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As the spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also onthe rise, although they may be under reported because of lack of awareness. This review compiles descriptions of atypical mani...
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As the spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also onthe rise, although they may be under reported because of lack of awareness. This review compiles descriptions of atypical manifestations of dengue, such as dengue encephalitis, dengue myocarditis, dengue hepatitis and dengue cholecystitis.
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Dengue encephalitis is extremely rare, with most patients showing no significant abnormality on neuroimaging (CT/MRI). We report one of the very few documented cases of dengue encephalitis, with abnormal signal intensities on all ...
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Dengue encephalitis is extremely rare, with most patients showing no significant abnormality on neuroimaging (CT/MRI). We report one of the very few documented cases of dengue encephalitis, with abnormal signal intensities on all major sequences on brain MRI.
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Dengue fever and dengue hemorrhagic fever incidence is increasing in Sri Lanka, especially among the young population. Uncommon presentations of this common illness make diagnostic dilemmas and can delay standard treatment which l...
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Dengue fever and dengue hemorrhagic fever incidence is increasing in Sri Lanka, especially among the young population. Uncommon presentations of this common illness make diagnostic dilemmas and can delay standard treatment which leads to unfavorable outcomes. An 18-year-old Sri Lankan Sinhalese boy presented with a history of 1 day of fever and an episode of seizure followed by left-side hemiparesis. He was diagnosed to have dengue complicated by dengue hemorrhagic fever and recovered with minimal residual weakness. He presented with neurological symptoms; cerebrospinal fluid analysis, electroencephalogram, and magnetic resonance imaging showed evidence of encephalitis. Positive dengue antigen and antibody in serum and cerebrospinal fluid with the exclusion of other possible etiologies confirmed parainfectious dengue encephalitis. He was started on sodium valproate 200?mg 8 hourly and made a slow neurological recovery with mild residual weakness (grade 4+ power) in his left upper limb at 2?months with intensive supervised physiotherapy. Standard national guideline-based management of dengue illness has significantly reduced its mortality rates in Sri Lanka. However, uncommon presentations of a common illness often cause diagnostic dilemmas. Hence, reporting of these presentations and knowing the epidemiologic patterns of the disease help physicians to arrive at the correct diagnosis even though they do not have sophisticated serological investigations. Overall, this can improve the quality of health care and reduce mortalities, especially in a resource-poor setup.
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Background: Acute Encephalitis Syndrome (AES) is defined as a person of any age at any time of year, with the acute onset of fever and a change in mental status such as confusion, disorientation, coma or inability to talk and/or n...
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Background: Acute Encephalitis Syndrome (AES) is defined as a person of any age at any time of year, with the acute onset of fever and a change in mental status such as confusion, disorientation, coma or inability to talk and/or new onset of seizures (excluding simple febrile seizure). Most cases of AES are due to viral encephalitis, which is more prevalent in South East Asia. Aim and Objectives: to study clinical profile and risk factors for adverse outcome of AES in children in Acharya Vinoba Bhave Rural Hospital (AVBRH). Material and Methods: This cross-sectional, observational study was conducted in children with AES admitted in Pediatric Intensive Care Unit (PICU) of AVBRH over period of 2 years (August 2017- July 2019). Data collection were done by using predesigned, structured proforma and analyzed by using SPSS version 22. Results: Of the 80 cases enrolled in the study 31.25% were between 10-15 years. In this study male to female ratio was 1.5. Mostly subjects were residing in rural area (54.1%), with a common presentation of fever (100%), altered sensorium (73.7%) and convulsion (71.25%). Mortality was observed in 23.7% cases out of which 40(50%) had viral etiology (other than dengue), 21(26.25%) had dengue, 5(6.2%) had malaria. Those who presented with shock and required mechanical ventilation and had deranged Liver Function Test (LFT) profile have statistically significant correlation with mortality. Conclusion: Majority of cases were in the age group 10-15 years, with male predominance. Deranged LFT, presence of shock significantly associated with mortality among children with AES. Viral encephalitis is an important cause of AES.
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Dengue infection classically presents with fever, thrombocytopaenia, and varying degrees of plasma leakage, giving rise to shock. However, a myriad of other manifestations, involving the cardiovascular system, the nervous system, ...
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Dengue infection classically presents with fever, thrombocytopaenia, and varying degrees of plasma leakage, giving rise to shock. However, a myriad of other manifestations, involving the cardiovascular system, the nervous system, the liver, the kidneys, the gut and the haematological system have been reported in dengue. This review summarizes these varied presentations.
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Background Dengue is the leading cause of mosquito-borne viral infection. It is responsible for high morbidity and mortality in children living in endemic areas. Nowadays, neurological complications are progressively referred to a...
