Conclusions dengue encephalopathy is a rare phenomenon complicating term pregnancy. In these cases computed tomography ct and magnetic resonance imaging mri findings may be normal. Encephalitis in the clinical spectrum of dengue infection varatharaj. Encephalopathy information page national institute of. Consultation on dengue diagnostic testing can be obtained from cdc at 7877062399. Dengue is a mosquitoborne disease caused by any one of four closely related dengue viruses. Diagnosis and management of dengue in children iap.
Neurologic involvement of dengue infection is uncommon and can be seen in 4%5% of those infected, and includes encephalopathy, acute disseminated encephalomyelitis, branchial neuritis, myelitis, hypokalemic paralysis, opsoclonus myoclonus, and guillainbarre syndrome. Understanding the pathophysiology of dengue encephalopathy is crucial toward. Miller fisher syndrome developing as a parainfectious manifestation of dengue. The laboratory diagnosis of dengue using commercial kits was also discussed. Dual infection with japanese encephalitis and dengue fever. The possible pathogenic mechanisms involved in development of encephalopathy include encephalopathy secondary to liver and renal impairment, cerebral hypoperfusion due to shock, cerebral edema because of vascular leak. Of 858 patients with dengue feverdhf admitted to the hospital during the study period, 109 cases with severe forms of disease required picu admission, of which 9 patients died.
The usual symptoms of dengue fever like rashes, muscular pain and bleeding are generally not seen in more than 50% of the total patients with encephalitis. Research article clinical profiles of dengue infection. This pdf is available for free download from a site hosted by medknow publications. This study may be useful in early detection of dengue fever patients with. Bilateral thalamic involvement, dengue encephalitis, dengue fever. Differential diagnosis of dengue with rash illness history exam test erythema infectiosum fifth disease occurs most commonly in children, 5 to 15 years, during winter and spring. Recent studies have shown dengue viral infection causing encephalitis with. A case of dengue haemorrhagic fever with fatal encephalopathy. Pdf on mar 1, 2014, soares cristiane and others published diagnosis criteria of dengue encephalitis find, read and cite all the research you need on researchgate. These factors include hypovolemic shock, anoxia, cerebral edema, electrolyte and fluid imbalances, coagulation abnormalities, and liver andor renal dysfunctions. Chronic symptoms lasting more than caused by viruses. Pdf we report a case of dengue fever with features of encephalitis.
Since the second edition of dengue haemorrhagic fever. Dengue haemorrhagic fever with encephalopathyfatality at. The treatment of dhf with cns involvement is supportive and symptomatic. The involvement of brain in dengue fever can occur either in the form of encephalopathy or encephalitis. Dengue encephalitisa rare manifestation of dengue fever. Differential diagnosis of meningoencephalitis was kept because of high grade fever, seizure and altered sensorium, but the parameter were normal and his dengue antigen came positive so the diagnosis of dengue encephalitis was made. There are four dengue virus denv types denv1, denv2, denv3, and denv4, all of which are capable of inducing severe disease dengue hemorrhagic fever dhf dengue shock syndrome dss. Dengue encephalitis and encephalopathy are different entity. Dengue dhfdss, queen sirikit national institute of child health. Our patient however did have the classic symptoms of dengue.
Review article diagnosis and management of dengue in children. Diagnosis dengue encephalopathy serological varicella zoster encephalitis vzv belongs to the herpesviridae family with 3 subfamilies. A transient macular rash may also be observed which usually resolves spontaneously. The encephalitis group were based on clinical features low gcs, altered sensorium, headache, and. Sep 06, 2019 background dengue fever and dengue hemorrhagic fever incidence is increasing in sri lanka, especially among the young population. Shastri c,d, a associate professor, department of pediatrics, institute of child health, kolkata, west bengal, india b secretary, iap infectious diseases chapter. Dengue encephalopathy is a rare but well recognised clinical entity, the incidence ranging from 0. English pdf icon pdf 2 pages zika and dengue testing algorithm for symptomatic pregnant women.
