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Dengue encephalitis in a child

The Sri Lanka Medical Association
Publication Date
  • Medicine
  • Decorticate Rigidity
  • Seizures
  • Medicine


cmj - Dec.2003 144 Ceylon Medical Journal Case reports lesions. Hepatic transaminases were elevated–AST: 147 iu/L (normal 5-40 iu/L) and ALT: 347 iu/L (normal 5–40 iu/L). The other liver function tests were normal. The elevated transaminases normalised in the subsequent two weeks. ESR was 6 mm/h. The mantoux test was negative. Urinalysis, serum urea, electrolytes, creatinine and fasting blood sugar estimations were within normal limits. HIV antibody test, VDRL, mycoplasma antibody titre in serum, serology for Hepatitis A and B viruses and Paul Bunnel tests were negative. Visual evoked potentials were normal. Titres of leptospira agglutination lysis tests performed on admission, 11 days later and 17 days later were 200, 200 and none respectively, thus confirming a recent leptospira infection. Urine darkground microscopy for leptospira was negative. He was given a course of intravenous crystalline penicillin and dexamethasone. At the time of discharge, 35 days after admission, he was independently mobile with minimum support and had regained bladder control. Discussion Leptospirosis has a worldwide distribution, predominantly involving tropical areas. The clinical spectrum of leptospirosis ranges from a mild, anicteric febrile illness to the more serious Weil syndrome, comprising jaundice, renal dysfunction and bleeding diathesis. Our patient presented with transverse myelitis without clinical features of renal dysfunction. Leptospires reach the CSF and brain as early as 48 h after inoculation [2]. However, nervous system involvement is essentially immune mediated. Neurological manifestations in leptospirosis include aseptic meningitis, encephalitis, intracranial bleeding (subarachnoid and extradural haemorrhage), cerebellitis, movement disorders, myelitis, flaccid paraplegia, mononeuritis, autonomic lability and polymyositis [2]. However, it is uncommon for leptospirosis to present as a primary neurological disease without clinical features to suggest leptospirosis (primary

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