Whipping Up a New Flavor - Video

The patient's specimens were submitted for further research investigation. He was found to have autoantibodies in the CSF to microtubule associated proteins, which were likely not disease mediating, and to Dengue virus. Dengue virus was present throughout the brain as identified by quantitative PCR, RNAscope, immunohistochemistry, and sequencing. Sequencing identified the virus to be from a strain that was in circulation at least three years prior to the autopsy, during the time the patient visited India. A diagnosis of chronic Dengue encephalitis was made. This is a novel finding, as there are no reported cases of chronic Dengue encephalitis in the literature, to our knowledge. Dengue is a single-stranded RNA virus of the flavivirus genus, endemic to southern and southeast Asia. Classically, encephalopathy in Dengue infections was thought to be secondary to metabolic derangements, resulting from liver failure, shock, and coagulopathy. However, Dengue virus has been shown to directly infect the CNS in acute presentations. Though there is no report of chronic CNS infection from Dengue, other flaviviruses, including WNV, have been found to persist in the brain months after infection.