Encephalopathy in Dengue with Hepatic Failure, Summary of Thai Cases

Dengue infection is a major vector-borne disease. The classical sings and symptoms of this infection include high fever, violent headache, chill and rash. However, there are a number of atypical forms of dengue infection including those presented with severe liver dysfunction. Sporadic case reports of dengue hepatic encephalopathy are documented in Thailand. Here, the author presents a summative study on the clinical presentation and outcome among Thai patients with dengue encephalopathy in the previous studies. A literature review on the prospective studies concerning dengue hepatic encephalopathy in Thailand was performed. According to this study, 4 reports covering 19 cases (12 females and 7 males) of dengue encephalopathy among the Thai can be detected. The summative on clinical presentation of all patients are presented in Table 1. The average age (mean ± SD) of all subjects is 8.0 ± 3.0 (range = 2-13 years old). Classified by grade on dengue infection, there are 14 grade IV, 4 grade III and 1 grade II. Most of the hepatic encephalopathy occur in convalescent stage (14 cases, 73.7 %). Concerning the depth of hepatic encephalopathy, there are 8 level IV, 6 level III, 4 level II and 1 level I. Of 16 known cases, the duration of encephalopathy ranges from 0.8 to 26 days (average 8.2 ± 6.6 days). Of 15 known cases, the liver span ranges from 2 to 6 cm (average 3.7 ± 1.2 cm). Concerning the laboratory investigation, severe hepatitis (SGOT and SGPT > 200 U/L) can be seen in all cases. Hypoglycemia and hyponatremia can be detected in 6 and 5 cases, respectively. Most of the cases (15 cases, 78.9 %) received conventional treatment and most (12 cases, 63.2 %) recovered completely.

Keywords: dengue, hepatic encephalopathy.