Central Nervous System Involvement in Dengue Virus Type 1 Infection: A Pediatric Case Series

Abstract

Central nervous system involvement accounted for 0.5 to 21.2% of dengue virus infections. Dengue virus type 2 and type 3 were commonly found in patients with central nervous system manifestations, while dengue virus type 1 (DENV-1) was rarely reported. We reported three dengue fever cases with neurological complications associated with DENV-1 infection. A previously healthy boy presented with fever, agitation, and an altered mental status in the first case. The other two cases presented with fever and seizures. All of them had no plasma leakage from dengue infection. DENV-1 was detected by reverse transcriptase-polymerase chain reaction assay in cerebrospinal fluid, serum, or both. All three cases were resolved entirely without neurological sequelae. This study can alert hospitals to prepare for the next epidemic in which there could be increasing cases of unusual or severe manifestations of dengue.

Keywords

dengue - encephalitis - encephalopathy - neurological complications - DENV-1

Publication History

Received: 20 December 2021

Accepted: 29 April 2022

Article published online:
02 August 2022

• References

• 1 Pancharoen C, Thisyakorn U. Neurological manifestations in dengue patients. Southeast Asian J Trop Med Public Health 2001; 32 (02) 341-345
• 2 Cam BV, Fonsmark L, Hue NB, Phuong NT, Poulsen A, Heegaard ED. Prospective case-control study of encephalopathy in children with dengue hemorrhagic fever. Am J Trop Med Hyg 2001; 65 (06) 848-851
• 3 Hendarto SK, Hadinegoro SR. Dengue encephalopathy. Acta Paediatr Jpn 1992; 34 (03) 350-357
• 4 Domingues RB, Kuster GW, Onuki-Castro FL, Souza VA, Levi JE, Pannuti CS. Involvement of the central nervous system in patients with dengue virus infection. J Neurol Sci 2008; 267 (1-2): 36-40
• 5 Solomon T, Dung NM, Vaughn DW. et al. Neurological manifestations of dengue infection. Lancet 2000; 355 (9209): 1053-1059
• 6 Ngwe Tun MM, Muthugala R, Nabeshima T. et al. Unusual, neurological and severe dengue manifestations during the outbreak in Sri Lanka, 2017. J Clin Virol 2020; 125: 104304
• 7 Carod-Artal FJ, Wichmann O, Farrar J, Gascón J. Neurological complications of dengue virus infection. Lancet Neurol 2013; 12 (09) 906-919
• 8 Li GH, Ning ZJ, Liu YM, Li XH. Neurological Manifestations of Dengue Infection. Front Cell Infect Microbiol 2017; 7: 449
• 9 World Health Organization. Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. 2nd edition. England: WHO; 1997
• 10 World Health Organization. Dengue and Severe Dengue. 2022 . Accessed May 16, 2022 at: https://www.who.int/health-topics/dengue-and-severe-dengue#tab=tab_1
• 11 Vector-Borne Diseases Division, Department of Disease Control, Ministry of Public Health. Predictive Model of Dengue hemorrhagic fever in Thailand 2020. Nonthaburi: DoDC; 2020
• 12 Chareonsook O, Foy HM, Teeraratkul A, Silarug N. Changing epidemiology of dengue hemorrhagic fever in Thailand. Epidemiol Infect 1999; 122 (01) 161-166
• 13 Nisalak A, Clapham HE, Kalayanarooj S. et al. Forty years of dengue surveillance at a tertiary pediatric hospital in Bangkok, Thailand, 1973-2012. Am J Trop Med Hyg 2016; 94 (06) 1342-1347
• 14 Sabchareon A, Sirivichayakul C, Limkittikul K. et al. Dengue infection in children in Ratchaburi, Thailand: a cohort study. I. Epidemiology of symptomatic acute dengue infection in children, 2006-2009. PLoS Negl Trop Dis 2012; 6 (07) e1732
• 15 Dhenni R, Karyanti MR, Putri ND. et al. Isolation and complete genome analysis of neurotropic dengue virus serotype 3 from the cerebrospinal fluid of an encephalitis patient. PLoS Negl Trop Dis 2018; 12 (01) e0006198
• 16 Ngwe Tun MM, Muthugala R, Nabeshima T. et al. Complete genome analysis and characterization of neurotropic dengue virus 2 cosmopolitan genotype isolated from the cerebrospinal fluid of encephalitis patients. PLoS One 2020; 15 (06) e0234508
• 17 Lin Y, Ma D, Wen S. et al. Molecular characterization of the viral structural gene of the first dengue virus type 1 outbreak in Xishuangbanna: a border area of China, Burma and Laos. Int J Infect Dis 2019; 79: 152-161
• 18 Dang TT, Pham MH, Bui HV, Van Le D. Whole genome sequencing and genetic variations in several dengue virus type 1 strains from unusual dengue epidemic of 2017 in Vietnam. Virol J 2020; 17 (01) 7
• 19 Anoop M, Mathew AJ, Jayakumar B. et al. Complete genome sequencing and evolutionary analysis of dengue virus serotype 1 isolates from an outbreak in Kerala, South India. Virus Genes 2012; 45 (01) 1-13
• 20 Sharp TM, Anderson KB, Katzelnick LC. et al. Knowledge gaps in the epidemiology of severe dengue impede vaccine evaluation. Lancet Infect Dis 2022; 22 (02) e42-e51
• 21 Sharp TM, Tomashek KM, Read JS, Margolis HS, Waterman SH. A new look at an old disease: recent insights into the global epidemiology of dengue. Curr Epidemiol Rep 2017; 4 (01) 11-21