Dengue viral infections as a cause of encephalopathy

Abstract

The aim of this study was to determine the clinical characteristics and poor prognostic factors associated with high mortality in dengue encephalopathy. Fifteen patients with confirmed dengue infections, who developed encephalopathy, were recruited from two tertiary care hospitals in Colombo, Sri Lanka. Among the factors that contributed to encephalopathy were: Acute liver failure (73%), electrolyte imbalances (80%) and shock (40%). Five (33.3%) patients developed seizures. Disseminated intravascular coagulation was seen in five (33.3%). Secondary bacterial infections were observed in 8 (53.3%) of our patients. The overall mortality rate was 47%.

Korelasi Kadar Plasminogen Activator Inhibitor-1 (PAI-1) Plasma dengan Enzim Transaminase Serum pada Demam Berdarah Dengue

“…12 Dijumpai peningkatan SGOT lebih besar daripada SGPT, sesuai dengan penelitian Seneviratne 12 dan Malavige 13 yang juga melaporkan adanya peningkatan SGOT yang lebih tinggi dibandingkan SGPT pada infeksi dengue, penurunan SGOT lebih cepat daripada SGPT dan mencapai nilai normal kembali dalam dua minggu. Dijumpai peningkatan SGOT yang lebih tinggi dibanding SGPT karena selain oleh hati SGOT juga dilepaskan oleh sel otot skletal dan miokardium yang juga menjadi organ target infeksi dengue.…”

“…Sedangkan SGPT juga dijumpai di beberapa jaringan, akan tetapi lebih banyak dijumpai di jaringan hati, sehingga SGPT lebih khas untuk jaringan hati daripada SGOT. 13 Secara klinis kedua enzim tersebut selalu digunakan sebagai penanda adanya kerusakan jaringan hati. Peningkatan moderat (tiga sampai duapuluh kali nilai normal) SGOT dan SGPT menunjukkan adanya peradangan jaringan hati yang bersifat akut.…”

Pathogenesis of severe dengue infection

“…The liver is commonly involved in dengue infections, and acute liver failure (ALF) has also been reported [16][17][18]. Autopsy studies carried out in patients with fatal hepatitis associated with dengue infection have shown midzonal hepatocyte necrosis, macrovascular steatosis and councilman bodies, with little inflammation [10,19].…”

“…Although most patients with ALF associated with dengue infection also have other complications, such as, fluid leakage and shock, ALF can occur in the absence of shock [20]. Dengue associated ALF has a high mortality due to complications such as encephalopathy, severe bleeding, renal failure and metabolic acidosis [18,20]. Direct hepatocyte damage by the virus [9,10], immune factors and apoptosis of cells due to oxidative stress, have all been suggested as possible mechanisms for liver cell damage [21].…”

“…Fluid extravasation, cerebral oedema, ALF, renal failure and electrolyte imbalance are thought to contribute to encephalopathy associated with dengue [18,22]. The DV can be neurovirulent, and has been isolated from the CSF in patients with encephalitis, in the absence of fluid leakage and other clinical features of severe dengue [23,24].…”