Immune-mediated neurological manifestations of dengue virus- a study of clinico-investigational variability, predictors of neuraxial involvement, and outcome with the role of immunomodulation

Bhushan, Bharat; Sardana, Vijay; Maheshwari, Dilip; Ojha, Piyush; Mohan, Sankalp; Moon, Parag; Kamble, Sumit; Jain, Neeraj; Sharma, Sunil Kumar

doi:10.4103/0028-3886.246273

Cited by 9 publications

(10 citation statements)

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“…patients with DENV infection 12 . In children, a study with 71 confirmed cases showed that 28.17% of the patients had neurological involvement 13 .…”

Section: Bhushan Et Al (2018) Found 486% Of Immune-mediated Neurolomentioning

confidence: 99%

“…GBS and its variants represent 5% of neurological complications in pediatric patients who had DF 13 , the period between the onsets of the illnesses of approximately 10,9 days 26 . Acute motor and sensitive axonal neuropathy (AMSAN) was the most common GBS subtype in these patients, followed by acute motor axonal neuropathy (AMAN), acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and Miller Fisher syndrome (MFS) 12 .…”

Section: Guillain-barre Syndromementioning

confidence: 99%

“…In the study of Bhushan et al 9 patients out of the 79 with immune mediated neurological complications presented with acute disseminated encephalomyelitis (ADEM), 3 had cerebellar demyelination only and 1 patient had limbic encephalitis 12 . Considering these three manifestations, 0,8% of the patients with dengue fever had encephalitis associated with dengue virus infection a higher number was found in a pediatric study although with a smaller sample n=71 patients, 8% of those children had encephalitis related with dengue fever and another interesting data was that of those 4 children that died 3 of them had encephalitis 13 .…”

Section: Encephalitismentioning

confidence: 99%

“…It is equally important testing the serum and CSF for herpes simplex virus, Mycobacterium tuberculosis, cytomegalovirus , human T cell lymphotropic virus type-1 , Epstein-Barr virus and varicella zoster virus in order to decline this potential causes once the respective results are negative 12 .…”

Section: Encephalitismentioning

confidence: 99%

“…had myelitis resulting in a 1.4% incidence 10 . Additionally, in a study with 1627 patients with 79 presenting neurological immune-mediated syndrome 9 patients had acute disseminated encephalomyelitis and 5 had just myelitis 12 . In children, 5% of the patients studied by Sil et al (2017) had myelitis associated with dengue infection 13 .…”

Section: Encephalitismentioning

confidence: 99%

See 4 more Smart Citations

Dengue Fever and Neurology: Well Beyond Hemorrhage and Strokes

Schlindwein¹,

Bandeira²,

Breis³

et al. 2020

Preprint

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Dengue virus an arbovirus is endemic in an area that comprise almost half of the world's population, contrary to past beliefs that dengue virus differentiate from other neuroinvasive arbovirus due to its lack of neurological invasion and disease related neurological complications excluding hemorrhagic and thromboembolic , the body of evidence have grown to demonstrate a series of neurological manifestations linked to dengue virus with possible mechanisms involving direct virus invasion of the nervous system or immune mediated complications. In this review we provide a wide approach to this neglect but not so rare manifestations of a very common disease.

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“…patients with DENV infection 12 . In children, a study with 71 confirmed cases showed that 28.17% of the patients had neurological involvement 13 .…”

Section: Bhushan Et Al (2018) Found 486% Of Immune-mediated Neurolomentioning

confidence: 99%

Section: Guillain-barre Syndromementioning

confidence: 99%

Section: Encephalitismentioning

confidence: 99%

Section: Encephalitismentioning

confidence: 99%

Section: Encephalitismentioning

confidence: 99%

See 3 more Smart Citations

Dengue Fever and Neurology: Well Beyond Hemorrhage and Strokes

Schlindwein¹,

Bandeira²,

Breis³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

Central nervous system manifestations of dengue infection: data from a tertiary care Centre in South India

George

Lenin

Koshy

et al. 2023

Postgraduate Medical Journal

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Background Dengue fever is the second most common mosquito-borne disease affecting human beings and neurological manifestations (NMs) of this arboviral infection are increasingly being reported. Methods In this retrospective study, conducted in a tertiary care centre in south India, we sought to describe the spectrum of NMs of dengue fever. The records of all patients admitted in the Department of Internal Medicine over 8 years, with a diagnosis of dengue—based on clinical symptoms and the detection of dengue IgM antibodies or detection of NS1 antigen or nucleic acid by reverse transcriptase–polymerase chain reaction (RT-PCR); with Glasgow coma score (GCS) ≤14, neck stiffness, focal neurological signs, seizures, or visual disturbances—were explored. Results Of 1121 patients admitted with dengue fever, 341 (30%) had severe dengue and 23 (2%) had NMs. Encephalopathy was seen in 9 patients (39%), encephalitis in 6 (27%), cerebellitis in 4 (17%), acute disseminated encephalomyelitis (ADEM) in 2 (9%), ischaemic stroke in 1 (4%) patient, and neuro-ophthalmological manifestations in 1 (4%) patient. The median duration of hospital stay was 7 days. Nine (39% of) patients required intensive care unit (ICU) admission and 5 (22%) had fatal outcomes. There was no association between thrombocytopenia, metabolic acidosis, transaminitis, hyponatremia, the type of dengue infection, and the various NMs described. Conclusions The NMs of dengue infection are varied, and a high index of suspicion is needed to identify them in patients who present with lethargy or altered sensorium on the background of an acute febrile illness suggestive of dengue.

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The Involvement of Neuroinflammation in Dengue Viral Disease: Importance of Innate and Adaptive Immunity

Niranjan

Muthukumaravel

Jambulingam

2019

Neuroimmunomodulation

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Neuroinflammation (inflammation in brain) has been known to play an important role in the development of dengue virus disease. Recently, studies from both clinical and experimental models suggest the involvement of neuroinflammation in dengue viral disease. Studies in clinical setup demonstrated that, microglial cells are actively involved in the patients having dengue virus infection, showing involvement of innate immune response in neuroinflammation. It was further proved that, clinical isolates of dengue-2 virus were able to initiate the pathologic response when injected in the mice brain. Natural killer cells were also found to play a crucial role to activate adaptive immune response. Notably, CXCL10/IFN-inducible protein 10 and CXCR3 are involved in dengue virus-mediated pathogenesis and play an important role in the development of dengue virus-mediated paralysis. In a latest report, it was seen that intracranial injection of dengue virus increases the CD8+ T-cell infiltration in brain, showing an important mechanism of neuroinflammation during the dengue virus infection. A similar study has described that, when DENV-3 is injected into the mice, it enhances the infiltration of CD8+ and CD4+ T cells as well as neutrophils. Cells immune-reactive against NS3 antigen were found throughout the brain. In conclusion, we focus on the various molecular mechanisms which contribute to the basic understanding about the role of neuroinflammation in dengue fever. These mechanisms will help in better understanding dengue pathophysiology and thus help in the development of possible therapeutics.

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Immune-mediated neurological manifestations of dengue virus- a study of clinico-investigational variability, predictors of neuraxial involvement, and outcome with the role of immunomodulation

Cited by 9 publications

References 0 publications

<strong>Dengue Fever and Neurology: Well Beyond Hemorrhage and Strokes</strong>

<strong>Dengue Fever and Neurology: Well Beyond Hemorrhage and Strokes</strong>

Central nervous system manifestations of dengue infection: data from a tertiary care Centre in South India

The Involvement of Neuroinflammation in Dengue Viral Disease: Importance of Innate and Adaptive Immunity

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