Dengue encephalitis – clinical spectrum and outcome

Background: Dengue viral infection is common worldwide caused by dengue virus. Recent studies have shown dengue viral infection causing encephalitis with high morbidity and mortality. The Dengue encephalitis patients usually present with altered sensorium, elevated lab parameters and high antibody titres at the time of admission. Aims: To compare initial lab parameters, clinical spectrum and outcome in patients of dengue fever with or without encephalitis. Settings and design: The study was done in a multi-speciality teaching hospital. Fourty nine patients were included in the study with febrile illness and thrombocytopenia, proved to be having Dengue fever. Material and Methods: A prospective study was conducted on 49 patients with febrile illness and thrombocytopenia proved to be having Dengue fever during a period of 6 months were included. Initial lab parameters, clinical spectrum and outcome were compared in patients with or without encephalitis. Statistical analysis used: The database of all parameters were analysed using “STATA SOFTWARE VERSION10.0”. Results: 49 cases of proven dengue fever were included in the study. Among these patients 25 patients had no encephalitis and 24 patients had encephalitis. Most common clinical features in patients without encephalitis were fever with chills and rigors and in patients with encephalitis were fever with altered sensorium (P-value < 0.05). Among total 49 patients, 24 patients had encephalitis. There were no statistical difference among factors like age, sex, PCV, Platelet count, PT, and INR in these two groups (with or without encephalitis) at admission. The APTT, serum Ig-M antibodies, Ig-G antibodies, SGOT and SGPT were significantly high in encephalitis group (P-value < 0.05). All 25 dengue patients without encephalitis recovered completely without any complication. Among 24 dengue patients with encephalitis, 22 patients recovered completely (independent for activities of daily living), and 2 patients died (due to severe sepsis with MODS). Conclusions: Increased incidence of dengue fever with encephalitis in the recent years, in the absence of single sensitive test for detecting dengue encephalitis, variable CSF and MRI Brain features, and associated high morbidity and mortality, this study may be helpful in focussing on early diagnosis and aggressive initial management which can influence final outcome.