Case Report ISSN (O):2395-2822; ISSN (P):2395-2814 Annals of International Medical and Dental Research, Vol (2), Issue (2) Page 33 Acute Encephalitis Syndrome (AES) as a Cause of Unfortunate Maternal Fetal Demise during the Japanese Encephalitis Epidemic - A Case Report. Shamim Khandaker 1 , Shabana Munshi 2 1 Assistant Professor, North Bengal Medical College, Sushrutanagar, Darjeeling. 2 R.M.O cum clinical tutor, North Bengal Medical College, Sushrutanagar, Darjeeling ABSTRACT Acute encephalitis syndrome (AES) is defined as the acute-onset of fever with change in mental status and often with new onset of seizures. Japanese encephalitis has been considered as the leading cause of AES in India. JE with pregnancy causes diagnostic dilemma especially in 3 rd trimester if the patient presents with convulsion and altered sensorium; as in our case. It is often confused with eclampsia. But careful history and clinical investigation is helpful towards correct diagnosis. Keywords:Pregnancy,Acute encephalitis syndrome, Japanese encephalitis. INTRODUCTION Acute encephalitis syndrome (AES) is defined as the acute-onset of fever with change in mental status and often with new onset of seizures. Japanese encephalitis has been considered as the leading cause of AES in India. We are here reporting an unfortunate case of maternal and fetal demise due to AES during JE epidemic in North Bengal and reviewing the literature regarding maternal fetal outcome in JE. Name & Address of Corresponding Author Dr. Shamim Khandaker, Assistant Professor, Dept of Obstetrics and Gynaecology, North Bengal Medical College, Sushrutanagar, Darjeeling, India E-mail: shamim_khandaker@yahoo.co.in CASE REPORT A 22 years old primigravida was referred to our medical college with history of acute onset fever and convulsion followed by unconsciousness. She had completed 37 weeks of gestation. Her fever was 3-4 days duration and fever was continuous in nature. After she develops convulsion and loses her consciousness, she was taken to the district hospital from where she was referred to our medical college. Her Glasgow coma scale was 5 at the time of admission. Her planter reflex was equivocal and all other reflexes were unresponsive. Her pupil was bilaterally dilated and sluggishly reacting to light. She had no neck rigidity. Her Blood pressure was 120/80, pulse rate was 120/min, respiratory rate was 30/min and temperature was 102 ◦ F. Her urine proteinuria was 1+ and capillary blood glucose was 99mg%. Her haemoglobin was 10gm% and blood group was B+. Her HIV and HBsAg status was negative. Her fatal anomaly scan, which was done at 19 weeks of gestation, was normal. Her P/V finding revealed that she was in latent phase of labour with 2 cm cervical dilatation. Emergency USG of the abdomen was done as there was no fetal heart sound and it was revealed as intrauterine fetal demise. Her blood was collected and sent for anti JE-IgM antibody, which was negative, giving the diagnosis of the acute encephalopathy syndrome (AES). She was managed conservatively with intravenous fluid, infusion mannitol, antipyretic infusion, injection phenytoin, in the high dependency unit. Unfortunately, she died sometime after admission. A post-mortem Caesarean section was performed (PMCS) and a 3.3 kg female fresh stillborn fetus was delivered. There was no meconium stain liquor. Fetal blood was sent for JE-IgM antibody detection, which was negative. DISCUSSION Acute encephalitis syndrome (AES) is defined as the acute-onset of fever with change in mental status (including symptoms such as confusion, disorientation, coma, or inability to talk) and often with new onset of seizures (excluding simple febrile convulsion) in a person of any age at any time of the year. [1] It is a major health problem in the eastern part of India especially in sub- Himalayan region. JE has been considered as the leading cause of AES in India. [1] Other causes of AES are enteroviruses (ENV), Chandipura virus (CHPV), Nipah virus (NiV), Kyasanur forest disease (KFD), West Nile virus (WNV), Herpes simplex virus in the Indian subcontinent on various outbreaks. [2] The main etiological agent is Japanese encephalitis virus (JEV), a positive-sense, single-stranded RNA virus that belongs to the genus Flavivirus, family Flaviviridae (an arthropod-borne virus family) and is closely related to dengue viruses. JE virus is transmitted to humans through the bite of an infected mosquito, primarily Culex species (Culex