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Post Dengue Fever Epidural Abscess With or Without Spondylodiscitis: A Case Series of Eight Patients in a Single Season in a Single Center

Does the Dengue Have a Predilection for the Neural Tissue?

Pillai, Suresh S., MS, DNB; Shameer, Moidu, DNB; Hassan, Asif, DNB; Parambil, Abdurehiman K., DM (Neuro); Reddy, Sivasankar, DNB; Vishnu R, Bala, DNB; Mohammad, Shameem G., MS ortho

doi: 10.1097/BRS.0000000000002767
CLINICAL CASE SERIES
SLIDE

Study Design. A retrospective case series.

Objective. The aim of this study was to report the immunosuppression and secondary bacterial infection after dengue viral infection and the predilection of these infections in the spine. This can trigger further research in to this fact. The possibility of change in the serotype of dengue virus, which are neurotropic, may be looked into.

Summary of Background Data. This is the largest case series of epidural abscess with or without spondylodiscitis within 6 weeks following dengue virus infection.

Methods. We performed a retrospective review of all the eight cases treated for epidural abscess with or without spondylodiscitis within 6 weeks following dengue virus infection in our center during the period of 3 months from June 2017 to August 2017.

Results. Of the eight cases, three of them were infected with Methicillin Resistant Saphylococcus Aureus and all of them grew the bug in the blood culture. Three of them had Methicillin Sensitive Staphylococcus Aureus (MSSA), one with MSSA septicemia, and one had associated Elizabeth Kingia meningoseptica infection and one patient had positive Acid Fast Bacilli stained in smears. Two patients were infected with pseudomonas. Some patients had multiple site abscess and epidural abscess without spondylodiscitis. Five of them had neurological deficit, which recovered with abscess drainage and antibiotic treatment. The Erythrocyte Sedimentation rate, C-Reactive Protein, and serum ferritin were elevated in these patients.

Conclusion. This is a large case series of epidural abscess with or without spondylodiscitis within 6 weeks following dengue virus infection. The predilection of dengue virus for the neural tissue should be further investigated. Post dengue immunosuppression also needs further study.

Level of Evidence: 4

Aster MIMS Hospital, Calicut, Kerala, India.

Address correspondence and reprint requests to Dr. Suresh S. Pillai, MS, DNB, Consultant Spine surgeon, HOD Department of Orthopedics, Aster Malabar Institute of Medical Sciences, Mini Bypass Road, Govindapuram, Calicut, Kerala 673016, India; E-mail- sureshorth@gmail.com

Received 5 March, 2018

Revised 13 May, 2018

Accepted 24 May, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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