Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14048900, Brazil.
Ther Adv Psychopharmacol. 2013 Apr;3(2):83-8. doi: 10.1177/2045125312464995.
Dengue is a febrile illness that is most common in tropical areas but is recognized worldwide as one of the most important arbovirus diseases of humans. This febrile illness generally has a course with mild alterations in white blood cell count, but there are also rare cases of severe neutropenia or agranulocytosis during dengue infection. Clozapine (CLZ) remains the most effective treatment for schizophrenia, but because of its poor side effect profile, in particular due to the increased risk of neutropenia and agranulocytosis, it is generally used for patients whose condition responds poorly to other antipsychotics.
We report three cases of dengue infection in patients with refractory schizophrenia who were using CLZ, and we discuss the implications of this infection on the continuation of CLZ treatment in these patients.
Of these three cases with dengue infection and co-occurence of CLZ use, the first would be classified as severe neutropenia and the second as moderate leucopenia; the last case had a white blood cell (WBC) count inside the normal range, and had no need to change his antipsychotic. The first and the second patient presented a worsening in their schizophrenic psychopathologies, after CLZ withdrawal, evolving into catatonic states, that were reverted after the careful reintroduction of CLZ.
It is very likely that during dengue epidemics many patients with schizophrenia and using CLZ have their treatment permanently discontinued given WBC count concerns, causing relapse of symptoms of schizophrenia and impairment of quality of life of these patients.This is the first report of neutropenia cases among CLZ-treated patients during dengue infection that describes the withdrawal of CLZ and its successful readministration.
登革热是一种发热性疾病，在热带地区最为常见，但已被全球公认为人类最重要的虫媒病毒病之一。这种发热性疾病通常伴有白细胞计数轻度改变，但在登革热感染期间，也有罕见的严重中性粒细胞减少症或粒细胞缺乏症病例。氯氮平（CLZ）仍然是治疗精神分裂症最有效的药物，但由于其不良副作用谱，特别是由于中性粒细胞减少症和粒细胞缺乏症的风险增加，一般仅用于对其他抗精神病药物反应不佳的患者。
我们报告了三例使用 CLZ 的难治性精神分裂症患者合并登革热感染的病例，并讨论了这种感染对这些患者继续使用 CLZ 治疗的影响。
在这三例合并登革热感染和 CLZ 使用的病例中，第一例被归类为严重中性粒细胞减少症，第二例为中度白细胞减少症；最后一例白细胞计数在正常范围内，无需改变其抗精神病药物。在 CLZ 停药后，第一例和第二例患者的精神分裂症精神病理表现恶化，发展为紧张症状态，在谨慎重新引入 CLZ 后得到逆转。
在登革热流行期间，由于担心白细胞计数，许多使用 CLZ 的精神分裂症患者可能会永久停止治疗，导致精神分裂症症状复发，影响这些患者的生活质量。这是首例报告 CLZ 治疗患者在登革热感染期间出现中性粒细胞减少症的病例，描述了 CLZ 的停药和成功重新给药。
