Dengue fever, a mosquito-borne viral infection caused by the dengue virus, presents a significant global health challenge. Typically, it manifests with high fever, severe headache, pain behind the eyes, joint and muscle pain, rash, and mild bleeding. However, in recent years, an alarming trend has emerged: the association of dengue fever with neurological complications. Neurological complications in dengue are not universally recognized, but they are increasingly documented in medical literature. These complications can arise during the acute phase of the infection or shortly thereafter and vary in their clinical presentation. Among the most common neurological manifestations are encephalopathy, encephalitis, Guillain-Barré syndrome (GBS), myelitis, and peripheral neuropathy.
Common neurological complications
Encephalopathy, a diffuse dysfunction of the brain, can result from direct viral invasion, systemic inflammation, or complications such as severe liver dysfunction. Patients may present with altered mental status, confusion, seizures, or even coma. Encephalitis, characterized by inflammation of the brain tissue, is more severe and can lead to significant morbidity and mortality. Symptoms of encephalitis include fever, severe headache, stiff neck, altered consciousness, and neurological deficits such as weakness or sensory changes.
Guillain-Barré syndrome, a rare neurological disorder where the body’s immune system attacks the nerves, has also been linked to dengue infection. GBS can cause muscle weakness, paralysis, and in severe cases, respiratory failure requiring mechanical ventilation. Myelitis, or inflammation of the spinal cord, can lead to symptoms ranging from mild sensory disturbances to severe motor deficits, depending on the level and extent of the inflammation. Peripheral neuropathy, which affects the nerves outside the brain and spinal cord, can cause tingling, numbness, and muscle weakness, significantly impacting a patient’s quality of life.
The exact mechanisms by which dengue virus leads to these neurological complications are not fully understood but are believed to involve a combination of direct viral invasion, immune-mediated damage, and systemic inflammatory responses. The diagnosis of neurological complications in dengue requires a high index of suspicion, particularly in endemic areas or during outbreaks. Diagnostic tools include cerebrospinal fluid analysis, neuroimaging, and serological tests for dengue virus.
How to manage the complications
Management of these complications primarily focuses on supportive care and treating the underlying dengue infection, according to Dr Bharath Kumar Surisett, Consultant Neuro Physician and Movement Disorder Specialist, Yashoda Hospitals Hyderabad. In severe cases, intensive care support may be necessary. Immunotherapy may be beneficial in immune-mediated conditions such as GBS. Public awareness and education are crucial in preventing dengue fever through mosquito control measures and early recognition of symptoms. Enhanced surveillance and research into the neurological aspects of dengue are essential to improve patient outcomes and develop targeted therapies.
