Neurologic Sequelae After Encephalitis Associated With Dengue Virus in Children

Neurologic complications associated with dengue infection have been increasingly recognized globally, particularly following detection of dengue virus in cerebrospinal fluid via polymerase chain reaction. Despite this, no prior study has assessed neurologic sequelae in patients with dengue-associated acute encephalitis syndrome (DEN-AES). This study aimed to evaluate the extent and domains of neurologic sequelae in pediatric DEN-AES cases.

The study was conducted in 2023, including diagnosed DEN-AES cases (≤18 years) discharged between January 2018 and December 2019. DEN-AES was defined as acute fever onset with altered mental status (confusion, disorientation, coma, or inability to speak) and/or new seizures (excluding simple febrile seizures), as confirmed by NS1/IgM enzyme-linked immunosorbent assay and reverse transcription polymerase chain reaction tests for dengue. Long-term sequelae were assessed via home visits with a standardized disability assessment tool. Hospital records provided clinical, biochemical, and laboratory data for analysis.

Of 56 children (median age, 7.5 years [IQR, 5-10]; 53.6% male), neurologic sequelae of varying severity were observed in 22 (39.3%) cases. Severe disabilities were noted in 6 children, with 1 postdischarge death. Thirty-four children were fully recovered, scoring 5 on the Liverpool Outcome Score. Cognitive and behavioral impairments were the most common sequelae (37.5%), and 5 children required antiepileptic drugs for ongoing seizure management.

Neurologic sequelae were identified in 39% of pediatric DEN-AES cases, underscoring the need for early diagnosis, continuous follow-up, and dedicated rehabilitation policies in dengue-endemic regions to support affected children.