Definition

Encephalopathy refers to a change in mental status caused by various health issues, such as liver or kidney failure, and systemic infections. It is a term used to describe damage or abnormality in the brain. One disease that can cause encephalopathy is dengue infection. Therefore, dengue encephalopathy is a condition or abnormality in the function and structure of the brain and central nervous system caused by the involvement of the dengue virus.

Indonesia is an endemic country for dengue infection. This disease is transmitted by Aedes aegypti and Aedes albopictus mosquitoes, which are commonly found in tropical countries like Indonesia. Over the past fifty years, there has been a thirtyfold increase in the geographic spread to new countries and regions, including the spread of dengue virus infections from urban to rural areas.

Dengue virus infection presents with a wide range of symptoms, including:

• Mild undifferentiated febrile illness, where there is a fever of less than two weeks accompanied by nonspecific symptoms.
• Dengue fever (DF).
• Dengue hemorrhagic fever (DHF).
• Dengue shock syndrome (DSS).

Due to its broad clinical manifestations, the dengue virus can involve several vital organs, such as the central nervous system, digestive system, and urinary system. Although this is rare, if dengue encephalopathy is not properly treated, it can become a permanent condition or lead to death.

Often misunderstood, encephalopathy and encephalitis are different conditions. In encephalitis, there is swelling of the brain tissue caused by inflammation. Encephalitis can lead to encephalopathy.

Causes

The most common cause of encephalopathy in general is viruses, such as the herpes simplex virus, measles, and the dengue virus transmitted by Aedes aegypti and Aedes albopictus mosquitoes.

Additionally, dengue encephalopathy can occur in individuals infected with dengue who have:

• Metabolic disorders.
• Kidney disorders.
• Liver disorders or the use of liver-damaging drugs.
• Electrolyte imbalances.
• Hypoglycemia or low blood sugar.
• Genetic diseases.
• Brain bleeding or swelling.
• Oxygen deficiency.
• Prolonged exposure to chemicals.
• Use of certain drugs and narcotics.

Risk factor

Various risk factors can lead to dengue encephalopathy, including:

• A history of central nervous system diseases.
• Genetic abnormalities.
• A history of alcohol addiction.
• A history of malnutrition.
• A history of other medical conditions, such as diabetes, liver abnormalities, kidney failure, or heart failure.
• Brain tumors.
• Cancer alongside dengue infection.
• Electrolyte disturbances.
• Gastrointestinal bleeding.
• High fluid requirements.

Symptoms

The symptoms of encephalopathy in general depend on the type and cause of the encephalopathy, but in the case of dengue encephalopathy, the symptoms typically include:

• Fever.
• Nausea and vomiting.
• Diarrhea (rarely).
• Muscle pain.
• Headache, especially behind the eyes.
• Decreased consciousness.
• Memory impairment, amnesia.
• Personality changes.
• Problems with focus and clear thinking.
• Difficulty speaking.
• Muscle seizures or twitching.
• Tremors.
• Difficulty swallowing.
• Excessive drowsiness.
• Uncontrollable eye movements.

Diagnosis

The diagnosis of dengue encephalopathy generally involves several examinations. The doctor will start with a medical interview, conduct a physical examination, and perform additional tests.

Medical interview

The interview starts with questions about:

• The patient's main complaint and associated symptoms.
• The duration of symptoms.
• Any previous illnesses.
• Previous treatments.
• Family medical history.

Physical examination

Next, the doctor will perform a physical examination. This starts with checking the patient's general condition. The doctor will look for changes in mental status and consciousness. Then the doctor will check vital signs such as blood pressure, pulse, respiratory rate, and body temperature. A thorough physical examination from head to toe will follow.

Diagnostic tests

The doctor may order Diagnostic tests, including blood tests to check for infections, liver function, kidney function, and electrolyte levels.

The doctor may also recommend a lumbar puncture to take a sample of the fluid that protects the brain and spinal cord. Imaging tests can also be performed to examine the central nervous system. The doctor may suggest radiological tests such as:

• Chest X-ray to check for fluid accumulation around the lungs.
• CT scan or MRI to detect brain abnormalities.
• Electroencephalography (EEG) to measure electrical activity in the brain.

Management

The treatment of dengue encephalopathy involves addressing the dengue infection first. Dengue infection can be treated by:

• Monitoring vital signs and warning signs in the patient.
• Providing adequate fluids and nutrition.
• Administering medications for symptoms such as fever, nausea, vomiting, diarrhea, and headaches.

The doctor may also provide appropriate antimicrobials and corticosteroids, along with medications for central nervous system symptoms like anticonvulsants. Treatment is tailored if the patient has other conditions such as liver or kidney disorders and diabetes. Blood transfusions are given if there are signs of severe bleeding.

All treatments for dengue encephalopathy must be tailored to the patient's needs and condition, so dengue encephalopathy patients are usually closely monitored by doctors.

Complications

Complications of dengue encephalopathy can include:

• Decreased consciousness leading to coma.
• Permanent brain function loss.
• Memory impairment.
• Paralysis.
• Death.

Prevention

Preventing dengue encephalopathy involves preventing dengue infection itself. Measures to prevent dengue infection include:

• Practising 3M Plus (Draining, Closing, Recycling, Plus preventing mosquito bites and breeding).
• Using mosquito nets and window screens.
• Applying mosquito repellent.
• Wearing long-sleeved shirts and long pants.
• Not hanging clothes in the room.
• Planting mosquito-repelling plants like lemongrass and lavender.
• Trimming and cleaning wild plants in the yard if any.
• Spraying insecticides (fogging), especially during the transitional season and when dengue cases increase in the area.
• Maintaining the immune system by ensuring adequate nutrition and hydration, eating a balanced diet, and drinking at least 1.5 to 2 litres of water per day.
• Administering dengue vaccines to children as a preventive measure to control the spread of dengue virus infection.

Additionally, general encephalopathy prevention includes:

• Avoiding alcohol and narcotic use.
• Regular hand washing.
• Wearing head protection when riding motorcycles or bicycles.
• Avoid prolonged exposure to harmful chemicals.
• Regular medical check-ups, especially if you have conditions that increase the risk of encephalopathy, such as liver, kidney, or diabetes disorders.

When to see a doctor?

You should see a doctor if you experience dengue infection symptoms along with central nervous system symptoms such as decreased consciousness, confusion, seizures, and changes in cognitive abilities. Immediately go to the emergency department for prompt and appropriate treatment.

Looking for more information about other diseases? Click here!