Viral encephalitis as a complication of dengue in western Paraná
Keywords:Dengue; Encephalitis; Severe Dengue; Viral Encephalitis; Arbovirus Encephalitis.
Dengue affected more than 770,000 people in Brazil during the first five months of 2020. Having four different serotypes, it is considered a severe endemic viral infection influenced by urbanization level. Diagnostic confirmation is performed only with the serological IgM and IgG tests, but due to late positivity of these tests, six and nine days respectively, the treatment is almost always empirical. Between 1-5% of dengue cases evolve into neurological disease, both by the immunological reaction, which ends up manifesting itself later in the form of encephalitis. This study reports the case of a patient with post-dengue encephalitis. Initially, the patient AST, 66 years old, sought care complaining of lipothymia and was discharged from hospital after supportive measures. She evolved with dyspeptic symptoms, myalgia and fluctuating level of consciousness, being hospitalized again for treatment. After multidimensional evaluation, computed tomography was performed, which showed no changes. A CSF puncture was also requested. Empirical therapy was performed with Sodium Valproate, Dexamethasone, Ceftriaxone, Panciclovir and supportive treatment for hemodynamic and seizure control. With positive dengue IgG serology, the team maintained therapy for viral encephalitis. The evolution was favorable with minimal sequelae, such as mild proximal weakness and lacunar amnesia. Therefore, it is concluded that infections by dengue virus, as well as by other arboviruses, can cause potentially fatal complications such as viral encephalitis, requiring early diagnosis and intervention.
Abbas, A., Lichtman, A., & Pillai, S. (2015). Imunologia Celular e Molecular (8a ed). Elsevier.
Baheti, G., Mehta, V., Ramchandani, M., & Ghosh, G. C. (2018). Dengue fever with encephalitis: A rare phenomenon. BMJ Case Reports, 2018, 1–3. https://doi.org/10.1136/bcr-2018-225463
Borawake, K., Wagh, A., & Dole, S. (2011). Dengue encephalitis. Indian Journal of Critical Care Medicine, 15(3), 190–193. https://doi.org/10.4103/0972-5229.84896
Chao, C. H., Wu, W. C., Lai, Y. C., Tsai, P. J., Perng, G. C., Lin, Y. S., & Yeh, T. M. (2019). Dengue virus nonstructural protein 1 activates platelets via Toll-like receptor 4, leading to thrombocytopenia and hemorrhage. PLoS Pathogens, 15(4), 1–26. https://doi.org/10.1371/journal.ppat.1007625
Collao-Parra, J. P., Romero-Urra, C., & Delgado-Derio, C. (2018). Encefalitis autoinmunes: criterios diagnósticos y pautas terapéuticas. Revista Médica de Chile, 146(3), 351–361. https://doi.org/10.4067/s0034-98872018000300351
Fonseca, M. F. (2016). Segunda opinião formativa: como é realizado o diagnóstico de dengue? https://bit.ly/2VGVt9h
Guzman, M. G., Gubler, D. J., Izquierdo, A., Martinez, E., & Halstead, S. B. (2016). Dengue infection. Nature Reviews Disease Primers, 2, 1–26. https://doi.org/10.1038/nrdp.2016.55
Homero, V. (2010). Vírus da dengue pode levar a transtornos neurológicos. FAPERJ – Fundação Carlos Chagas Filho de Amparo à Pesquisa Do Estado Do Rio de Janeiro. https://bit.ly/2Bx6umR
Instituto René Rachou. (2020). Dengue. Agência Fiocruz de Notícias. https://bit.ly/2YUVgSc
Kamal, M., Kenawy, M. A., Rady, M. H., Khaled, A. S., & Samy, A. M. (2018). Mapping the global potential distributions of two arboviral vectors Aedes aegypti and Ae. albopictus under changing climate. PLOS ONE, 13(12), e0210122. https://doi.org/10.1371/journal.pone.0210122
Khetarpal, N., & Khanna, I. (2016). Dengue Fever: Causes, Complications, and Vaccine Strategies. Journal of Immunology Research, 2016, 1–14. https://doi.org/10.1155/2016/6803098
Krishnamoorthy, S., Bhatt, A. N., Mathew, C. T., & Ittyachen, A. M. (2017). Hepatitis and thrombocytopenia: markers of dengue mortality. Tropical Doctor, 47(2), 136–141. https://doi.org/10.1177/0049475517691878
Machado, A., & Haertel, L. M. (2013). Neuroanatomia funcional (3a ed). Atheneu.
Ministério da Saúde. (2020). Boletim Epidemiológico 02: Monitoramento dos casos de arboviroses urbanas transmitidas pelo Aedes (dengue, chikungunya e zika), Semanas Epidemiológicas 1 a 52.
Ministério da Saúde. (2020). Boletim Epidemiológico 21: Monitoramento dos casos de arboviroses urbanas transmitidas pelo Aedes Aegypti (dengue, chikungunya e zika), Semanas Epidemiológicas 1 a 20, 2020.
Neto, J. P. B., & Takayanagui, O. (2013). Tratado de Neurologia da Academia Brasileira de Neurologia. Elsevier.
Newman, M. P., Blum, S., Wong, R. C. W., Scott, J. G., Prain, K., Wilson, R. J., & Gillis, D. (2016). Autoimmune encephalitis. Internal Medicine Journal, 46(2), 148–157. https://doi.org/10.1111/imj.12974
Porwal, J., & Chauhan, A. (2016). Dengue Encephalitis. The Journal of the Association of Physicians of India, 64(8), 99–100. http://www.ncbi.nlm.nih.gov/pubmed/27762126
Varatharaj, A. (2010). Encephalitis in the clinical spectrum of dengue infection. Neurology India, 58(4), 585. https://doi.org/10.4103/0028-3886.68655
Yin, R.K. (2015). O estudo de caso. Porto Alegre: Bookman.
How to Cite
Copyright (c) 2021 Wesley Gabriel Novaes Botelho; Anderson Dillmann Groto; Beatriz Paiola Albrecht; Breno Emanuel Santana Rego; Alcântara Ramos de Assis César
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.