Kumar A, Ghosh D. Letter to the Editor: Dengue virus as an underrecognized cause of encephalitis in tropical Asia - Bridging diagnostic and surveillance gaps. World J Virol 2026; 15(2): 118082 [DOI: 10.5501/wjv.v15.i2.118082]
Corresponding Author of This Article
Alok Kumar, PhD, Additional Professor, Department of Molecular Medicine and Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, Uttar Pradesh, India. dralokkumar03@gmail.com
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Infectious Diseases
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letter
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Kumar A, Ghosh D. Letter to the Editor: Dengue virus as an underrecognized cause of encephalitis in tropical Asia - Bridging diagnostic and surveillance gaps. World J Virol 2026; 15(2): 118082 [DOI: 10.5501/wjv.v15.i2.118082]
World J Virol. Jun 25, 2026; 15(2): 118082 Published online Jun 25, 2026. doi: 10.5501/wjv.v15.i2.118082
Letter to the Editor: Dengue virus as an underrecognized cause of encephalitis in tropical Asia - Bridging diagnostic and surveillance gaps
Alok Kumar, Devlina Ghosh
Alok Kumar, Department of Molecular Medicine and Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Devlina Ghosh, Department of Biochemistry, Saraswati Dental College and Hospital, Lucknow 226028, Uttar Pradesh, India
Author contributions: Kumar A conceived the study, developed the overall concept and manuscript framework, and contributed substantially to writing, critical discussion, editing, and figure design; Ghosh D contributed to the drafting and critical revision of the manuscript. All authors reviewed and approved the final submitted version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Alok Kumar, PhD, Additional Professor, Department of Molecular Medicine and Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, Uttar Pradesh, India. dralokkumar03@gmail.com
Received: December 23, 2025 Revised: February 1, 2026 Accepted: March 5, 2026 Published online: June 25, 2026 Processing time: 177 Days and 16.4 Hours
Abstract
Arboviral encephalitis remains a major public health concern in tropical Asia, where the etiology of a substantial proportion of central nervous system infections remains undetermined despite endemic circulation of dengue virus (DENV) and Japanese encephalitis virus. Laboratory confirmation is frequently absent in clinically suspected encephalitis. Perera et al recently published a study in World Journal of Virology, highlight this diagnostic gap by identifying DENV infection in 6.06% of encephalitis cases, including molecular evidence of DENV-3 neuroinvasion. These findings add to the growing evidence that DENV can cause encephalitis and meningoencephalitis across age groups. However, encephalitis in endemic settings is etiologically heterogeneous, and dengue represents only one of several infectious and immune-mediated contributors. Neurological dengue is likely under-recognized due to overlapping clinical presentations and limited diagnostic capacity. The identification of DENV-3 is noteworthy given its recurrent association with neurological disease. Limited concordance between reverse transcription polymerase chain reaction and immunoglobulin M assays reflects challenges related to viral kinetics, timing of specimen collection, and flaviviral serological cross-reactivity. Strengthening surveillance through integrated molecular and serological diagnostic strategies, including multiplex polymerase chain reaction and metagenomic next-generation sequencing, is essential to reduce undiagnosed encephalitis and improve clinical management and public health preparedness in tropical Asia.
Core Tip: Dengue virus is an under-recognized but clinically relevant cause of encephalitis in tropical Asia, where acute encephalitis syndrome remains etiologically heterogeneous. Emerging evidence of dengue virus serotype 3 neuroinvasion highlights diagnostic gaps arising from overlapping clinical features and limitations of conventional assays. Incorporating dengue testing within integrated, multi-pathogen diagnostic frameworks - combining molecular, serological, and advanced platforms such as metagenomic next-generation sequencing - can improve etiological attribution, surveillance accuracy, and patient management.
