Dengue Viral Infections as a Cause of Encephalopathy

Malavige, GN; Ranatunga, PK; Jayaratne, S D; Wijesiriwardana, B; Seneviratne, SL; Karunatilaka, D.H.

doi:10.1016/s0255-0857(21)02174-5

Cited by 12 publications

(4 citation statements)

References 9 publications

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“…Liver involvement is common in dengue infections and acute liver injury leading to hepatic dysfunction is a well-known entity causing high mortality [19,20]. In our study, elevated liver enzymes signify that there is transaminitis during the leaking phase of DHF.…”

Section: Discussionmentioning

confidence: 60%

A Comparison of Changes in Venous Lactate and Haematocrit during Fluid Resuscitation of Dengue Haemorrhagic Fever

Priyankara

Samarutilake

Viswakula

et al. 2022

Preprint

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Background Dengue haemorrhagic fever (DHF) causes significant morbidity and mortality. Judicious fluid resuscitation is the cornerstone of managing vascular leakage in DHF and haematocrit (HCT) measurement is used to monitor the response to fluid resuscitation. Serum lactate level is a measure of tissue perfusion which can be a useful parameter to monitor adequate fluid therapy. The usefulness of lactate in the management of DHF is poorly investigated. Methodology and Principal Findings A prospective observational study was conducted in two treatment centers in Sri Lanka recruiting 162 DHF patients, to study the correlation of venous lactate and HCT during fluid resuscitation. Patients were recruited within 12 hours of diagnosis of the critical phase and venous lactate level was measured at each time of performing HCT, using a pre-validated handheld lactate analyzer. Median lactate level was 1.3 (range 0.3 - 6 mmol/L) in the study population and 154 (95.2%) patients had median lactate levels less than 2 mmol/L. The HCT values in the study participants ranged from 28 to 62, with a median value of 43. There was no statistically significant correlation between the lactate and HCT values obtained at the same time. In addition, a statistically significant reduction in venous lactate was not observed following administration of fluid boluses. However, HCT reduction expected by administration of the fluid boluses was seen following dextran and crystalloid/dextran combination. Capillary HCT increased following blood transfusion. The highest lactate level measured in a patient was associated with an increase in hospital stay. Conclusions This study concludes that venous lactate is not an appropriate parameter to monitor response to fluid therapy in uncomplicated DHF.

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Section: Discussionmentioning

confidence: 60%

A Comparison of Changes in Venous Lactate and Haematocrit during Fluid Resuscitation of Dengue Haemorrhagic Fever

Priyankara

Samarutilake

Viswakula

et al. 2022

Preprint

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“…The blood-brain barrier (BBB) is a complex structure that constitutes a barrier between the blood and the central nervous system [ 40 ]. BBB destruction caused by DENV infection may lead to encephalopathy or encephalitis, which is associated with morbidity in 5–7% of patients and mortality in ~50% of patients [ 41 ]. DENV-associated encephalopathy or encephalitis will be better understood if the mechanisms causing the upper respiratory tract-to-brain infection are further investigated.…”

Section: Discussionmentioning

confidence: 99%

Effective Infection with Dengue Virus in Experimental Neonate and Adult Mice through the Intranasal Route

Qiu

Zhao

Zhang

et al. 2022

Viruses

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Dengue virus, the causative agent of dengue fever, life-threatening hemorrhagic fever, and shock syndrome, is mainly transmitted to humans through mosquito vectors. It can also be transmitted through atypical routes, including needle stick injury, vertical transmission, blood transfusion, and organ transplantation. In addition, sporadic cases which have no clear infectious causes have raised the respiratory exposure concerns, and the risks remain unclear. Here, we analyze the respiratory infectivity of the dengue virus in BALB/c suckling and adult immunodeficient mice by the intranasal inoculation of dengue virus serotype 2. The infected mice presented with clinical symptoms, including excitement, emaciation, malaise, and death. Viremia was detected for 3 days post inoculation. Histopathological changes were observed in the brain, liver, and spleen. The virus showed evident brain tropism post inoculation and viral loads peaked at 7 days post inoculation. Furthermore, the virus was isolated from the infected mice; the sequence homology between the origin and isolates was 99.99%. Similar results were observed in adult IFN-α/β receptor-deficient mice. Overall, dengue virus can infect suckling mice and adult immune-deficient mice via the nasal route. This study broadens our perception of atypical dengue transmission routes and provides evidence of nasal transmission of dengue virus in the absence of mosquito vectors.

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“…The blood-brain barrier (BBB) is a complex structure that constitutes a barrier between the blood and the central nervous system (39). BBB destruction caused by DENV infection may lead to encephalopathy or encephalitis, which is associated with morbidity in 5%-7% of patients and mortality in ~50% of patients (40). Further investigation of the mechanisms underlying upper respiratory tract-to-brain infection will help understand the mechanisms of DENV-associated encephalopathy or encephalitis.…”

Section: Discussionmentioning

confidence: 99%

Effective infection with dengue virus in experimental neonate and adult mice through intranasal route

Qiu

Zhao

et al. 2022

Preprint

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As a member of the family Flaviviridae, the dengue virus is transmitted to humans through mosquito vectors. The virus causes dengue fever with flu-like symptoms, life-threatening dengue hemorrhagic fever, and dengue shock syndrome that affects four billion people in 128 countries. It can also be transmitted through atypical routes, such as needle stick injury, vertical transmission, and the receipt of contaminated blood or organs. Although sporadic cases cannot be classified as atypical transmission routes and raise respiratory exposure concerns, the risks remain unclear. Here, we analyzed the respiratory infectivity of the dengue virus in BALB/c suckling and A6 adult mice using the dengue virus serotype 2 and intranasal inoculation. The results showed that the clinical symptoms of intranasally infected mice included excitement, emaciation, malaise, and death, and histopathological changes and viremia dynamics were observed in multiple tissues, including the brain, liver, and spleen. Notably, the DENV serotype 2 showed clear brain tropism after intranasal infection, and viral loads peaked at seven days post-inoculation. Furthermore, the virus was isolated from mouse brains, and the sequence homology between the viral stock and dengue virus isolates was 99.99%. Similar results were observed in adult IFN-α/β receptor-deficient mice. Taken together, our results suggest that the DENV serotype 2 can infect suckling mice and adult immune-deficient mice via the nasal route. The results of our study broaden our perception of atypical dengue transmission routes and may help explain dengue virus infections that occur without the presence of mosquito vectors.

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Dengue Viral Infections as a Cause of Encephalopathy

Cited by 12 publications

References 9 publications

A Comparison of Changes in Venous Lactate and Haematocrit during Fluid Resuscitation of Dengue Haemorrhagic Fever

A Comparison of Changes in Venous Lactate and Haematocrit during Fluid Resuscitation of Dengue Haemorrhagic Fever

Effective Infection with Dengue Virus in Experimental Neonate and Adult Mice through the Intranasal Route

Effective infection with dengue virus in experimental neonate and adult mice through intranasal route

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