Fatal dengue encephalitis in a recruit: lessons learnt

Dengue infections may present within a widely variable spectrum of clinical manifestations. However, neurologic complications in general are rare and unusual. A 19 yrs old healthy male army recruit was brought to a service hospital in South India in a state of unresponsiveness, following 12 km route march. Despite aggressive and prompt management, his condition progressively deteriorated and he finally passed away about 10 hrs after reporting to the hospital. The final cause of death was acute dengue encephalitis with raised intracranial pressure. Epidemio-clinico-pathological correlation in this case led to the conclusion that vigorous exertion with a hyper-metabolic state of fever in a setting of encephalitis led to metabolic injury, multi-organ failure, cerebral edema and intracranial hemorrhage. Encephalitis following dengue virus (DENV) infection is a rare phenomenon with the incidence ranging from 0.5% to 6.2%. Neurological features associated with DENV were first reported by Sanguansermsri et al in 1976. The rare neurologic presentations reported with DENV infection are transverse myelitis, acute encephalomyelitis, myositis, and gullain barre syndrome. As encephalitis caused by DENV mimics that caused by other pathogens it should always be kept in mind while managing encephalitis of unknown origin. Medical officers should maintain a high index of suspicion of DENV encephalitis. Training of medical officers; therefore, needs to be undertaken with regular refresher cadres, besides equipping of all peripheral facilities with rapid diagnostic kits for dengue. The same will ensure prompt detection of cases and timely referral to higher medical centres in chain. The instant case reflects an important, potentially fatal, complication of dengue. Pathophysiology of DENV encephalitis needs to be elucidated on priority through research involving all stakeholders.

Impoliteness in institutional and non-institutional contexts

The analysis of impoliteness has mainly concentrated on the relation between text and context itself rather than on the differences between types of contexts. The aim of this study is to compare impoliteness in both institutional and non-institutional contexts. The institutional contexts to be dealt with are: A) face-to-face political debate and B) army recruit training. The selected non-institutional contexts are C) the Tango lyrics of the 1920’s and D) the interaction among lower middle-class people who speak River Plate Spanish. In a previous paper (Kaul de Marlangeon 2005a), I proposed the category of fustigation impoliteness by refractoriness or exacerbated affiliation where refractoriness and exacerbated affiliation function as counterparts to Bravo’s categories of politeness, autonomy and affiliation. In the present paper and within the theoretical and methodological framework for the study of fustigation impoliteness, I deal with three of the above mentioned contexts A) , B) and C), and the type of fustigation impoliteness that characterises each of them. In my analysis I show that in face-to-face political debate and military recruit training impoliteness is public, bi-directional in the former and unidirectional in the latter. In the Tango lyrics of the 1920’s fustigation impoliteness is private and unidirectional. Finally in the context of interaction among lower middle-class people who speak River Plate Spanish, impoliteness is chronic, intra-group, private and multi-directional. For this kind of impoliteness the concepts of refractoriness and exacerbated affiliation do not apply because this impoliteness is about the relationship between an individual versus another individual within the same group rather than an individual versus the group.