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LETTER TO EDITOR
Year : 2022  |  Volume : 70  |  Issue : 2  |  Page : 790-791

Dengue Encephalitis and Dengue Hepatitis in an Infant


Department of Pediatrics, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India

Date of Submission07-Dec-2019
Date of Decision08-Feb-2020
Date of Acceptance12-Jul-2020
Date of Web Publication3-May-2022

Correspondence Address:
Dr. Nanda S Chhavi
Associate Professor, Department of Pediatrics, Era's Lucknow Medical College and Hospital, Lucknow - 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.344599

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How to cite this article:
Srivastava G, Chhavi NS. Dengue Encephalitis and Dengue Hepatitis in an Infant. Neurol India 2022;70:790-1

How to cite this URL:
Srivastava G, Chhavi NS. Dengue Encephalitis and Dengue Hepatitis in an Infant. Neurol India [serial online] 2022 [cited 2022 Jun 25];70:790-1. Available from: https://www.neurologyindia.com/text.asp?2022/70/2/790/344599




Dear Editor,

Dengue encephalitis (DE) is an atypical neurological manifestation of dengue virus (DENV) infection. Here we report a 4-month-old child who presented, on third day of illness, with high-grade fever, irritability, refusal to feed, and generalized seizures followed by drowsiness for 12 h. The baby had uneventful antenatal, perinatal, neonatal periods, and normal development. He was vaccinated according to age and had received last vaccination about 2 weeks ago. The child was febrile, hemodynamically stable, irritable, and had multiple petechae. The fundus examination was normal and there were no meningeal signs, fullness of fontanelles, or focal neurological deficit. The child had normal size liver and splenomegaly.

Dengue fever was diagnosed with a combination of acute febrile illness, ongoing dengue epidemic, low platelet counts (minimum was 30,000/micro liters), and NS1 antigen positivity. Total bilirubin 3.2 mg%, alanine aminotransferase 643 IU/L, and aspartate aminotransferase 1423 IU/L suggested liver injury. Cerebrospinal fluid (CSF) examination was normal (nonturbid, normal cell count, sugar 68 mg%, protein 14 mg%, Gram stain negative, and culture sterile). Virological studies of CSF were not done. Brain magnetic resonance imaging (MRI) showed hyperintensities in globus pallidus in T1-weighted images [Figure 1]. The child improved with supportive care without neurological sequelae. Laboratory investigations were normalized in 3 weeks' time.
Figure 1: Hyperintensity in the globus pallidus region in brain MRI

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The baby simultaneously had DE and dengue hepatitis. The encephalitis was marked with altered sensorium and hyperintensities in globus pallidus and hepatitis manifested with markedly increased serum levels of liver enzymes.

The DENV has tropism for liver cells.[1] The affinity of the DENV for hepatocyte is reflected in the high frequency of dengue hepatitis in patients with dengue infection.[2] DENV also is a member of genus Flavivirus which includes few of the known neurotropic viruses such as Japanese encephalitis virus, West Nile virus, and tick-borne encephalitis virus.[3] Encephalitis is a result of direct neural invasion by DENV.

The dengue antigen or antibody testing in CSF has limitations such as it needs expertise, risk of complications, restricted availability, and limited diagnostic yield.[4] Further, the CSF examination is reported as normal in majority of those with DE. MRI of the brain has occasionally identified hyperintensities in globus pallidus which is known as “Double Doughnut Sign.”[5] The child had DF, features of neurological involvement, and hyperintensities in globus pallidus.

In conclusion, DE should be considered as a possibility in an infant with dengue fever who develops features of brain involvement.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Martina BE, Koraka P, Osterhaus AD. Dengue virus pathogenesis: An integrated view. Clin Microbiol Rev 2009;22:564-81.  Back to cited text no. 1
    
2.
Srivastava G, Chhavi N, Goel A. Validation of serum aminotransferases levels to define severe dengue fever in children. Pediatr Gastroenterol Hepatol Nutr 2018;21:289-96.  Back to cited text no. 2
    
3.
Maximova OA, Pletnev AG. Flaviviruses and the Central nervous system: Revisiting neuropathological concepts. Annu Rev Virol 2018;5:255-72.  Back to cited text no. 3
    
4.
Kumar R, Tripathi S, Tambe JJ, Arora V, Srivastava A, Nag VL. Dengue encephalopathy in children in Northern India: Clinical features and comparison with non dengue. J Neurol Sci 2008;269:41-8.  Back to cited text no. 4
    
5.
Kumar AS, Mehta S, Singh P, Lal V. Dengue encephalitis: “Double doughnut” sign. Neurol India 2017;65:670-1.  Back to cited text no. 5
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