Encefalitis como complicación neurológica por dengue / Encephalitis as neurological complication due dengue

Resumen Se presenta el caso de un varón de 32 años, previamente sano, que consultó por fiebre de cinco días, cefalea, dolor retro-ocular, rash, petequias, mialgias, artralgias y dolor abdominal. Presentaba leucopenia, trombocitopenia intensa, transaminitis y tiempo de coagulación prolongado. Se diagnosticó un dengue grave con coagulopatía que requirió manejo en Unidad de Cuidados Intensivos. Evolucionó con alteración del estado de conciencia, agitación psicomotora y agresividad. Se descartaron alteraciones estructurales, isquémicohemorrágicas, infecciones bacterianas y micóticas. Se confirmó finalmente una encefalitis por dengue por una RPC para virus dengue positiva en LCR. Se brindaron medidas de soporte con una evolución favorable. La encefalitis es la complicación neurológica más grave tras la infección por virus del dengue.

Abstract We present the case of a 32-year-old male, previously healthy, with a 5-day history of fever, frontal-occipital headache, retro-ocular pain, rash, petechiae, myalgia, arthralgia, and abdominal pain. Blood tests with leukopenia, severe thrombocytopenia, transaminitis, long clotting times. Severe dengue with associated coagulopathy was diagnosed, indicating transfer to ICU. Presents torpid evolution, altered state of consciousness, psychomotor agitation, and aggressiveness. Structural, ischemic-hemorrhagic alterations, bacterial and fungal infections were ruled out. Finally diagnosing dengue encephalitis, confirmed by DENV PCR in CSF. Support measures are provided with favorable evolution. Encephalitis is the most serious neurological complication after dengue virus infection.

Dengue Encephalitis - A Diagnostic Dilemma

Introduction: Dengue is most important arthropod-borneviral disease worldwide, with approximately 390 millioninfection occurung per year, of which approximately 96 milliocause sign of disease. Dengue virus is single stranded RNAvirus belonging to flaviviridae family having four serotypes.Case report: We are thus reporting a case of Dengue feverwhich presented as encephalitis. Very few cases of dengueencephalitis has been reported worldwide and the literatureavailable on the illness is limited.Conclusion: Dengue is classically thought to be a nonneurotropic virus. Most common dengue serotype causingneurological complication are DEN 2 and DEN 3. Neurologicalcomplication are rare in dengue.

The clinical profile and outcome of children with Dengue Encephalitis at the Philippine Children’s Medical Center: A retrospective study from January 2011-June 2017

Background@#Dengue, a mosquito-borne flavivirus, is hyperendemic in the Philippines. One of its rare complication is dengue encephalitis, characterized by altered sensorium, elevated liver enzymes, and high dengue-specific antibody titers. Previously known as non-neurotropic, dengue presents with an increasing incidence of neurologic manifestations. @*Objective@#To describe the clinico-demographic profile and outcome of laboratory-confirmed dengue encephalitis patients. @*Methods@#This is a retrospective study that used purposive sampling to describe laboratory-confirmed dengue encephalitis cases aged 0-18 years. The clinico-demographic profiles and outcomes were collected using chart review, and variables were analyzed using descriptive statistics. @*Results@#14 laboratory-confirmed cases were reviewed. Most (57%) were males aged 3 days-15 years. Fever lasted 3-11 days. Following nonspecific signs and symptoms, neurological manifestations developed within 1-5 days, the most common being seizures (71%). Majority (57%) had anemia. All, except one, exhibited leukopenia and thrombocytopenia. Elevated liver enzymes, bleeding parameter derangements, electrolyte, and glucose imbalances were noted. All were seropositive for dengue IgM, and 5 dengue IgM in the CSF. Most common EEG findings showed generalized slowing. Neuroimaging reports were normal in some or showed cerebral edema in the others. Half of the patients recovered fully, 3 showing partial recovery from neurologic changes, and 3 others had neurologic sequelae. One infant expired. @*Conclusions and Recommendations@#Dengue encephalitis should be considered in patients living in an endemic country, presenting with fever with neurologic changes or elevated liver enzymes, with a risk for developing neurologic sequelae or death.

