A case series on infective spinal sequelae post dengue fever
Dengue, an arboviral infection transmitted by Aedes aegypti and Aedes albopictus mosquitoes, is
emerging as the most important mosquito-borne viral diseases. Owing to the climate change, the
expansion of dengue vectors to new geographic regions, urban migrations, and global trade, it is fast
scaling as a global concern. Among the endemic countries of dengue, India holds a major burden .Over
years, there has been major twists and turns in the clinical presentations and complications of the
disease.In 2009, WHO endorsed new guidelines that, for the first time, consider neurological
manifestations in the clinical case classification for severe dengue. Dengue can manifest with a wide
range of neurological features, can be categorised into dengue encephalopathy (eg, caused by hepatic
failure or metabolic disorders), encephalitis (caused by direct virus invasion), neuromuscular
complications (eg, Guillain-Barré syndrome or transient muscle dysfunctions), and neuro-ophthalmic
involvement, sometimes the etiology being uncertain.
This year witnessed a very new presentation as an infective spinal sequelae post dengue, 6 cases in our
institute, all of them being spinal epidural abscess, which required surgical drainage. These cases holds
clinical significance, as there was no such case reporting till date, and no literatures available on such a
presentation.
The cases reported and mentioned above are a hospital based study, during the period of July-august
2017, the peak outbreak time. In all the cases, there was a background history of dengue fever, and the
infective spinal sequelae developed atleast after two weeks of resolution of fever.Of all the patients
presented to ED with complaints of back pain, two of them had neurological manifestations as tingling
sensations and numbness. Others had only back pain, which couldn’t be attributed to the alternative
causes of a recent onset back pain.All the cases developed spinal epidural abscess, which eventually
underwent surgical drainage.Evaluating the culture and sensitivity reports, a strong association was
noted with MRSA.
A high degree of suspicion in endemic areas can help in picking up more cases thereby helping in
understanding the true extent of neurological complications in dengue fever. Also knowledge regarding
the various neurological complications helps in looking for the warning signs and early diagnosis
thereby improving patient outcome.
These cases holds significance, as it is an entirely new presentation, and should alert the ED physicians to see a recent onset backpain in post dengue patients as one of the red flag signs in recent onset back pain.
