Dengue Encephalopathy in Hadoti Region: Clinical Presentation, Diagnostic Evaluation, Management and Outcome

Dengue viral infection is common worldwide. Recent studies have shown dengue viral infection causing encephalopathy, with high morbidity and mortality. Dengue encephalopathy patients usually present with altered sensorium, elevated lab parameters and high antibody titres at the time of admission. Dengue infection was very common and virulent in Hadoti region during August to November 2017 and many patients presented with encephalopathy.

To study the clinical presentation, lab parameters and other diagnostic features, management and outcome of patients of dengue fever with encephalopathy in Hadoti region in August to November 2017.

The study was done in Govt Medical college Hospital Kota and other multi-speciality hospitals of Kota. Study population comprised of 60 patients presenting with febrile illness and thrombocytopenia, serologically proved to be having Dengue fever. Among these 60 patients, 30 patients had encephalopathy who presented with altered sensorium, seizures or any other neurological symptoms and remaining 30 had no signs and symptoms of encephalopathy.

Among 30 patients with encephalopathy and positive serology (NS1/IgM/ IgG), fever and altered sensorium was most common symptom, while amongst patients without encephalopathy fever with chills and generalised bodyache was more common clinical feature. Convulsions and respiratory distress were very common among encephalopathy patients. Out of 30 encephalopathy patients 16 patients (53%) had convulsions, 14 (46%) had respiratory distress, 17(56%) had shock and 3 patients (10%) had hemiplegia. 2 patients also had visual blurring and dysarthria. Mean duration between appearance of fever and altered sensorium was 4.6 (±2.1) days. Most of patients with encephalopathy had deranged hepatic (bilirubin, SGOT, SGPT), renal (urea, creatinine, decreased urine output) and coagulation parameters (PT/INR, bleeding manifestations). 9 (30%) patients died and 21(70%) patients improved with complete recovery (except 3 hemiplegic patients).

Increased incidence of dengue fever with encephalopathy in the recent years, in the absence of single sensitive test for detecting dengue encephalopathy, variable CSF and MRI Brain features, and associated high morbidity and mortality poses a big problem for clinician. This study may be helpful in focussing on early diagnosis and aggressive initial management which can influence final outcome.