Neurological complications and death in children with dengue virus infection: report of two cases

 

Neydi Osnaya-Romero^1  2, Maria Gabriela Perez-Guille¹, Sandra Andrade-García², Erika Gonzalez-Vargas², Rebeca Borgaro-Payro², Sandra Villagomez-Martinez¹, José de Jesús Ortega-Maldonado², Jose Luis Arredondo-García¹

 

1 Intituto Nacional de Pediatria Insurgentes Sur 3700, letra C, Col. Insurgentes Cuicuilco, CP 04530 Ciudad de México, Mexico.

2 Morelense Children’s Hospital, Emiliano Zapata, Morelos, Mexico.

 

ABSTRACT

Background

Dengue virus infection can have different complications; the best known is hemorrhagic dengue fever. However, other effects such as neurological disorders may endanger the lives of patients. Dengue neurological manifestations can be confused with encephalitis symptoms and can lead to cerebral edema and death. Therefore, we consider important in the endemic areas to take into account the diagnosis of dengue encephalitis in patients with neurological disorders, and to request the determination of serology in cerebrospinal fluid for the NS1 antigen test.

Case presentation

We present the cases of two patients from the state of Morelos, Mexico, with 17 and 14 years of age. Both cases presented a rapid evolution characterized by fever, seizures and neurological deterioration secondary to severe cerebral edema that evolved to cerebral death in both cases. The diagnosis of brain death was confirmed by electroencephalogram in both patients. The two patients were submitted to serology for NS1 that tested positive in both cases. They died between the second and fifth day after admission.

Conclusions

Retrospective studies have found that up to 4% of the patients have dengue virus infections, which leads us to believe that in endemic areas, this infection should be suspected in cases of encephalic and febrile symptoms. RT-PCR should be performed to identify cases of encephalitis caused by the dengue virus, and early interventions should be performed to attempt to reduce the morbidity and mortality of these cases.

 

Key words: Dengue; Dengue virus; Neurological disorders; Death; Children

 

Funding

Not applicable.

 

Received: December 14, 2016.

Revised: April 8, 2017.

Accepted: April 27, 2017.

 

Correspondence: arredondo.joseluis@gmail.com

 

Authors’ contributions

NOR, SAG, EGV, and JJOM made substantial contributions to the conception and design of the study and to the acquisition of data. MGPG and RBP made substantial contributions to the conception and design of the study and to the analysis and interpretation of the data. NOR, MGPG, SVM, and JLAG were involved in drafting the manuscript and revising it critically for important intellectual content. SVM and JLAG are dengue experts and made substantial contributions to the conception and design of the study. All of the authors read and approved the final manuscript, agreed to be accountable for all aspects of the work, and ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

 

Competing interests

The authors declare that they have no competing interests.

 

Consent for publication

Written informed consent was obtained from the parents of the patients for publication of this case report.

 

Ethics approval and consent to participate

Not applicable.

 

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