Neurology Service, Antônio Pedro Hospital/Federal Fluminense University, Brazil.
J Neurol Sci. 2011 Apr 15;303(1-2):75-9. doi: 10.1016/j.jns.2011.01.012. Epub 2011 Feb 2.
To evaluate the etiology of viral meningitis and encephalitis in adults and adolescents living in areas affected by dengue.
Over two years, adults and adolescents with diagnoses of viral encephalitis or meningitis were selected for study in Brazil. PCRs for dengue, enterovirus, HSV1 and 2 and cytomegalovirus were performed in CSF samples. Serum and CSF samples were tested for the presence of anti-dengue IgM antibodies.
The etiologies of encephalitis and meningitis were determined in 70% of cases (30/47). Dengue was the leading cause of encephalitis (47%) with normal CSF cellularity in 75% of these patients. HSV1 was found in 17.6% of the cases, two of which had mild encephalitis. Enterovirus was the most common cause of meningitis (50%), followed by HSV1 (15%), cytomegalovirus and dengue (10%, each).
We identified the viral agents causing encephalitis and meningitis in a higher proportion of cases than has been reported in other studies. Dengue was the most frequent cause of encephalitis, which surpassed HSV. In endemic areas, dengue should be investigated as an important cause of encephalitis. Normal CSF cellularity should not exclude dengue encephalitis. Enterovirus is known to be the leading cause of meningitis in children, but here we found it was also the main cause of the disease in adults. HSV1 should be investigated in patients with mild forms of encephalitis and meningitis.
评估流行地区成人和青少年罹患病毒性脑炎和脑膜炎的病因。
本研究在巴西进行，为期两年，选择诊断为病毒性脑炎或脑膜炎的成人和青少年进行研究。对脑脊液样本进行登革热、肠道病毒、单纯疱疹病毒 1 型和 2 型以及巨细胞病毒的 PCR 检测。检测血清和脑脊液样本中是否存在抗登革热 IgM 抗体。
70%（30/47）的病例确定了脑炎和脑膜炎的病因。登革热是脑炎的主要病因（47%），其中 75%的患者脑脊液细胞数正常。单纯疱疹病毒 1 型占 17.6%，其中 2 例为轻度脑炎。肠道病毒是最常见的脑膜炎病因（50%），其次是单纯疱疹病毒 1 型（15%）、巨细胞病毒和登革热（各 10%）。
与其他研究相比，我们在更高比例的病例中确定了引起脑炎和脑膜炎的病毒病原体。登革热是脑炎最常见的病因，超过了单纯疱疹病毒。在流行地区，应将登革热视为脑炎的重要病因进行调查。正常的脑脊液细胞数不应排除登革热脑炎。肠道病毒是儿童脑膜炎的主要病因，但在这里我们发现它也是成人发病的主要原因。单纯疱疹病毒 1 型应在患有轻度脑炎和脑膜炎的患者中进行调查。
