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Year : 2017  |  Volume : 1  |  Issue : 2  |  Page : 132

Mania in a case of dengue fever: Arare entity

Department of Neurology, Government T D Medical College, Alappuzha, Kerala, India

Date of Web Publication8-Dec-2017

Correspondence Address:
P K Muhammad
Nasnas, Chempad P.O, Arayakkool, Kannur - 670 694, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aip.aip_29_17

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How to cite this article:
Muhammad P K, Shaji C V, Panicker VV, Prasanth S R. Mania in a case of dengue fever: Arare entity. Ann Indian Psychiatry 2017;1:132

How to cite this URL:
Muhammad P K, Shaji C V, Panicker VV, Prasanth S R. Mania in a case of dengue fever: Arare entity. Ann Indian Psychiatry [serial online] 2017 [cited 2023 Jan 31];1:132. Available from: https://www.anip.co.in/text.asp?2017/1/2/132/220250


Dengue fever (DF) is a mosquito-borne infection which can present with unusual manifestations, especially with neurological symptoms.[1] Neurological manifestations occur in 0.5%–5.4% cases of DF.[2],[3] Psychiatric manifestations due to dengue virus infection is very rare.

A 17-year-old male student who was admitted in the department of psychiatry with excessive talk, feeling excessively happy, with increased activity, self-confidence, aggression, over familiarity with strangers, over religiosity, grandiose ideas and decreased need for sleep and food, irritability, over9days. One week prior to the onset of these symptoms he had developed high grade fever associated with severe headache, bodyache and cough which was treated from local hospital.

A detailed psychiatric evaluation was done. He was diagnosed to have acute manic episode, admitted and started on mood stabilizers with antipsychotics. Next day, he developed high grade fever. In view of presence of fever he was transferred to department of neurology to rule out organic etiology. On admission to neurology ward he was conscious oriented, increased psychomotor activities with euphoric mood and grandiose delusions. There were no motor or sensory deficits; no signs of meningeal irritation. Investigations revealed total count of 8500 with platelet count of 2.4 lakh. Liver function tests showed elevated aspartate transaminase(168IU/ml) and alanine transaminase(81IU/ml) levels. Blood sugar and renal function tests were normal. IgM Dengue antibody testing came as equivocal which showed raising titre on repeat testing after 1week. All other serology work ups, Cerebrospinal fluid(CSF) study, Electroencephalogram and magnetic resonance imaging of brain were normal. Peripheral smear and rapid malarial test were negative for malarial parasite. CSF NMDA antibody testing was done to rule out autoimmune encephalitis which also came as negative. Blood and urine culture were normal. Past history of DF with thrombocytopenia at the age of 6years. He became afebrile 3days following admission and fever to reappear again after 3days of afebrile period. During the reappearance period of fever patient also developed altered sensorium.

He was treated with low doses of risperidone, valproate and clonazepam. He steadily improved with treatment. Now he is euthymic and is on tapering doses of risperidone and valproate.

Neurological complications can be categorized in to dengue encephalopathy, encephalitis, immune-mediated syndromes, dengue muscle dysfunction, and neuro-ophthalmic disorders. Most commonly reported manifestation is dengue encephalopathy.[4] Our case is possibly a case of dengue encephalitis which can present with diminished consciousness, dizziness, headache, seizures, disorientation, and behavioral symptoms.[5]

There was clear temporal relationship between the fever and onset of symptoms in this patient. Also there was no past history or family history to suggest any mood disorder or cyclothymia in our patient. Also his manic symptoms improved with control of fever and low doses of antipsychotics. So it is very important to consider DF as an etiology for patients presenting with manic symptoms in temporal relation with fever.

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  References Top

FerreiraML, CavalcantiCG, CoelhoCA, MesquitaSD. Neurological manifestations of dengue: Study of 41cases. Arq Neuropsiquiatr 2005;63:488-93.  Back to cited text no. 1
SolomonT, DungNM, VaughnDW, KneenR, ThaoLT, RaengsakulrachB, etal. Neurological manifestations of dengue infection. Lancet 2000;355:1053-9.  Back to cited text no. 2
PancharoenC, ThisyakornU. Neurological manifestations in dengue patients. Southeast Asian J Trop Med Public Health 2001;32:341-5.  Back to cited text no. 3
Carod-ArtalFJ, WichmannO, FarrarJ, Gascón J. Neurological complications of dengue virus infection. Lancet Neurol 2013;12:906-19.  Back to cited text no. 4
DominguesRB, KusterGW, Onuki-CastroFL, SouzaVA, LeviJE, PannutiCS, etal. Involvement of the central nervous system in patients with dengue virus infection. JNeurol Sci 2008;267:36-40.  Back to cited text no. 5


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