As igm and igg antibodies against dengue virus were positive in the csf, and igm and igg antibodies against hsv1 and 2 were negative, a diagnosis of dengue. The study by carodartal and colleagues2 published in the lancet in 20 proposed a panel in which dengue encephalitis was defined by the following criteria. Encephalopathy is more common and may occur with multisystem derangement like hepatic failure. In these cases computed tomography ct and magnetic resonance imaging. Guidelines on management of dengue fever in children and. Encephalitis is considered a severe manifestation of dengue virus infection, and found in the three classical disease groups. Fulltext dengue encephalitis clinical spectrum and outcome. Case presentation an 18yearold sri lankan sinhalese boy presented with a history of 1 day of fever and an episode of. Mar 27, 2019 encephalopathy is a term for any diffuse disease of the brain that alters brain function or structure. Central sleep apnea in a patient with dengue encephalitis. Any virus serotype may be involved, but den2 and den3 are most frequently reported as the cause of severe neurological disease.
Background dengue fever has an expanded clinical spectrum ranging from an asymptomatic infection to life threatening dengue hemorrhagic fever and refractory shock. We describe a case of dengue associated posterior reversible encephalopathy syndrome and discuss diagnosis and management. When a patient presents with dengue or dengue like illness the differentiation between dhf and df will be a key factor in guiding management. Posterior reversible encephalopathy syndrome has rarely been described in dengue, although the pathophysiology of endothelial dysfunction likely underlies both. It is vital for developing a more effective management plan. Recommendations and iap id chapter plan of action jaydeep choudhury a,b, digant d.
Dengue encephalitis indian journal of critical care medicine. The commonest indication for picu admission was persistent shock 39 patients followed by requirement for positive pressure. Dengue virus infection can have different complications. Overt hepatic encephalopathy is diagnosed by clinical criteria and can be graded. Neurological complications and death in children with dengue virus. Diagnosis and management of hepatic encephalopathy core. The diagnosis of dengue fever was based on clinical features, fever, headache or bodyache, altered sensorium in case of encephalitis or encephalopathy, hemorrhagic manifestation, jaundice, and shock and positive serum igm igg antibodies. The guidelines to determine the precise timing and mode of delivery for term mothers suffering dengue infection are essential to facilitate management and to prevent adverse outcomes. Dengue infection in pregnancy can be a diagnostic dilemma, particularly considering the physiological changes in pregnancy and the obstetric complications encountered in clinical practice. Dengue encephalopathy involves a diminished level of consciousness that can be precipitated or caused by several factors, including prolonged shock, anoxia, cerebral oedema, metabolic disturbances eg, hypo.
The diagnosis of dengue was confirmed by the serum antibodies to dengue and the presence of a dengue antigen in the cerebrospinal fluid. Dengue fever has always been considered to be nonneurotropic. The morbidity and sometimes fatal outcome of dengue encephalitis necessitates a better understanding of the disease, early diagnosis and appropriate management. Most reported cases of dengue encephalopathy or encephalitis recover without neurological sequelae. These studies should be requested as soon as dhfdss is.
Sep 29, 2018 your symptoms will depend on the cause and severity of your encephalopathy. Persistent hyper somnolence and desaturation despite resolution of fever led to a polysomnographic evaluation, which revealed significant central. Encephalopathy, reported occasionally, can occur in association with metabolic. Encephalopathy in dhf is an atypical manifestation and may appear in various forms, including depressed sensitivity. This case explains the importance of considering the diagnosis of dengue encephalitis in appropriate situations. During hospitalization, patient responded well to anti epileptics inj. Dengue shock syndrome the condition of patients who progress to shock suddenly deteriorates after a fever of 27 days duration. Dengue is a febrile illness caused by a flavivirus transmitted by aedes aegypti or aedes albopictus mosquitoes while taking a blood meal.
Dengue encephalopathy acute encephalopathy is the most commonly reported neurological disorder associated with dengue virus infection. Dengue hemorrhagic fever presenting as encephalitis. Thrombocytopenia and haemoconcentration are usually detectable before the subsidence of fever and the onset of shock. Neurological manifestations of dengue infection cellular. Clinical and laboratory diagnosis of dengue virus infection oxford. Pdf prospective casecontrol study of encephalopathy in.
