Neurological complications of dengue fever: Experience from a tertiary center of north India

Abstract

Introduction:Dengue, an acute viral disease transmitted by Aedes mosquitoes, is highly endemic in many tropical and subtropical areas of the world. Neurological complications of dengue infection have been observed more frequently in the recent past and some studies highlighted varied neurological complications arising in the course of dengue illness. In this retrospective study, we report various neurological complications observed during the last 2 years in patients of dengue fever.Materials and Methods:The patients presenting with neurological complications with positive serology (IgM antibody) for dengue infection were consecutively recruited from the Department of Neurology/Medicine from a tertiary center of Lucknow, India. These patients were subjected to a detailed clinical evaluation, laboratory assessment including blood count, hematocrit, coagulation parameters, biochemical assays, serology for dengue fever, enzyme-linked immunosorbent assay for human immunodeficiency virus and other relevant investigations.Results:Twenty-six patients with neurological complications associated with confirmed dengue infection were observed during the last 2 years. Eighteen of these patients were male. Of the 26 patients, 10 patients were suffering from brachial neuritis, four patients had encephalopathy, three patients were consistent with the diagnosis of Guillain Barre syndrome, three patients had hypokalemic paralysis associated with dengue fever and two patients had acute viral myositis. Opsoclonus-myoclonus syndrome was diagnosed in two patients, myelitis in one patient and acute disseminated encephalo-myelitis also in one patient.Conclusion:Dengue fever was associated with widespread neurological complications. Brachial neuritis and opsoclonus-myoclonus syndrome were observed for the first time in this study.

Encephalitic Arboviruses: Emergence, Clinical Presentation, and Neuropathogenesis

“…Dengue hemorrhagic fever (DHF) results from secondary infection and is characterized by a recurrent high fever with vascular leak causing widespread bleeding and multisystem disorder. Presentations of CNS disorder were therefore initially attributed to DHF; however, recent studies indicate that patients with DHF infection may present with acute encephalitis, GBS, and polyradiculopathy, and that DENV is directly neurotropic [68][69][70][71].…”

Patogénesis de la enfermedad por virus del dengue. Revisión de la literatura

“…1. El neutrotropismo que se mencionó anteriormente, como responsable de la encefalitis, meningitis, miositis y mielitis 18 . Las complicaciones sistémicas resultantes en encefalopatía y parálisis hipokalémica, como hipotensión, edema cerebral, hemorragia microvascular o franca, hiponatremia y falla fulminante hepática.…”

“…Las complicaciones sistémicas resultantes en encefalopatía y parálisis hipokalémica, como hipotensión, edema cerebral, hemorragia microvascular o franca, hiponatremia y falla fulminante hepática. 18,19 Además, se podría presentar un cuadro de encefalomielitis postinfecciosa con mediación inmune, que incluye también al síndrome de Guillain Barré y la neuritis óptica.…”

Proteinuria asociada al dengue

“…La gravedad de estos órganos dañados además del riñón (hígado, miocardio, músculo esquelético, sistema nervioso central y periférico) es muy variable y no existen factores predictores conocidos de [14][15][16][17][18][19][20] severidad. Se cree que infecciones previas con otros serotipos del virus predisponen a una gran liberación de citoquinas que persisten en la memoria inmunológica.…”