Psychiatrische Manifestation einer Dengue-Encephalopathie

Abstract

Psychiatric manifestation of dengue virus infections is seldom reported. Here a case is presented of a 21-year-old man who developed mainly neuropsychiatric symptoms which he caught one week after a feverish infection during his stay in India: troubles with concentration and memory, confusion, as well as depressive delusions and agoraphobia. Liquor diagnosis as well as CCT and MRI was mainly inconspicuous. The FDG-PET showed a diffuse lack of activity. IgM and IgG antibodies of dengue virus were positive. We interpreted these psychiatric symptoms as a result of a dengue virus infection.

Neurological Manifestations of Dengue Infection

“…Encephalopathy caused by dengue fever can be reflected by reduced sensitivity, cognitive impairment, convulsions, and personality and behavior disorders, including acute mania, depression, emotional lability, anxiety, psychosis, and agoraphobia (Rittmannsberger et al, 2010 ; Baldaçara et al, 2013 ; Srivastava et al, 2013 ). In a review reporting cases of dengue fever associated with neurological disorders in 2012, encephalopathy was considered by far the most encountered complication (Oehler et al, 2012 ).…”

Increased 18F-FDG Uptake in the Spleen and Multiple Lymph Nodes in Dengue Fever

“…1,2 About FDG PET images in dengue fever, only brain findings in German have been published. 3 Diffusely increased splenic uptake with lymph node uptake has also been reported in malignant lymphoma, 4 sarcoidosis, 4 adult-onset Still disease, 5 and other infections including acute hepatitis C, 6 Epstein-Barr virus, 7 varicella, 8 and early stage of human immunodeficiency virus infection. 4 In a recent study by tissues from autopsy cases that died of acute dengue hemorrhagic fever/ dengue shock syndrome, evidence of viral replication was observed in macrophage-like cells in spleens and lymph nodes.…”

Dengue and Psychiatry: Manifestations, Mechanisms, and Management Options

“…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.…”

“…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. 41 It was noted that clonazepam and lowdose quetiapine were started for dengue patients with psychiatric comorbidity without an appropriate specialist referral.…”