Dados do Trabalho

Título

CLINICAL PRESENTATION OF ARBOVIRUS ENCEPHALITIS – CASE SERIES

Apresentação dos casos

Case 1: A 5-year-old male with a history of well-controlled epilepsy presented with fever. The next day, he developed status epilepticus and decreased consciousness. Electrographic status epilepticus was noted, requiring multiple drugs. A cranial CT scan showed slight cortical atrophy. Routine and culture tests in the cerebrospinal fluid (CSF) were unremarkable. Arbovirus testing in the CSF was negative, but serum NS1 was positive. Case 2: A previously healthy 2-year-and-4-month-old male presented with a bilateral tonic-clonic seizure during a febrile episode, progressing to a 4-minute cardiorespiratory arrest. He subsequently had decreased consciousness. A cranial CT scan was normal. CSF was unremarkable except for a positive PCR for dengue. The patient then developed status dystonicus, which was well-controlled with intravenous and enteral medications. Case 3: A 2-month-old male presented with fever, rash, blistering lesions, irritability, and status epilepticus. He developed decreased consciousness. A cranial CT scan was normal. Routine CSF analysis was unremarkable. Rapid serum test was positive for chikungunya IgM. Case 4: A 2-year-and-4-month-old male presented with fever, irritability, decreased consciousness, and seizures. A cranial CT scan was normal. CSF routine analysis showed increased cellularity (30 cells/mm³) with 55% mononuclear cells and 55% polymorphonuclear cells. IgM serology for chikungunya was positive.

Discussão

Arboviruses are a group of viral diseases primarily transmitted by arthropods such as mosquitoes and ticks. In Brazil, dengue and chikungunya are among the most common. Generally, these viruses cause nonspecific symptoms like fever, myalgia, and rash, but they can also progress to neuroinvasive diseases, presenting with signs and symptoms of encephalitis. In these cases, decreased consciousness and seizures are commonly observed.

Comentários finais

This report presents four cases of arbovirus infections, with two cases of dengue and two cases of chikungunya, all presenting with secondary encephalitis. All patients experienced seizures and cognitive impairments after the recovery period. Understanding the presentation of arboviruses is crucial given the national epidemiological context and the current outbreak in 2024.

Referências

Salimi H, Cain MD, Klein RS. Encephalitic arboviruses: emergence, clinical presentation, and neuropathogenesis. Neurotherapeutics. 2016 Jun 1;13(3):514-34. Beckham JD, Tyler KL. Arbovirus infections. CONTINUUM: Lifelong Learning in Neurology. 2015 Dec 1;21(6):1599-611. Rust RS. Human arboviral encephalitis. InSeminars in pediatric neurology 2012 Sep 1 (Vol. 19, No. 3, pp. 130-151). WB Saunders.

Palavras Chave

arbovirus; Encephalitis; dengue