Neurological manifestations of dengue viral infection

Figures & data

Table 1 Factors that may favor resurgence of dengue

Geographical expansion of mosquito viruses and vectors

Presence of endemic virus transmission

Hyperendemicity

Expansion from urban to semiurban and rural areas

Extensive vector infestation

Decline of vector control campaigns

Increase of human population density in urban areas

Unreliable water supply systems and poor solid waste disposal

Increase of nonbiodegradable containers in endemic areas

Human traveling

Table 2 The 2009 World Health Organization classification for dengue severity

Criterial for dengue and warning signs

Probable dengue

Live in/travel to dengue endemic area

Fever and two of the following criteria

Nausea

Rash

Aches and pains

Tourniquet test positive

Leukopenia

Any warning sign

Warning signs

Abdominal pain or tenderness

Persistent vomiting

Clinical fluid accumulation

Mucosal bleed

Lethargy, restlessness

Liver enlargement ˃2 cm

Laboratory: increase in hematocrit concurrent with rapid decrease in platelet count

Criteria for severe dengue

Severe plasma leakage leading to

Shock (DSS)

Fluid accumulation with respiratory distress

or

Severe bleeding as evaluated by the clinician

or

Severe organ involvement

Liver: AST or ALT ˃1,000 IU/L

CNS: impaired consciousness

Heart or other organs

Abbreviations: ALT, alanine transaminase; AST, aspartate transaminase; CNS, central nervous system; DSS, dengue shock syndrome

Table 3 Dengue-associated stroke subtypes

Hemorrhagic stroke

Basal ganglia hemorrhage

Brain lobe hemorrhage (single or multiple)

Bilateral cerebellar hemorrhage

Pontine hemorrhage

Acute subdural hematoma (single or multiple)

Pituitary adenoma hemorrhage

Subarachnoid hemorrhage

Ischemic stroke

Watershed infarct

Cortical infarcts

Lacunar infarcts in corona radiata and putamen

Table 4 Differential diagnosis of a febrile encephalopathy/encephalitis in the tropics

Cerebral malaria

Leptospirosis

Typhoid fever

Rickettsial infection

Tuberculosis meningitis

Japanese encephalitis virus

West Nile virus infection

Herpes simplex virus infection

Enteroviruses infection

Other viral and bacterial infections

Dengue encephalopathy