Neurological complications and death in children with dengue virus infection: report of two cases

Abstract

BackgroundDengue virus infection can have different complications; the best known is hemorrhagic dengue fever. However, other effects such as neurological disorders may endanger the lives of patients. Dengue neurological manifestations can be confused with encephalitis symptoms and can lead to cerebral edema and death. Therefore, we consider important in the endemic areas to take into account the diagnosis of dengue encephalitis in patients with neurological disorders, and to request the determination of serology in cerebrospinal fluid for the NS1 antigen test.Case presentationWe present the cases of two patients from the state of Morelos, Mexico, with 17 and 14 years of age. Both cases presented a rapid evolution characterized by fever, seizures and neurological deterioration secondary to severe cerebral edema that evolved to cerebral death in both cases. The diagnosis of brain death was confirmed by electroencephalogram in both patients. The two patients were submitted to serology for NS1 that tested positive in both cases. They died between the second and fifth day after admission.ConclusionsRetrospective studies have found that up to 4% of the patients have dengue virus infections, which leads us to believe that in endemic areas, this infection should be suspected in cases of encephalic and febrile symptoms. RT-PCR should be performed to identify cases of encephalitis caused by the dengue virus, and early interventions should be performed to attempt to reduce the morbidity and mortality of these cases.

Dengue hemophagocytic syndrome: A systematic review and meta‐analysis on epidemiology, clinical signs, outcomes, and risk factors

“…3,9 Dengue patients sometimes present with complications such as liver disorder, encephalopathy, cardiac, and acute renal failure. 10 Hemophagocytic syndrome is known to be a rare but potentially fatal complication of dengue infection characterized by hyperinflammation, uncontrolled proliferation of activated lymphocytes, prolonged fever, pancytopenia, jaundice, and hepatosplenomegaly. 11 The pathologic characteristic of hemophagocytic lymphohistiocytosis (HLH) is known as an inappropriate stimulation of macrophages in bone marrow result in phagocytosis of blood cells and production of high amounts of pro-inflammatory cytokines.…”

“…Dengue patients sometimes present with complications such as liver disorder, encephalopathy, cardiac, and acute renal failure . Hemophagocytic syndrome is known to be a rare but potentially fatal complication of dengue infection characterized by hyper‐inflammation, uncontrolled proliferation of activated lymphocytes, prolonged fever, pancytopenia, jaundice, and hepatosplenomegaly .…”

Viral Parkinsonism: An underdiagnosed neurological complication of Dengue virus infection

“…Tremors, myoclonic movements, tonic-clonic movements, generalized convulsion, clonic flexion jerks, involuntary movements, involuntary twitching, or spasticity were reported in 12 of the cases ( Table 5 ), [ 64 , 65 , 67 , 69 , 75 , 78 , 80 , 82 , 84 , 86 , 94 , 95 ]. Additionally, patients exhibited cogwheel rigidity, mask-like facies, increased muscle tone, rigidity, quadriplegia, and involuntary muscle tightening ( Table 5 ), [ 67 – 69 , 82 , 84 , 86 , 95 ]. Of these cases, 33.33% perished ( Table 5 ), [ 65 , 75 , 78 , 86 , 95 ].…”

“…Additionally, patients exhibited cogwheel rigidity, mask-like facies, increased muscle tone, rigidity, quadriplegia, and involuntary muscle tightening ( Table 5 ), [ 67 – 69 , 82 , 84 , 86 , 95 ]. Of these cases, 33.33% perished ( Table 5 ), [ 65 , 75 , 78 , 86 , 95 ].…”

“…The 15 suspect cases had vague diagnoses but met the case criteria for parkinsonism outlined in this paper. Some of the cases have a questionable origin for the cause of their neurological symptoms [ 82 ], others were diagnosed into the broad category of an “encephalitis” diagnosis [ 64 ], or “cerebellitis” [ 74 ], some were grouped in with seizure disorders [ 95 ]. With this variety of symptoms reported in the case studies, a more uniform reporting of symptoms could provide a clearer picture and help with differential diagnoses.…”