Encephalitis and myelitis associated with dengue viral infection

Wasay, Mohammad; Channa, Roomasa; Jumani, Maliha; Shabbir, Ghulam; Azeemuddin, Muhammad; Zafar, Afia

doi:10.1016/j.clineuro.2008.03.011

Cited by 93 publications

(66 citation statements)

References 9 publications

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“…Encephalitis secondary to dengue infection usually has a benign outcome. However some patients exhibit persistent neurological symptoms 14 . Glucocorticoid can be used, which highlights the importance of an early diagnosis for a good prognosis 15 .…”

mentioning

confidence: 99%

Neurological complications in dengue infection: a review for clinical practice

Puccioni-Sohler

Rosadas

Cabral‐Castro

2013

Arq. Neuro-Psiquiatr.

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The dengue virus belongs to the Flaviviridae family. There are four closely related, but antigenically different virus serotypes: DENV1 to DENV4. An infection caused by one of them can cause dengue fever and, rarely, most severe form of the disease. The infection provides life-long protective immunity to the same subtype, but no immunity against the other three serotypes. Moreover, previous infection with a different subtype increases the chances of developing dengue hemorrhagic fever. This is due to a phenomenon called antibody dependent enhancement (ADE). In ADE, the heterotypic non-neutralizing antibodies form complexes with dengue virus, which infect mononuclear phagocytes with enhanced efficiency. Consequently, a higher number of host cells are infected, improving viral replication, worsening the clinical signs. Thus, this may also contribute to the development of neurological and other complications 1 . The neurological manifestations are mainly associated with DENV-2 and DENV-3. These serotypes were found in cases of encephalitis, meningitis and myelitis 2,3 . DENV-4 was also detected in brain cells by immunohistochemistry and in cerebrospinal fluid (CSF) of a patient with encephalitis 4 . The present article highlights some important points that should be addressed when evaluating a possible case of neurological complication of dengue virus infection. Conflict of interest:There is no conflict of interest. ABStrACtDengue is an important global public health problem. The World Health Organization estimates that 2/5 of entire world population are in risk of dengue infection. Almost 50 millions cases occur annually, with at least 20 thousand deaths. The etiological agent of this acute febrile disease is a single-strand positive-sense RNA virus of Flavivirus genus. It is an arboviral disease transmitted by Aedes sp. mosquitoes (Aedes aegypti and A. albopictus). Most infected individuals present asymptomatic infection, but some may develop clinical signs. Therefore, a wide spectrum of illness can be observed, ranging from unapparent, mild disease, called dengue fever, to a severe and occasionally fatal dengue hemorrhagic fever/dengue shock syndrome. Currently, neurological manifestations related to dengue infections are increasingly been observed and appears as a challenge for medical practice. In this study the neurological complications of dengue infection will be reviewed, focusing a better understanding of the disease for the clinical practice.Keywords: dengue, nervous system, diagnosis. rESUMO A dengue é um importante problema de saúde pública. A Organização Mundial de Saúde estima que 2/5 da população mundial encontra-se em risco de desenvolver a infecção. Cerca de 50 milhões de casos ocorrem anualmente, com ao menos 20 mil mortes. O agente etiológico desta doença febril aguda é um vírus RNA, do gênero Flavivirus. Este arbovírus é transmitido pelo mosquito Aedes sp. A maioria dos indivíduos infectados apresenta infecção assintomática, porém alguns desenvolvem sintomas clínicos. Estes manifestações podem...

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mentioning

confidence: 99%

Neurological complications in dengue infection: a review for clinical practice

Puccioni-Sohler

Rosadas

Cabral‐Castro

2013

Arq. Neuro-Psiquiatr.

