Late Onset Mania in Dengue Fever

Abstract

Here, we are reporting a case of late onset mania in a 61 year old male secondary to dengue fever. The past and family history of the mood disorder was absent in the patient. Episode of mania had a temporal correlation with the dengue fever. Psychiatric co-morbidities are mentioned in the literature following dengue fever but the literature on the mania following dengue is sparse. The late onset mania in dengue fever is unreported in the literature.

Dengue and Psychiatry: Manifestations, Mechanisms, and Management Options

“…Seven of the reviewed reports utilized any one agent (valproate, quetiapine, or carbamazepine) with HDAC/DNMT inhibition. [24][25][26][27][28][29]31,34 These reports suggested an early and favorable outcome. However, reports utilizing other agents without HDAC/DNMT inhibition also suggested favorable outcomes.…”

“…At 6-24 months' follow-up after dengue infection, the rates of depression were 15%. 20 There are multiple case reports of manic presentation, [24][25][26][27][28][29][30][31] acute polymorphic psychosis, [32][33][34][35][36][37][38][39] prolonged depression, 40 and catatonia 29,41 and one on rapid cognitive decline. 42 However, the evidence for a psychotic, manic, or catatonic presentation from observational studies is lacking.…”

“…Mania in dengue patients was managed with antipsychotic/benzodiazepines or a combination of mood stabilizers and antipsychotic/benzodiazepines. 24,[26][27][28][29] For psychotic presentations, a good response was achieved with oral antipsychotic agents, mostly in low doses. [32][33][34][35][36][37]39 Catatonic presentation responded well to intravenous lorazepam 4 mg/day, which was tapered and stopped over four weeks.…”

“…36,39 But, the analysis was considered normal in the other two reports. 27,42 Brain imaging studies such as computed tomography [25][26][27]34,35,41 and magnetic resonance imaging 32,33,36,38 in most reports were normal. Metabolic derangements, including elevated liver enzymes, 24,25 electrolyte abnormalities, 27 vasculitis with capillary leak, and fluid extravasations, were postulated.…”

“…22 Only a few studies used standard diagnostic criteria and structured psychopathology and cognition rating scales to quantify the presentation. 17,18,25,26,29 Most studies had little/no information on follow-up details, and retrospective studies had suggested predominant anxiety and depressive symptoms as chronic consequences. However, the persistence of these symptoms and the need for prolonged treatment for secondary psychiatric manifestations are not specifically described in the available studies.…”