Dengue infection: neurological manifestations and cerebrospinal fluid (CSF) analysis

Dengue in Patients with Central Nervous System Manifestations, Brazil

“…Prior to the 1996 publication of fi ndings by Lum et al, involvement of the CNS in dengue infection had been thought to be secondary to vasculitis only; direct involvement of the brain by DENV was thought to be unlikely (14),. The literature has reported detection of DENV in the brain and CSF by PCR and virus isolation and detection of NS1 and dengue IgM, providing strong evidence that DENV has neurovirulent properties (3,4,11,(13)(14)(15). Meningeal lesions, neuronal damage, and evidence of DENV in CSF by RT-PCR and ELISA (NS1/ IgM) found in this study are consistent with CNS infection (Table 1).…”

“…The NS1Ag was detected in 4 of the fatal cases reported here, but because none fulfi lled the World Health Organization criteria for DHF, they were considered to have been cases of severe dengue because the patients died (1) ( Table 1). Detection of dengue IgM in CSF has shown a high specifi city (97%) for diagnosing neurologic dengue and might be associated with the neurovirulence of DENV and its ability to cause encephalitis (13). Prior to the 1996 publication of fi ndings by Lum et al, involvement of the CNS in dengue infection had been thought to be secondary to vasculitis only; direct involvement of the brain by DENV was thought to be unlikely (14),.…”

Dengue infection in the nervous system: lessons learned for Zika and Chikungunya

“…However, false-positive serological results may occur due the presence of cross-reacting antibodies against dengue 1 . Diagnosis of neurological manifestations associated with DENV/CHIKV infection are determined by specific IgM antibodies, increasing IgG antibodies titers, viral antigens, RNA fragments in samples of blood/CSF or the intrathecal synthesis of anti-specific antibodies in dengue patients 1,17,26,36,37,38 . Despite the detection of IgM antibodies for Zika virus in the CSF of neonates with microcephaly, there is an immaturity of the blood-brain and blood-CSF barrier in neonates, which increases the permeability to serum proteins 39 .…”

Dengue: twenty-five years since reemergence in Brazil

“…However, as already discussed, in Brazil the incidence of dengue hemorrhagic fever is lower, and until 2006 both dengue fever and dengue hemorrhagic fever occurred predominantly in adults 6,7,37 . Atypical manifestations of dengue (neurological, hepatic, and cardiac, among others) have been described both in Brazil 37,44,45,46,47,48,49,50 and in other countries of the Americas and Southeast Asia 51 , but the lack of epidemiological studies on their incidence does not allow comparisons.…”