Treatment of Dengue Encephalitis
Dengue encephalitis treatment is entirely supportive, focusing on intensive care management of complications, as no specific antiviral therapy has proven effective for dengue virus neurological infections. 1, 2
Immediate Hospitalization and Intensive Care
Admit all patients with suspected dengue encephalitis to a facility with immediate access to intensive care for airway protection, mechanical ventilation if needed, and management of increased intracranial pressure. 1
Transfer patients to a neurological unit or ICU within 24 hours if initial presentation occurs at a non-specialized center, as multidisciplinary neurological care optimizes morbidity and mortality outcomes. 1, 3
Assess airway protection needs urgently in patients with declining consciousness, as dengue encephalitis can cause rapid deterioration requiring ICU-level interventions. 3
Diagnostic Workup
Obtain MRI of the brain within 48 hours (preferred over CT), looking specifically for T2 hyperintensities in the thalamus, basal ganglia, and cortex, the "double doughnut" sign, and microhaemorrhages—though these findings are nonspecific for dengue. 2
Perform lumbar puncture for CSF analysis unless contraindicated by increased intracranial pressure, with CSF PCR for dengue virus being the definitive diagnostic test, combined with dengue antibody testing in both CSF and serum. 1, 2
Measure CSF IL-6 and TNF-α levels, as elevated neuroinflammatory markers strengthen early identification of dengue encephalitis. 2
Note that dengue serotypes 2 and 3 exhibit heightened neurovirulence, and seizures occur in 30-40% of dengue encephalitis cases. 2
Specialist Consultation
Obtain neurological specialist consultation within 24 hours of admission, and involve infectious disease specialists in the management team. 1, 3
Ensure multidisciplinary input including neurologists, infectious disease physicians, virologists, neurophysiologists, neuroradiologists, and intensive care staff. 4
Supportive Management
Provide judicious fluid resuscitation to maintain adequate cerebral perfusion while avoiding fluid overload, as this is the cornerstone of dengue management. 5, 6
Manage seizures with standard anticonvulsant therapy as needed, given the 30-40% seizure rate in dengue encephalitis. 2
Correct electrolyte imbalances and optimize cerebral perfusion pressure in patients with raised intracranial pressure. 3
Experimental Therapies (Limited Evidence)
Consider intravenous immunoglobulin (IVIG) and corticosteroids in a subset of severe cases, though evidence for efficacy is limited and these remain experimental interventions. 2
Do not routinely use corticosteroids, interferon alpha-2a, ribavirin, minocycline, or other antivirals, as controlled clinical trials have demonstrated no improvement in clinical outcomes for flavivirus encephalitis. 4
Critical Pitfall to Avoid
Never delay supportive care while awaiting definitive virological diagnosis, as dengue encephalitis has a 20-30% case-fatality ratio and early aggressive supportive management is the only intervention proven to reduce mortality. 4
Do not confuse dengue encephalitis with Japanese encephalitis or other flavivirus infections based solely on imaging, as cross-reactive antibodies and similar MRI patterns can occur—CSF PCR is essential for differentiation. 2
Discharge Planning and Rehabilitation
All patients require comprehensive rehabilitation assessment before discharge, as 30-50% of survivors develop long-term neurological or psychiatric sequelae including cognitive deficits, seizures, motor weakness, language impairment, anxiety, depression, and behavioral problems. 4, 1
Establish a definite or suspected diagnosis before discharge and formulate clear outpatient follow-up plans with ongoing therapy and rehabilitation at a discharge meeting. 4, 1
Arrange follow-up with neurology, neuropsychology, neuropsychiatry, speech and language therapy, physiotherapy, and occupational therapy as indicated. 4
Monitor for delayed complications that may not be immediately apparent at hospital discharge, as sequelae often emerge weeks to months after the acute illness. 1, 3