title: Clinico-genetic characterisation of an encephalitic Dengue virus 4 associated with multi-organ involvement.
abstract: Neurological manifestations due to Dengue virus (DENV) infection are atypical and uncommon. Genomic information of clinically characterised, neurotrophic DENV in humans is extremely limited albeit their importance in deciphering the pathogenicity is substantial. Here, we report a rare case of fatal DENV-4 infection complicated with encephalitis and multi-organ failure. The clinical presentation was unusual due to its rapid onset of encephalitis despite a very low virus titre. Full genomes of serum and CSF-derived viruses shared 99.99% similarity, indicating the virus dissemination across blood-brain barrier. Even though virus genomes did not reveal any of the neurotrophic substitutions of DENV documented so far, case isolates possessed a combination of 8 novel amino acid alterations, predominantly distributed in non-structural genes of DENV-4.
authors: Environmental Health Institute, National Environment Agency, 11 Biopolis Way, 06-05/08 Helios Block, Singapore 138667, Singapore.
authors: Hapuarachchige C
authors: HC
authors: Hapuarachchi
authors: Helen M L
authors: HM
authors: Oh
authors: Tun Linn
authors: TL
authors: Thein
authors: Kwoon-Yong
authors: KY
authors: Pok
authors: Yee-Ling
authors: YL
authors: Lai
authors: Li-Kiang
authors: LK
authors: Tan
authors: Kim-Sung
authors: KS
authors: Lee
authors: Yee-Sin
authors: YS
authors: Leo
authors: Lee-Ching
authors: LC
authors: Ng
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D003715:Dengue / Q000150:complications / Q000276:immunology / Q000821:virology*; D003716:Dengue Virus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D018792:Encephalitis, Viral / Q000150:complications / Q000821:virology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009102:Multiple Organ Failure / Q000150:complications / Q000821:virology*; D010802:Phylogeny; D014759:Viral Envelope Proteins / Q000235:genetics
chemical_list: D000914:Antibodies, Viral; D014759:Viral Envelope Proteins; C466981:glycoprotein E, dengue virus type 4