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| LETTER TO EDITOR |
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| Year : 2023 | Volume
: 11
| Issue : 2 | Page : 168-169 |
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Neurological complications of dengue virus infection
Mayank Jha1, Ana Leticia Fornari Caprara2, Jamir Pitton Rissardo2
1 Department of Clinical Medicine, Government Medical College, Surat, Gujarat, India
2 Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
| Date of Submission | 07-Dec-2022 |
| Date of Acceptance | 08-Feb-2023 |
| Date of Web Publication | 18-Apr-2023 |
Correspondence Address:
Jamir Pitton Rissardo
Av. Roraima, 1000 - Camobi, Santa Maria - RS
Brazil
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/mjhs.mjhs_167_22
How to cite this article:
Jha M, Fornari Caprara AL, Rissardo JP. Neurological complications of dengue virus infection. MRIMS J Health Sci 2023;11:168-9 |
Dear Editor,
We read the article entitled “Knowledge and practice about dengue fever among urban slum dwellers in one district of Andhra Pradesh, India: A study on current status” in the esteemed medical journal of MRIMS Journal of Health Sciences with great interest. Lavanya et al. assessed the knowledge and practice of dengue fever. They found that dengue awareness among urban slum dwellers is good. However, there is still need to improve practices related to mosquito control measures. In this way, surveillance activities can be strengthened to close monitoring of disease trends and take prompt measures when required.[1]
Dengue fever is a condition categorized as a “neglected tropical disease” by the World Health Organization. It is a mosquito-borne viral disease and highly endemic and prevalent in Asiatic regions. Dengue can cause various symptoms, from isolated fever to atypical life-threatening conditions such as encephalitis, which is associated with severe long-term neurological complications.[2] Herein, we would like to discuss the recent article published on neurological manifestations of dengue fever.
Dengue virus is considered a potential neuroinvasive pathogen [Figure 1]. Sweety Trivedi et al. reviewed the literature about immunological techniques to categorize dengue's diverse neurological presentations. In this context, they observed that the differentiation between dengue-associated encephalopathy and dengue encephalitis is still challenging.[2] The most recent hypothesis for the pathological mechanisms for neurological manifestations associated with the dengue virus involves molecular mimicry. Interestingly, the first mechanical hypotheses were thrombocytopenia and cerebral vasculitis. However, these processes do not explain the regulated cytokine release phenomenon observed in posterior reversible encephalopathy syndrome.
Another Indian study conducted among 5821 patients with dengue reported around 154 individuals with neurological complications. The most frequent manifestations were encephalopathy with multisystem involvement, encephalitis with focal features, abnormal neuroimaging and cerebrospinal fluid analysis, and acute symptomatic seizures. On the other hand, less common neurological presentations of dengue virus were intracranial hemorrhage, Guillain–Barre syndrome, optic neuritis, myositis, hypokalemic paralysis, ischemic stroke, posterior reversible encephalopathy syndrome, myoclonus, and brachial plexopathy.[3] It is worth mentioning that the individual had the presentations associated with positive serologies, so only indirect associations can be assumed.
Dengue-associated encephalitis syndromes are increasingly being recognized in tropical and subtropical regions. In an accurate observation of the neuroimaging of dengue-associated encephalitis, the “double doughnut sign” was observed. This sign is characterized by hyperintensity in bilateral thalami with intense diffusion restriction at the center and hemorrhages. The “double doughnut sign” is commonly described with dengue, but it was already observed in other conditions, such as acute disseminated encephalomyelitis.[4]
Hypokalemic periodic paralysis resembling Guillain–Barre syndrome was reported to be associated with dengue in the literature. Interestingly, a study observed that up to 28% of the individuals with dengue infection have abnormal potassium levels without any associated weakness.[4] This finding is interesting because there is no potassium concentration in the current criteria for diagnosis of dengue. Moreover, we believe that the percentage of hypokalemia may be even worse if we consider potassium levels according to the basal levels of the individuals.[5]
The neurological complications of dengue are poorly described in the literature. There are several studies regarding this context, but there is no direct association between the causes of neurological manifestations and the dengue virus. The neurological complications of dengue fever need more elaborated studies to understand it and have a more brief and clear descriptive picture as a whole for potential outcomes and a better therapeutic approach.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Lavanya KM, Kumar Andey UV, Mishra SK, Vutharkar NR. Knowledge and practice about dengue fever among Urban slum dwellers in one district of Andhra Pradesh, India: A study on current status. MRIMS J Health Sci 2022;10:93-8.  [Full text] |
| 2. | Trivedi S, Chakravarty A. Neurological complications of dengue fever. Curr Neurol Neurosci Rep 2022;22:515-29. |
| 3. | Kulkarni R, Pujari S, Gupta D. Neurological manifestations of dengue fever. Ann Indian Acad Neurol 2021;24:693-702. [Full text] |
| 4. | Chakravarty K, Ray S. Neurological manifestations of dengue – Editorial commentary. Ann Indian Acad Neurol 2021;24:648-9. [Full text] |
| 5. | Kamath V, Ganguly S, Avinash BL, Vinodh V. Secondary hypokalemic periodic paralysis: A study of a case series. APIK J Int Med 2019;7:74-9. [Full text] |
[Figure 1]
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