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| Year : 2018 | Volume
: 66
| Issue : 5 | Page : 1525-1526 |
Dengue and Japanese encephalitis E: Concurrent infection, cross reactivity, and false positivity
Sora Yasri1, Viroj Wiwanitkit2
1 Medical Center, KMT Primary Care Center, Bangkok KMT Primary Care Center, Bangkok, Thailand
2 Hainan Medical University, China
| Date of Web Publication | 17-Sep-2018 |
Correspondence Address:
Dr. Sora Yasri
Medical Center, KMT Primary Care Center, Bangkok
Thailand
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.241361
How to cite this article:
Yasri S, Wiwanitkit V. Dengue and Japanese encephalitis E: Concurrent infection, cross reactivity, and false positivity. Neurol India 2018;66:1525-6 |
Sir,
The case report entitled “Diagnostic dilemma—dengue or Japanese encephalitis?” by Sivamani et al., is very interesting.[1] Sivamani et al., raised the interesting query regarding the diagnosis of the case. As noted by Garg et al.,[2] the presence of dual or concurrent infections might be the possible explanation. Indeed, dengue and Japanese encephalitis are concurrently endemic in several tropical countries. Based on our setting in tropical Southeast Asia, the two infections are highly endemic, but the presence of concurrent infection is extremely rare. In the present case, it was likely to have been a severe dengue infection that had neurological manifestations. The occurrence of thrombocytopenia and the complete resolution of the neurological deficits, and the presence of normal platelet count on the follow-up visit supports the view that the case could not have been Japanese encephalitis infection. In fact, a cross reactivity between dengue and Japanese encephalitis might have been observed. The false positive result during the performance of the immunoglobulins (Ig) M and IgG test for dengue and Japanese encephalitis has often been seen,[3] and it is not clinically recommended to use the immunological test for establishing the definitive diagnosis of the case.[4] The key point for the diagnosis of the present case should have been the “appearance of thrombocytopenia that would have completely recovered” and “the neurological disorder that would also have recovered.” This feature would not have been common in Japanese encephalitis infection, as the symptomatic infection in the latter case is usually severe, causing permanent neurological sequelae, and is usually not associated with platelet dysfunction.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | |  |
| 1. | Sivamani K, Dhir V, Singh S, Sharma A. Diagnostic dilemma—dengue or Japanese encephalitis?. Neurol India 2017;65:105-7.  [ PUBMED] [Full text] |
| 2. | Garg RK, Malhotra HS, Jain A. Dual infection with Japanese encephalitis and dengue fever: Issues with diagnosis. Neurol India 2017;65:108-9. [ PUBMED] [Full text] |
| 3. | Wiwanitkit V. Dengue fever: Diagnosis and treatment. Expert Rev Anti Infect Ther 2010;8:841-5. |
| 4. | Mangold KA, Reynolds SL. A review of dengue fever: a resurging tropical disease. Pediatr Emerg Care 2013;29:665-9; quiz 670-1. |
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