A rare case of dengue encephalitis

Abstract

Dengue fever has a variable clinical spectrum ranging from asymptomatic infection to life-threatening dengue haemorrhagic fever and dengue shock syndrome. However, neurological complications, in general, are unusual. Dengue encephalopathy is not an unknown entity; however, dengue encephalitis, a direct neuronal infiltration by the dengue virus, is an extremely rare disease. Although dengue is classically considered a non-neurotropic virus, there is increasing evidence for dengue viral neurotropism, suggesting that, in a proportion of cases, there may be an element of direct viral encephalitis. An MRI brain rarely shows focal abnormalities in dengue encephalitis. We report an interesting case of dengue encephalitis during an outbreak in Delhi, India. The diagnosis was confirmed by blood and cerebrospinal fluid dengue serology and (NS1) antigen assay. The case showed extensive lesions involving the midbrain, cerebellum, thalamus and medial temporal region on both sides of the MRI brain, which is an uncommon manifestation of dengue fever.

Rare case of acute dengue encephalitis with correlated MRI findings

“…The major differences between the two have been outlined in Table . There is increasing evidence for dengue virus neurotropism, with several documented cases of direct isolation of dengue serotypes 2 and 3 from the CSF and from the midbrain . Nervous system involvement is more commonly seen with serotypes 2 and 3 .…”

“…Nervous system involvement is more commonly seen with serotypes 2 and 3 . To our knowledge, only three other articles reporting abnormal brain MRI findings in dengue have been written …”

“…There is increasing evidence for dengue virus neurotropism, with several documented cases of direct isolation of dengue serotypes 2 and 3 from the CSF and from the midbrain. [1][2][3][4] Nervous system involvement is more commonly seen with serotypes 2 and 3. 4 To our knowledge, only three other articles reporting abnormal brain MRI findings in dengue have been written.…”

“…4 To our knowledge, only three other articles reporting abnormal brain MRI findings in dengue have been written. [2][3][4] Management of viral encephalitis involves airway maintenance, hydration, anti-epileptics and mannitol for increased intracranial pressure. Use of corticosteroids is controversial and not considered safe.…”

Zika virus as a causative agent for primary microencephaly: the evidence so far

“…For the latter, fetal exposure to Toxoplasma, Rubella virus, Cytomegalovirus, Herpes virus and the Syphilis bacteria (termed the 1 3 TORCHS factors) represents the main congenital infections that could cause microcephaly (Neu et al 2015). The Flavivirus genus does not lack members that are neurotrophic and could cause rare but documented cases of brain infection in infants or pediatric subjects (Turtle et al 2012), such as West Nile virus (Tyler 2014), Japanese Encephalitis virus (Li et al 2015) and Dengue virus (Rao et al 2013). However, ZIKV is perhaps the first Flavivirus to be so strongly associated with congenital teratogenesis.…”