Post-dengue acute disseminated encephalomyelitis: A case report and meta-analysis

Abstract

BackgroundDengue is one of the most common infectious diseases. The aim of this study was to systematically review acute disseminated encephalomyelitis (ADEM) and to represent a new case.Methodology/Principal findingsWe searched for articles in nine databases for case reports, series or previous reviews reporting ADEM cases in human. We used Fisher’s exact and Mann-Whitney U tests. Classification trees were used to find the predictors of the disease outcomes. We combined findings using fixed- and random-effects models. A 13-year-old girl was admitted to the hospital due to fever. She has a urinary retention. The neurological examinations revealed that she became lethargic and quadriplegic. She had upper limbs weakness and lower limbs complete paraplegia. Her status gradually improved after the treatment. She was nearly intact with the proximal part of her legs had a mild weakness in discharge. The prevalence of ADEM among dengue patients was 0.4% [95% confidence intervals (95% CI) 0.1–2.5%], all neurological disorders among dengue was 2.6% [95% CI 1.8–3.8%], and ADEM among neurological disorders was 6.8% [95% CI 3.4–13%]. The most frequent manifestation of ADEM was altered sensorium/consciousness (58%), seizures and urination problems (35%), vision problems (31%), slurred speech (23%), walk problems (15%) then ataxia (12%). There was a significant difference between cases having complete recovery or bad outcomes in the onset day of neurological manifestations being earlier and in temperature being higher in cases having bad outcomes (p-value < 0.05). This was confirmed by classification trees which included these two variables.Conclusions/SignificanceThe prevalence of ADEM among dengue and other dengue-related neurological disorders is not too rare. The high fever of ADEM cases at admission and earlier onset day of neurological manifestations are associated with the bad outcomes.

Clinical outcomes of current medical approaches for Middle East respiratory syndrome: A systematic review and meta‐analysis

“…Fisher exact (or chi‐square, as appropriate) and Mann‐Whitney U tests were used for the categorical and continuous variables, respectively. The classification and regression tree (CART) model was used to identify independent variables that predict mortality outcome . Invasive ventilation and renal replacement therapy were also chosen as the outcomes in the CART model because of direct correlation with severity and mortality .…”

“…The classification and regression tree (CART) model was used to identify independent variables that predict mortality outcome . Invasive ventilation and renal replacement therapy were also chosen as the outcomes in the CART model because of direct correlation with severity and mortality . All possible variables were extracted to build CART (Table S4, Found in the Supporting Information).…”

“…All possible variables were extracted to build CART (Table S4, Found in the Supporting Information). The performance parameters are accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) . Results were considered to have statistical significance if the P value was <.05.…”

Systematic review of spontaneous splenic rupture in dengue‐infected patients

“…A new classification made by the World Health Organization (WHO) society in 2009 classifies dengue as dengue without warning signs, dengue with warning signs, and severe dengue (SD) . Plasma leakage and virus pathogenesis are responsible for several serious complications: shock, cardiomyopathy, encephalopathy, encephalitis, hepatic damage, and neural manifestations . Spontaneous splenic rupture is known as a complication of infectious diseases such as malaria, mononucleosis, and hematopoietic disorder .…”

“…1 Plasma leakage and virus pathogenesis are responsible for several serious complications: shock, cardiomyopathy, encephalopathy, encephalitis, hepatic damage, and neural manifestations. [3][4][5] Spontaneous splenic rupture is known as a complication of infectious diseases such as malaria, mononucleosis, and hematopoietic disorder. [6][7][8] The aim of this study was to systematically review all relevant studies reporting splenic rupture related to dengue infection to summarize demography, clinical picture, and time of splenic rupture during illness, management, and outcome.…”