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Background Dengue is the leading cause of mosquito-borne viral infection. It is responsible for high morbidity and mortality in children living in endemic areas. Nowadays, neurological complications are progressively referred to and include a broad spectrum of symptoms. It can be secondary to metabolic alterations, direct invasion by the virus, and enhanced autoimmune response. Case presentation Here, we report a rare case of hydrocephalus secondary to dengue encephalitis. A 13-day-old boy was diagnosed with dengue. He evolved with seizures and impaired consciousness being diagnosed with encephalitis. After clinical treatment, he was discharged fully recovered. Three months later, he presented with signs and symptoms of intracranial hypertension. Brain MRI revealed hydrocephalus secondary to acquired aqueduct stenosis. The patient underwent an endoscopic third ventriculocisternostomy. Conclusion Dengue infection is a differential diagnosis for acute febrile neurological impairment in children from endemic areas. Follow-up should be offered after dengue encephalitis to detect possible late-onset complications, as hydrocephalus.
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Introduction: Meningitis is a common tropical infection which causes significant morbidity and mortality in children. Vaccination is available now-a-days for Haemophilus influenza and pneumococcus which are the common infection ca...
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Introduction: Meningitis is a common tropical infection which causes significant morbidity and mortality in children. Vaccination is available now-a-days for Haemophilus influenza and pneumococcus which are the common infection causing meningitis. Profile of acute Central Nervous System (CNS) infection in children varies with time to time as it depends on the organism, age, seasonal period, outbreaks, immunisation and place. Aim: To study the clinical, microbiological, radiological profile and outcome of children with acute CNS infection in a tertiary care centre in the present vaccination era. Materials and Methods: This prospective observational study was done in the Department of Paediatrics, Government Dharmapuri Medical College Hospital, Tamil Nadu, India, from December 2018 to June 2020. Total 50 children from one month to 12 years with features of acute CNS infection were included in the study. Clinical features, Cerebrospinal Fluid (CSF) and serology findings, Computed Tomography (CT) scan findings and outcome were taken for analysis. The data were entered in Microsoft Excel software and analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. Results: During the study period, 50 children were diagnosed with acute CNS infection. A total of 37 (74%) children were less than 3 years and 31 (62%) male children were commonly affected. Fever 42 (84%), seizures 46 (92%) and altered sensorium 31 (62%) were the common symptoms. Status epilepticus 40 (87%), shock 18 (36%), respiratory distress 16 (32%) were common findings. In CSF, elevated cell count, reduced sugar, elevated protein were seen in 21 (42%), 14 (28%) and 27 (54%), respectively. Pneumococcus 3 (6%), Japanese Encephalitis (JE) 8 (16%), dengue 5 (10%), herpes 4 (8%), scrub typhus (aetiological agent Orientia tsutsugamushi ) 2 (4%) were the common aetiological agents for CNS infection. CT brain was abnormal in 8 (16%) children. Nine children died (18%) and rest 41 (82%) recovered. Conclusion: In the present vaccination era, viruses and tropical fevers- JE, dengue, herpes and scrub typhus were common causes for acute CNS infection in children. Common clinical features were status epilepticus, fever, altered sensorium, respiratory distress and shock. Initial stabilisation of physiological status, specific management and JE vaccination are mandatory to improve the outcome in CNS infection.
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The hemagglutination inhibition assay (HAI) is commonly used for serological screening of dengue virus (DENV) and Japanese encephalitis virus (JEV) infections. However, HAI is time- and resource-intensive due to the multiple steps...
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The hemagglutination inhibition assay (HAI) is commonly used for serological screening of dengue virus (DENV) and Japanese encephalitis virus (JEV) infections. However, HAI is time- and resource-intensive due to the multiple steps required for serum processing. This study evaluated the sensitivity and specificity of a monoclonal antibody (mAb)-based capture enzyme-linked immunosorbent assay (mAb-ELISA) in screening DENV- and JEV-specific IgG compared to the more traditional HAI. We selected 170 pairs of serum specimens obtained eight months apart during routine DENV surveillances in Kamphaeng Phet, Thailand, 2004-2005. These specimen pairs were tested by HAI to measure changes in neutralizing titers in individual subjects, followed by plaque reduction neutralization test for confirmation. Comparison of the HAI and anti-DENV/JEV IgG mAb-ELISA showed 100% specificity of IgG mAb-ELISA using 4G2 or the pair 2H2/J93 mAbs, and 92.9% and 97.6% sensitivity for 4G2 and 2H2/J93 mAb, respectively. Both anti-DENV/JEV IgG-4G2 and anti-DENV/JEV IgG-2H2/J93 mAb-ELISA correlated highly with DENV/JEV HAI. Hence, the anti-DENV/JEV IgG mAb-ELISA should be considered as an alternative screening tool to HAI for serological screening of DENV/JEV infection.
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Background: Parkinsonism following viral encephalitis is well reported. However, in addition, to parkinsonism other movement disorders such as dystonia, chorea, myoclonus?may also be observed in these patients. Stereotypy is a ver...
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Background: Parkinsonism following viral encephalitis is well reported. However, in addition, to parkinsonism other movement disorders such as dystonia, chorea, myoclonus?may also be observed in these patients. Stereotypy is a very rare manifestation following viral encephalitis.Case report: Here we report a rare case of a 25-year-old young man who developed stereotypy and parkinsonism following dengue virus encephalitis. The stereotypy was in the form of snapping of fingers of left-hand which was repetitive, purposeless, non-goal directed, present for most of the day and partially suppressible.Discussion: This report expands the spectrum of movement disorders seen in dengue infection.
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