Annals of Indian Psychiatry

LETTER TO EDITOR
Year
: 2017  |  Volume : 1  |  Issue : 2  |  Page : 132-

Mania in a case of dengue fever: A rare entity


PK Muhammad, CV Shaji, Vishal V Panicker, SR Prasanth 
 Department of Neurology, Government T D Medical College, Alappuzha, Kerala, India

Correspondence Address:
P K Muhammad
Nasnas, Chempad P.O, Arayakkool, Kannur  -  670  694, Kerala
India




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


How to cite this URL:
Muhammad P K, Shaji C V, Panicker VV, Prasanth S R. Mania in a case of dengue fever: A rare entity. Ann Indian Psychiatry [serial online] 2017 [cited 2022 Dec 4 ];1:132-132
Available from: https://www.anip.co.in/text.asp?2017/1/2/132/220250


Full Text



Sir,

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, over 9 days. 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 (168 IU/ml) and alanine transaminase (81 IU/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 1 week. 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 6 years. He became afebrile 3 days following admission and fever to reappear again after 3 days 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Ferreira ML, Cavalcanti CG, Coelho CA, Mesquita SD. Neurological manifestations of dengue: Study of 41 cases. Arq Neuropsiquiatr 2005;63:488-93.
2Solomon T, Dung NM, Vaughn DW, Kneen R, Thao LT, Raengsakulrach B, et al. Neurological manifestations of dengue infection. Lancet 2000;355:1053-9.
3Pancharoen C, Thisyakorn U. Neurological manifestations in dengue patients. Southeast Asian J Trop Med Public Health 2001;32:341-5.
4Carod-Artal FJ, Wichmann O, Farrar J, Gascón J. Neurological complications of dengue virus infection. Lancet Neurol 2013;12:906-19.
5Domingues RB, Kuster GW, Onuki-Castro FL, Souza VA, Levi JE, Pannuti CS, et al. Involvement of the central nervous system in patients with dengue virus infection. J Neurol Sci 2008;267:36-40.