You may also have trouble with problemsolving skills. Dengue encephalitis and encephalopathy are different. Clinical features, complications and atypical manifestations. Encephalopathy may be caused by infectious agent bacteria, virus, or prion, metabolic or mitochondrial dysfunction, brain tumor or increased pressure in the skull, prolonged exposure to toxic elements including solvents, drugs, radiation, paints, industrial chemicals, and certain metals. In the standardised guidelines for epidemiological monitoring and laboratory diagnosis of infection with zika virus in mexico, it is proposed that 10% of patients with confirmed zika virus infection will be tested for dengue and chikungunya to identify coinfections. The diagnosis criteria for dengue encephalitis consists of. Mar 04, 2015 diagnosis and management of dengue in children iap infectious diseases chapter 1. Complications of dengue fever are common and usually related to renal and hepatic dysfunction 1,2. Pdf dengue encephalitis clinical spectrum and outcome. Neurological complications of dengue virus infection. The choice of one of these laboratorial methods should be performed according to the time of infection onset4.
On december 20, 2015, a 55yearold woman in vietnam sought medical care at her local hospital near ho chi minh city with 1 day of fever, muscle aches, and anorexia. Posterior reversible encephalopathy pres in a child with. Two case reports on thalamic and basal ganglia involvement in children with dengue fever. Dengue fever and dengue haemorrhagic fever are two different clinical conditions from the beginning. Classical dengue fever is rare among indigenous people as most of the adults are immune. Dengue, the most common arboviral disease transmitted globally, is caused by four antigenically distinct dengue.
Dengue viral infections as a cause of encephalopathy gn malavige, pk ranatunga, sd jayaratne, b wijesiriwardana, sl seneviratne, dh karunatilaka abstract. The diagnosis of he is through exclusion of other causes of brain dysfunction grade ii2, a, 1. The pathophysiology of dengue encephalitis and encephalopathy are a benign but potentially fatal disease. Jun 30, 2014 in a 2year prospective casecontrol study performed in vietnam, dengue associated encephalopathy accounted for 0. Mar 01, 2015 a diagnosis of dengue fever was made on the basis of igm antibodies in serum and encephalopathy was attributed to dengue encephalitis in the absence of another etiological cause of encephalopathy. A rare case of dengue encephalopathy complicating a term. Dengue virus is an underrecognised causative agent of acute. Uncommon presentations of this common illness make diagnostic dilemmas and can delay standard treatment which leads to unfavorable outcomes. Brain imaging in cases with positive serology for dengue. Dengue viruses are single stranded viruses of flaviviridae family, which can cause dengue fever and dengue hemorrhagic fever. Jul 20, 2002 neurological complications associated with dengue infection can arise in dengue fever and dengue haemorrhagic fever. A presumptive diagnosis of viral encephalitis was made, and he was started on intravenously administered acyclovir 500 mg 8 hourly and. However, encephalitis must always be distinguished from an encephalopathy, which may present similar manner. Full text neurological manifestations of dengue viral.
If history of exposure to person with coldlike symptoms, patient would have been infected 414 days before onset of symptoms. Diagnosis of dengue encephalopathy is based on clinically diagnosed dhf according to the w. Dengueassociated posterior reversible encephalopathy. Children with chronic liver or development of neurological symptoms showed a median of 848 encephalopathy in dengue hemorrhagic fever 849 table 1 significant paraclinical findings in 27 patients with encephalopathy and 27 control patients parameter normal range study group control group p value hematocrit % 31. Zika and dengue testing algorithm for symptomatic nonpregnant patients. Hepatic encephalopathy should be divided into various stages of severity, reflecting the degree of selfsufficiency and the need for care grade iii, b, 1. Cortical laminar necrosis in dengue encephalitisa case report cortical laminar necrosis in dengue encephalitisa case report. Early detection and proper fluid management of dhf should be done to prevent any. Brain imaging in cases with positive serology for dengue with. The second day featured diagnostic needs for dengue and covered specific methods for the diagnosis of dengue by means of the detection of antigen and antibody, including. Dengue encephalopathy is a condition that is characterized by altered sensorium and caused by certain metaboliccirculatory factors, but not by the dengue virus itself. With symptomatic dengue infection, the principal symptoms are high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash, mild bleeding e.
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