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“…Spinal cord abnormalities may be seen mainly in the thoracic and cervical regions. 18 Acute cerebellitis and other autoimmune syndromes Acute cerebellitis following DENV infection has been recently described. 60 The clinical picture consists of dysarthria, horizontal nystagmus, bilateral dysmetria, dysdiadochokinesia, incoordination and wide-based ataxic gait.…”

Section: Acute Disseminated Encephalomyelitismentioning

confidence: 99%

“…16 Neuroimaging studies (computed tomography and/or magnetic resonance imaging [MRI] scan) may be normal or show diffuse cerebral edema. 18 Prognosis depends on causal factors, associated comorbidities, and early supportive treatment, and mortality may be high. 16 …”

Section: Dengue Encephalopathymentioning

confidence: 99%

Neurological manifestations of dengue viral infection

Carod-Artal

2014

RRTM

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Dengue is the most common mosquito-borne viral infection worldwide. There is increased evidence for dengue virus neurotropism, and neurological manifestations could make part of the clinical picture of dengue virus infection in at least 0.5%-7.4% of symptomatic cases. Neurological complications have been classified into dengue virus encephalopathy, dengue virus encephalitis, immune-mediated syndromes (acute disseminated encephalomyelitis, myelitis, Guillain-Barré syndrome, neuritis brachialis, acute cerebellitis, and others), neuromuscular complications (hypokalemic paralysis, transient benign muscle dysfunction and myositis), and dengue-associated stroke. Common neuro-ophthalmic complications are maculopathy and retinal vasculopathy. Pathogenic mechanisms include systemic complications and metabolic disturbances resulting in encephalopathy, direct effect of the virus provoking encephalitis, and postinfectious immune mechanisms causing immune-mediated syndromes. Dengue viruses should be considered as a cause of neurological disorders in endemic regions. Standardized case definitions for specific neurological complications are still needed.

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“…Examples of viral infections caused by this group include yellow fever, Japanese encephalitis, West Nile infection and Dengue. The later can be associated with CNS involvement in 3% -21% of cases commonly presenting with encephalitis, delirium, confusion and seizures [81] [82]. West Nile virus is an arthropod-borne flavivirus which spread by infected mosquitoes and can infect birds, human and horses.…”

Section: Flavivirusesmentioning

confidence: 99%

Psychiatric Aspects of Infectious Diseases

Mufaddel¹,

Omer²,

Salem³

2014

OJPsych

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Psychiatric symptoms can be associated with several systemic and central nervous system infections and they can be the initial presenting symptoms, occurring in the absence of neurological symptoms in some disorders as in some cases of viral encephalitis. They could also be part of the clinical picture in other cases such as psychosis or mood symptoms secondary to brucellosis or toxoplasmosis. Late-onset neuropsychiatric complications may also occur several years following the infection such as in the case of subacute sclerosing panencephalitis due to measles. Some Infectious diseases may have possible etiological role for major psychiatric disorders, based on yet unconfirmed reports for viral infectious diseases (e.g. Influenza virus and HSV-1) which are thought to have risk for developing schizophrenia and psychosis. Neuropsychiatric adverse effects can occur due to drugs (e.g. mefloquine, interferon-alpha) that are used for treatment of infectious diseases. Psychiatric symptoms can also be reactivated resulting from chronic, complicated and serious infections such as HIV that can lead to depression, anxiety or adjustment disorders, although CNS involvement can also be a possible etiological factor. Patients suffering from primary and severe psychiatric disorders are at increased risk of contracting infection; that is mainly related to high risk behaviors in patients with mania or schizophrenia. It is also important to consider that the co-occurrence of psychiatric symptoms and infection can be incidental (i.e. infectious diseases can occur in psychiatric patients regardless of the above mentioned factors). Early identification of the underlying etiology for organic/secondary psychiatric symptoms is essential for appropriate intervention and early treatment of the primary condition that could be the etiology of psychiatric symptoms so as to avoid unnecessary long-term psychiatric treatment and to avoid complications of possible misdiagnosis or delayed diagnosis of the primary condition.

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Encephalitis and myelitis associated with dengue viral infection

Cited by 93 publications

References 9 publications

Neurological complications in dengue infection: a review for clinical practice

Neurological complications in dengue infection: a review for clinical practice

Neurological manifestations of dengue viral infection

Psychiatric Aspects of Infectious Diseases

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