Sandra Dehning, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Germany.
during dengue has become a major international health concern, with some countries, such as Brazil, experiencing annual epidemics [McBride and Bielefeldt-Ohmann, 2000; Schmidt, 2010; Barreto et al. 2011]. There are different forms and clinical manifestations Inhibitors,research,lifescience,medical of the disease, with the most severe being the life-threatening dengue hemorrhagic fever (DHF)/dengue shock syndrome [Onlamoon et al. 2010]. The most common manifestation of this disease, classic dengue fever, is a mild

febrile illness that is characterized by fever, musculoskeletal pain, severe headache, pain behind the eyes, nausea and vomiting, maculopapular rash, leucopenia and thrombocytopenia Inhibitors,research,lifescience,medical [WHO, 1997]. Severe thrombocytopenia is often present in DHF cases, but not in classic dengue fever, when just mild thrombocytopenia

generally occurs. Leucopenia, generally a consequence of neutropenia, is typical and generally found among patients with dengue as a mild reduction of white blood cell (WBC) count. However, there are also rare cases of severe selleck chemicals Pacritinib neutropenia or life-threatening agranulocytosis [Insiripong, 2010]. The exact pathogenic mechanisms that lead to WBC alterations are not fully understood, but bone marrow suppression in dengue infection is well documented and probably Inhibitors,research,lifescience,medical has a major role in the hematologic alterations present among patients with dengue [Srichaikul and Nimmannitya, 2000]. Clozapine (CLZ) remains the most effective treatment for schizophrenia, Inhibitors,research,lifescience,medical but because of its poor side-effect profile, is generally used for patients who respond poorly to other antipsychotics [Tandon et al. 2007]. The side effects of CLZ, in particular neutropenia and agranulocytosis, continue to be a focus of concern during treatment with this antipsychotic, with an incidence of agranulocytosis of around 1% and of neutropenia of about 3%, with the highest risk within the first 6–18 weeks of treatment [Atkin Inhibitors,research,lifescience,medical et al. 1996]. Such a risk demands guarantees of safety during treatment with CLZ through close clinical followup and mandatory scheduled

hematologic screening [Novartis Pharmaceuticals Canada Inc., 2010] (Table 1). The occurrence of such complications during the treatment of patients whose condition has usually failed to respond to all other pharmacological alternatives may leave their psychiatrists without viable options for Cilengitide an effective treatment. Therefore, it is critical to understand the relevance of WBC alterations during dengue infection in patients with schizophrenia who are taking CLZ. Table 1. Clozapine hematological monitoring and appropriate management based on CBC results [Novartis Pharmaceuticals Canada Inc., 2010]. Materials and methods We are addressing this concern by presenting three cases of dengue infection in CLZ-treated patients with schizophrenia (Table 2).