Dengue encephalitis – clinical spectrum and outcome

Abstract

Background: Dengue viral infection is common worldwide caused by dengue virus. Recent studies have shown dengue viral infection causing encephalitis with high morbidity and mortality. The Dengue encephalitis patients usually present with altered sensorium, elevated lab parameters and high antibody titres at the time of admission. Aims: To compare initial lab parameters, clinical spectrum and outcome in patients of dengue fever with or without encephalitis. Settings and design:The study was done in a multi-speciality teaching hospital. Fourty nine patients were included in the study with febrile illness and thrombocytopenia, proved to be having Dengue fever. Material and Methods: A prospective study was conducted on 49 patients with febrile illness and thrombocytopenia proved to be having Dengue fever during a period of 6 months were included. Initial lab parameters, clinical spectrum and outcome were compared in patients with or without encephalitis. Statistical analysis used:The database of all parameters were analysed using "STATA SOFTWARE VERSION10.0". Results: 49 cases of proven dengue fever were included in the study. Among these patients 25 patients had no encephalitis and 24 patients had encephalitis. Most common clinical features in patients without encephalitis were fever with chills and rigors and in patients with encephalitis were fever with altered sensorium (P-value < 0.05). Among total 49 patients, 24 patients had encephalitis. There were no statistical difference among factors like age, sex, PCV, Platelet count, PT, and INR in these two groups (with or without encephalitis) at admission. The APTT, serum Ig-M antibodies, Ig-G antibodies, SGOT and SGPT were significantly high in encephalitis group (P-value < 0.05). All 25 dengue patients without encephalitis recovered completely without any complication. Among 24 dengue patients with encephalitis, 22 patients recovered completely (independent for activities of daily living), and 2 patients died (due to severe sepsis with MODS). Conclusions: Increased incidence of dengue fever with encephalitis in the recent years, in the absence of single sensitive test for detecting dengue encephalitis, variable CSF and MRI Brain features, and associated high morbidity and mortality, this study may be helpful in focussing on early diagnosis and aggressive initial management which can influence final outcome.

The Clinical Profile and Outcome of Children with Dengue Encephalitis at the Philippine Children’s Medical Center: A Retrospective Study From January 2011-June 2017

“…Neurologic manifestations due to dengue have been well reported, and has previously been thought to result from the multisystem derangement that occurs in severe dengue infection, with liver failure, shock and coagulopathy causing cerebral insult as opposed to encephalitis defined by a localized invasion of the CNS. Recent studies, however 10,11,13,14,21 , describe a possible direct neurotropic effect of dengue virus. The incidence of dengue with neurologic complications is unclear, with calculations ranging from 0.5% 14 to 6.2% 26 of DHF cases.…”

“…The most common EEG and neuroimaging findings were likewise consistent with dengue encephalitis. 10,11,13,14,21,27,35 Most patients manifested with generalized or focal background slowing via EEG, and neuroimaging findings ranged from being normal, to having evidence of cerebral edema, some with changes consistent with acute meningoencephalitis. Testing for correlation between established factors for poor prognosis, which were noted in some of the patients, such as extremes of age, under or over nutrition, presence of co-morbidities, signs of plasma leakage, hepatic involvement, and patient outcome could not be done due to the very limited subjects.…”

“…14 Dengue encephalitis patients usually present with altered sensorium, elevated liver enzymes and high antibody titers at the time of admission. 10 Acute encephalitis, defined by the presence of an inflammatory process of the brain in association with clinical evidence of neurologic dysfunction, is a serious and potentially debilitating condition, which may lead to adverse outcomes of prolonged neurologic sequelae or death.…”

Dengue breathing down our neck: A case report of dengue encephalitis

“…Unlike the well recognized neurotropic viruses such as herpes simplex virus, West Nile virus, Saint Louis encephalitis virus, Japanese encephalitis virus, dengue was seldom associated with encephalitis. A comprehensive review of all publications on dengue and neurological complications revealed that over the last two decades, there have been prospective studies on patients with dengue and encephalitis in various cohorts in Southeast Asia, India and South America [2][3][4].…”

The Etiological Diagnosis and Outcome in Patients of Acute Viral Encephalitis: A Prospective Observational Study at Tertiary Care Centre of North India

“…In the study conducted by Rao et al on 24 dengue, encephalitic patients, 22 patients recovered completely (independent for activities of daily living), and 2 patients died (due to severe sepsis with MODS) [6]. Singh et al prospective observational study explored the independent predictors of adverse outcome in the patients with confirmed/probable viral encephalitis [7].…”