Dengue and Psychiatry: Manifestations, Mechanisms, and Management Options

Abstract

Dengue is an arboviral infection endemic in tropical countries. Neurological sequelae to dengue infection are not uncommon, and psychiatric manifestations are increasingly reported. This narrative review aims to present the varied manifestations, postulated mechanisms, and the available treatment options for psychiatric morbidity associated with dengue. The evidence available from eight observational studies is summarized in this review. Depression and anxiety are noted to be prevalent during both the acute and convalescent stages of the infection. The presence of encephalopathy and other neurological conditions is not a prerequisite for developing psychiatric disorders. However, treatment options to manage such psychiatric manifestations were not specified in the observational studies. Anecdotal evidence from case reports is outlined. Special attention is paid to the role of epigenetic modifications following dengue infections and the role of histone deacetylase inhibitors in the management. DNA methylation inhibitors such as valproic acid play a significant role in reversing stress-, viral-, or drug-induced epigenetic modifications.

Severe Dengue With Multisystem Inflammatory Syndrome in Children Due to COVID-19: A Co-infection Case Series

“…He also developed neurological manifestations. Transient psychological disturbance is often seen in patients with MIS-C due to COVID-19 [18], and dengue [19].…”

Neurological or Psychiatric Disorders After Dengue Fever

“…This cohort study’s findings support those of previous research suggesting a potential association between dengue fever and neurological and psychiatric complications, especially in individuals older than 60 years. Although prior case reports and smaller studies 4 , 5 noted the neurotropic nature of the dengue fever virus, this study stands out due to its extensive scale and use of long-term, comprehensive national health data, which may avoid selection bias inherent in smaller datasets. 6 The study has several limitations.…”

“… 1 , 2 Apart from possible direct invasion of dengue fever virus to the neurological system, the disease has been reported to be associated with neurological complications probably attributable to autoimmune reactions and metabolic alterations. 3 Several studies 4 , 5 have found an association between dengue fever and neurologic and psychiatric disorders, including anxiety and depression symptoms. This retrospective nationwide cohort study attempted to further scrutinize the association between dengue fever and risk of subsequent neurological or psychiatric complications.…”

Dengue virus pathogenesis and host molecular machineries

“…This epigenetic modification is important for investigating mental health issues related to dengue infection. Various HDAC inhibitors like valproate, quetiapine, or carbamazepine are prescribed for treatment as HDAC/Dnmt inhibitors [ 28 ]. Comprehensive transcriptome analysis identified that DENV proteins interact with host genes (CCR10, CNG7, PLXNA3) and lncRNAs (CTBP1-AS, MAFG-AS1) engaged in various biological processes, such as the immune response, inflammation, and the cell cycle, as illustrated in Fig.…”

“…3 DENV and host epigenetic regulation: A DENV infection results in cytokine storm and leads to oxidative stress conditions in host cell, activating histone deacetylase (HDAC). HDAC activity condenses the chromatin and slows down the host transcription processes [ 28 ]. B DENV protein interacts with various host cellular genes/lnCRNAs and results in m6A RNA methylation.…”