viral encephalitis is associated with the most mortality rate and physical disabling, compared to other etiologies.
Conclusion: Primary CNS infections including bacterial meningitis and viral meningoencephalitis account for the most causes of AFE in adult and elderly patients with the most fatality for viral agents.