Background

Clinical diagnosis of encephalitis is often difficult in children. In many infants, the only presentation of encephalitis can be irritability and excessive cry.  With few exceptions, no specific therapy is available for most forms of viral encephalitis. Mortality and morbidity may be high and long-term sequelae are known among survivors. This propels treating physicians to be aggressive in laboratory and neuroradiology investigations and institution of management. Hypocalcemia is a treatable close differential of excessive cry in infants. In this study, we estimated the proportion of hypocalcemia cases wrongly suspected of encephalitis on initial evaluation.

Methods

A retrospective clinical audit was performed, of all encephalitis presentations below 1 year of age between 1 July 2015 and 30 June 2018 to the tertiary care pediatric specialty hospital in Northern India. Case notes were examined for evidence of relevant history taking, clinical features, physical examination, laboratory investigations, neuroradiology investigations, and outcomes.

Results

A total of 44 cases were included in the case series. Overall hypocalcemia was documented in 23 patients (52.3%) who were suspected of encephalitis. 21 patients (47.7%) had seizures and 14 (66.7%) of them had low ionic calcium. 15 patients (34%) had normal EEG, MRI and CSF analysis and all were found to have hypocalcemia. Retrospective analysis suggests that at least 16 patients (36.3%) had features of hypocalcemia clinically indistinguishable from encephalitis.

Conclusions

Ionic calcium level should be incorporated in the diagnostic assessment of infants with suspected encephalitis.