Publication:

Neurological complications in Dengue fever

Background Neurological involvement in dengue was previously observed as an encephalopathy mainly due to prolonged shock, hyponatremia and liver failure. Recently, direct neurotropic potential of the virus has been recognized. This study was performed to record the neurological complications in children with dengue infection.

Methods A prospective, cross-sectional study was conducted in 315 consecutive pediatric cases of dengue fever to record the neurological complications and perform detailed clinical evaluation and laboratory assessment. These patients were admitted in the pediatric ward or ICU of the Department of Pediatrics of a tertiary care teaching hospital located 50 km from Jaipur city amidst rural surroundings from 1st January 2016 till 31st October 2017. Appropriate statistical analysis was carried out using SPSS software version 22.0.

Results The neurological complications due to dengue fever was observed in 30 cases (9.5%). The most common symptoms were headache (73.3%, n = 22), altered sensorium (73.3%, n = 22), seizure (73.3%, n = 22), besides fever (100%, n = 30) and vomiting (56.6%, n = 17). The common signs were exaggerated DTR (73.3 %, n = 22), papilloedema (20%, n = 6) and muscle tenderness (13.3%, n = 4) besides hepatomegaly (100%, n = 30), and facial puffiness (66.6%, n = 20). The most commonly observed neurological complications were encephalopathy (53.3%, n = 16), encephalitis (n = 7, 23.3%), myositis (13.3%, n = 4), acute disseminated encephalomyelitis (3.3%, n = 1), hemiplegia with facial palsy (3.3%, n = 1) and intracranial hemorrhage (3.3%, n = 1). Mortality was observed in 3 cases (10%).

Conclusions Neurological complications of dengue in children are relatively uncommon. However, awareness is required for prevention, early recognition, and timely therapeutic intervention to prevent further complications and mortality.