Encephalitis in the clinical spectrum of dengue infection

Abstract

Dengue viral infections are common worldwide. Clinical manifestations form a broad spectrum, and include uncomplicated dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. Encephalopathy has been well reported and has classically been thought to result from the multisystem derangement that occurs in severe dengue infection; with liver failure, shock, and coagulopathy causing cerebral insult. However, there is increasing evidence for dengue viral neurotropism, suggesting that, in a proportion of cases, there may be an element of direct viral encephalitis. Understanding the pathophysiology of dengue encephalopathy is crucial toward developing a more effective management strategy. This review provides an overview of the clinical spectrum of dengue infection, and examines evidence supporting the existence of dengue encephalitis.

Dengue epidemic management in a developing country

“…Similar observations regarding neurological sequelae are noted in earlier reports. [7][8][9][10] Only three of the seven with neurological manifestations had shock that is similar to the observations of Kamath and Ranjit. [8] The total mortality among the treated patients was one with a case fatality rate of <1%.…”

Encephalitic Arboviruses: Emergence, Clinical Presentation, and Neuropathogenesis

“…Dengue hemorrhagic fever (DHF) results from secondary infection and is characterized by a recurrent high fever with vascular leak causing widespread bleeding and multisystem disorder. Presentations of CNS disorder were therefore initially attributed to DHF; however, recent studies indicate that patients with DHF infection may present with acute encephalitis, GBS, and polyradiculopathy, and that DENV is directly neurotropic [68][69][70][71].…”

“…Primary infection with DENV causes a self-limited, acute febrile illness with headache, malaise, retro-orbital pain, myalgia, arthralgia, and a generalized, maculopapular rash [68]. Dengue hemorrhagic fever (DHF) results from secondary infection and is characterized by a recurrent high fever with vascular leak causing widespread bleeding and multisystem disorder.…”

Dengue haemorrhagic fever in a child presenting as encephalitis on day one of fever

“…Neurologic manifestations including transverse myelitis, Guillain-Barré syndrome, acute disseminated encephalomyelitis and acute motor weakness have been reported in dengue patients [2,3]. Dengue encephalitis is defined as fever, headache, reduced consciousness not explained by liver failure, electrolyte derangement, shock, intracranial haemorrhage, dengue IgM in CSF or serum and neuroimaging suggestive of viral encephalitis [2].…”

“…Dengue encephalitis is defined as fever, headache, reduced consciousness not explained by liver failure, electrolyte derangement, shock, intracranial haemorrhage, dengue IgM in CSF or serum and neuroimaging suggestive of viral encephalitis [2]. Encephalitis on the first day of fever is a rare manifestation of dengue.…”