The Clinical Profile and Outcome of Children with Dengue Encephalitis at the Philippine Children&rsquo;s Medical Center: A Retrospective Study from January 2011-June 2017

Madelyn  P. Pascual,; Kristine  Alvarado-Dela Cruz,; Maria Eva  Luna-Dizon,; Remedios  O. Salonga,

The Clinical Profile and Outcome of Children with Dengue Encephalitis at the Philippine Children’s Medical Center: A Retrospective Study from January 2011-June 2017

Kristine Alvarado-Dela Cruz | Madelyn P Pascual | Remedios O. Salonga | Maria Eva Luna-Dizon

Abstract:

BACKGROUND: Dengue, a mosquito-borne flavivirus infection, is hyperendemic in the Philippines. One of the rare complications is dengue encephalitis, characterized by altered sensorium, elevated liver enzymes, and high dengue-specific antibody titers. The actual incidence of dengue encephalitis is underestimated due to problems of pathogen detection. To address this, an integrated surveillance system has been in place since 2007, which detects laboratory-confirmed dengue meningoencephalitis from blood and CSF samples via IgM capture ELISA. OBJECTIVES: To describe the clinico-demographic profile and outcome upon hospital discharge of laboratory-confirmed dengue encephalitis patients admitted at the Philippine Children’s Medical Center (PCMC) from January 2011 to June 2017. METHODS: This is a retrospective observational study to describe laboratory-confirmed dengue encephalitis cases aged 0-18 years at PCMC from January 2011 to June 2017.The clinico-demographic profiles and outcomes of patients were collected using chart review, and variables were analyzed using descriptive statistics. RESULTS: 14 cases of laboratory-confirmed dengue encephalitis children were reviewed. None had known previous dengue infection nor received dengue vaccination. Following nonspecific signs and symptoms, neurological manifestations developed with a median of 2 days, the most common being seizures, most of which were generalized, and decreased sensorium. Most common abnormal EEG waveforms were generalized background slowing; neuroimaging was normal or showed cerebral edema. Full recovery upon discharge was seen in half the patients reviewed, 3 showing partial recovery from neurologic signs and symptoms, and 3 others were discharged with neurologic sequelae. One infant expired. RECOMMENDATIONS: Prospective studies with larger sample sizes that will follow-up on the patient’s long-term outcome are recommended.

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