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Neurological issues on the rise among dengue patients: Docs

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Neurological issues on the rise among dengue patients: Docs

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PUNE: Doctors are seeing a significant rise in dengue cases, particularly among children below one year of age who are showing higher chances of developing shock due to early onset of ‘leaky phase’, requiring aggressive management.

The surge in dengue infections has raised concerns as some patients are presenting with critical conditions, including myocarditis (heart involvement), hypotension (low blood pressure), dengue encephalopathy and even co-infections with hepatitis A leading to dengue-associated jaundice.

Dr Sagar Lad, a senior paediatric intensivist at Jehangir and Sahyadri hospitals in Pune, told TOI, “Dengue, a mosquito-borne viral infection, has typically affected individuals of all age groups, but the recent case spike among very young children and adolescents is causing a concern. However, the most significant aspect of the dengue surge is the emergence of dengue encephalopathy in patients.”

Dengue encephalopathy is a rare but severe complication where the virus affects the central nervous system, leading to symptoms like drowsiness, sleepiness and even seizures. “If managed early, we can improve the outcome. We are also seeing co-infections of dengue with hepatitis A, resulting in dengue-associated jaundice. This co-infection adds a layer of complexity in the treatment process, as managing both the conditions simultaneously can be challenging. Sometimes, on the first day of fever, the dengue test may yield a negative result and may need to be repeated. These changes are possibly associated with post-Covid effects and change in virulence of the virus,” Dr Lad said.

Dr Mahesh Kumar Manohar Lakhe, infectious disease specialist at Sahyadri Hospitals, said, “In dengue infections, we are observing mild to moderate hepatitis. Among adults, there is an increase in cases involving central nervous system complications, which was relatively rare. This year, some patients have been diagnosed with dengue encephalitis, although it is important to note that this condition is not typically fatal.”

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Dengue encephalitis refers to a broader term for neurological complications associated with dengue virus infection, which can include altered mental status, headache, impaired consciousness and seizures. “Dengue encephalitis specifically indicates inflammation of the brain caused by the dengue virus. One needs to rule out chikungunya and rickettsial co-infection as well when encephalitis is suspected,” Dr Lakhe said.

Dr Ravindra Khetre, a paediatrician heading Om Clinic in Wadgaonsheri, said, “Some children with dengue are experiencing central nervous system involvement, exhibiting symptoms like drowsiness or sleepiness lasting for over 24-48 hours in the initial days of illness. Most of these infants need management in ICUs. Children aged between 6 months to 3 years are primarily affected by this during the current dengue outbreak. In fact, we have witnessed an increase in such paediatric patients this year.”

Dr Ameet Dravid, an infectious diseases expert with Noble Hospital, said, “It is common to encounter isolated cases of CNS-related dengue complications and hepatic complications in dengue cases, among various other issues in children. However, while ward admissions for dengue remain high, ICU admissions are relatively low. The government has recently mandated the reporting of all dengue cases, which also encompasses the reporting of dengue-related complications. It is plausible that the reporting of dengue cases has improved, leading to increased awareness of complications associated with the disease.”

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