Solomon T, Dung N M, Vaughn D W, Kneen R, Thao L T, Raengsakulrach B, Loan H T, Day N P, Farrar J, Myint K S, Warrell M J, James W S, Nisalak A, White N J
Wellcome Trust Clinical Research Unit, Cho Quan Hospital, Ho Chi Minh City, Vietnam.
Lancet. 2000 Mar 25;355(9209):1053-9. doi: 10.1016/S0140-6736(00)02036-5.
Severe forms of dengue, the most important arboviral infection of man, are associated with haemorrhagic disease and a generalised vascular leak syndrome. The importance of dengue as a cause of neurological disease is uncertain.
During 1995, all patients with suspected CNS infections admitted to a referral hospital in southern Vietnam were investigated by culture, PCR, and antibody measurement in serum and CSF for dengue and other viruses.
Of 378 patients, 16 (4.2%) were infected with dengue viruses, compared with four (1.4%) of 286 hospital controls (odds ratio [95% CI] 3.1 [1.7-5.8]). Five additional dengue positive patients with CNS abnormalities were studied subsequently. No other cause of CNS infection was identified. Seven infections were primary dengue, 13 secondary, and one was not classified. Ten patients had dengue viruses isolated or detected by PCR, and three had dengue antibody in the CSF. 12 of the 21 had no characteristic features of dengue on admission. The most frequent neurological manifestations were reduced consciousness and convulsions. Nine patients had encephalitis. No patient died, but six had neurological sequelae at discharge. Phylogenetic analysis of the four DEN-2 strains isolated mapped them with a DEN-2 strain isolated from a patient with dengue haemorrhagic fever, and with other strains previously isolated in southern Vietnam.
In dengue endemic areas patients with encephalitis and encephalopathy should be investigated for this infection, whether or not they have other features of the disease.
登革热是人类最重要的虫媒病毒感染，严重形式的登革热与出血性疾病及全身性血管渗漏综合征相关。登革热作为神经系统疾病病因的重要性尚不确定。
1995年期间，对越南南部一家转诊医院收治的所有疑似中枢神经系统感染患者进行了调查，通过培养、聚合酶链反应（PCR）以及检测血清和脑脊液中的登革热病毒及其他病毒抗体来进行诊断。
378例患者中，16例（4.2%）感染了登革热病毒，相比之下，286例医院对照患者中有4例（1.4%）感染（比值比[95%可信区间]3.1[1.7 - 5.8]）。随后又对另外5例登革热阳性且有中枢神经系统异常的患者进行了研究。未发现其他中枢神经系统感染病因。7例感染为原发性登革热，13例为继发性，1例未分类。10例患者的登革热病毒通过分离或PCR检测到，3例患者脑脊液中有登革热抗体。21例患者中有12例入院时无登革热特征性表现。最常见的神经系统表现为意识减退和惊厥。9例患者患有脑炎。无患者死亡，但6例患者出院时有神经系统后遗症。对分离出的4株DEN - 2病毒株进行系统发育分析，结果显示它们与一株从登革出血热患者分离出的DEN - 2病毒株以及越南南部先前分离出的其他病毒株归为一类。
在登革热流行地区，对于患有脑炎和脑病的患者，无论其是否有登革热的其他特征，均应进行该感染的调查。
