Neurological sequelae after encephalitis associated with dengue virus in children

Background Neurological complications associated with dengue infection have been increasingly recognized globally, particularly following detection of the dengue virus in cerebrospinal fluid (CSF) via PCR. Despite this, no prior study has specifically assessed neurological sequelae in patients with dengue-associated acute encephalitis syndrome (DEN-AES). This study aimed to evaluate the extent and domains of neurological sequelae in pediatric DEN-AES cases. Methods The study was conducted in 2023, including diagnosed DEN-AES cases (≤18 years) discharged between January 2018 and December 2019. DEN-AES was defined as acute fever onset with altered mental status (confusion, disorientation, coma, or inability to speak) and/or new seizures (excluding simple febrile seizures), confirmed by NS1/IgM ELISA and RT-PCR tests for dengue. Long-term sequelae were assessed via home visits using a standardized disability assessment tool. Hospital records provided clinical, biochemical, and laboratory data for analysis. Results Of 56 children (median age: 7.5 years, IQR: 5–10; 53.6% male), neurological sequelae of varying severity were observed in 22 (39.3%) cases. Severe disabilities were noted in six children, with one post-discharge death. Thirty-four children were fully recovered, scoring 5 on the Liverpool Outcome Score (LOS). Cognitive and behavioral impairments were the most common sequelae (37.5%), and five children required anti-epileptic drugs for ongoing seizure management. Conclusions Neurological sequelae were identified in 39% of pediatric DEN-AES cases, underscoring the need for early diagnosis, continuous follow-up, and dedicated rehabilitation policies in dengue-endemic regions to support affected children.