The clinical profile and outcome of children with dengue encephalitis at the Philippine Children’s Medical Center: A retrospective study from January 2011-June 2017

BACKGROUND@#Dengue, a mosquito-borne flavivirus infection, is hyperendemic in the Philippines. One of the rare complications is dengue encephalitis, characterized by altered sensorium, elevated liver enzymes, and high dengue-specific antibody titers. The actual incidence of dengue encephalitis is underestimated due to problems of pathogen detection. To address this, an integrated surveillance system has been in place since 2007, which detects laboratory-confirmed dengue meningoencephalitis from blood and CSF samples via IgM capture ELISA.@*OBJECTIVES@# To describe the clinico-demographic profile and outcome upon hospital discharge of laboratory-confirmed dengue encephalitis patients admitted at the Philippine Children’s Medical Center (PCMC) from January 2011 to June 2017.@*METHODS@#This is a retrospective observational study to describe laboratory-confirmed dengue encephalitis cases aged 0-18 years at PCMC from January 2011 to June 2017.The clinico-demographic profiles and outcomes of patients were collected using chart review, and variables were analyzed using descriptive statistics.@*RESULTS@#14 cases of laboratory-confirmed dengue encephalitis children were reviewed. None had known previous dengue infection nor received dengue vaccination. Following nonspecific signs and symptoms, neurological manifestations developed with a median of 2 days, the most common being seizures, most of which were generalized, and decreased sensorium. Most common abnormal EEG waveforms were generalized background slowing; neuroimaging was normal or showed cerebral edema. Full recovery upon discharge was seen in half the patients reviewed, 3 showing partial recovery from neurologic signs and symptoms, and 3 others were discharged with neurologic sequelae. One infant expired.@*RECOMMENDATIONS@#Prospective studies with larger sample sizes that will follow-up on the patient’s long-term outcome are recommended.

Clinical profile and outcomes in acute viral encephalitis

Objective@#This study aimed to determine the clinical profile and outcome of pediatric patients with acute viral encephalitis syndrome admitted at a single tertiary government hospital. @*Methods@#All pediatric patients admitted at the Philippine General Hospital from January 2011 to December 2014 and discharged with a final diagnosis of acute viral encephalitis were included. After demographic data, clinical manifestations, and laboratory findings were collected, the outcome was determined using the Modified Rankin Scale for children. The data were summarized using descriptive statistics. The median test was used to compare the outcomes while the chi-square test was used to analyze the comparison between study groups. @*Results@#Sixty-four patients diagnosed with acute viral encephalitis syndrome were included in the study. The highest number of cases was reported in ages 1- 4 years (32.81%) and among the male population (68.75%). The most common symptoms were seizure (46.87%), abnormal behavior (21.88%), and altered sensorium (20.31%). Forty-four patients had CSF viral studies done, and among them, the 11 (25%) were positive for Japanese encephalitis. The modified Rankin scale showed that 41 (64.08 %) subjects showed good outcomes, while 23 (35.23%) exhibited poor outcomes. There was no significant difference in the modified Rankin scale for Japanese encephalitis compared to the other etiologic agents of acute viral encephalitis (p value= 0.717). @*Conclusion@#In patients with acute viral encephalitis, the most common symptoms were seizures, abnormal behavior, and altered sensorium. Majority of the subjects did not show any significant symptoms and disability. No difference was seen in the clinical outcome of patients infected with Japanese encephalitis compared to other etiologic agents, but these results need to be verified by larger studies.<

Dengue encephalitis-A rare manifestation of dengue fever

The clinical spectrum of dengue fever ranges from asymptomatic infection to dengue shock syndrome. Dengue is classically considered a non-neurotropic virus. Neurological complications are not commonly seen in dengue. The neurological manifestations seen in dengue are encephalitis, meningitis, encephalopathy, stroke and Guillain-Barré syndrome. Dengue encephalitis is a rare disease. We report an interesting case of dengue encephalitis from Southern India. A 49-year-old gentleman presented with fever, altered sensorium and seizures. Dengue NS-1 antigen test was reactive. Dengue IgM was also positive. CSF PCR was negative for herpes simplex 1 & 2. Dengue encephalitis should be considered in the differential diagnosis of fever with altered sensorium, especially in countries like India where dengue is rampant.