Goswami Rudra Prosad, Mukherjee Arindam, Biswas Tapan, Karmakar Partha Sarathi, Ghosh Alakendu
Department of Internal Medicine , Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
J Infect Dev Ctries. 2012 Feb 13;6(2):208-11. doi: 10.3855/jidc.2241.
Dengue, a mosquito-borne disease caused by a flavivirus, is recognized in over 120 countries with 3.6 billion people living in areas at risk. Neurological manifestations are infrequently reported as clinical consequences of dengue infection. Though severe dengue may be associated with meningoencephalitis, meningitis is a rare initial presentation of otherwise uncomplicated dengue fever. We report two adult patients who presented with fever, headache, and nuchal rigidity without the typical symptoms of dengue infection. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis in one and slight neutrophilic pleocytosis in the other with a normal glucose value and negative bacterial cultures. Dengue was suspected because thrombocytopenia was symptomatic in one patient and documented during the hospital course, and was confirmed by demonstration of IgM antibody in the cerebrospinal fluid samples specific for dengue in both cases. Our report demonstrates that meningitis with or without encephalitis can be the first manifestation of dengue infection. In endemic areas, dengue infection should be considered as a probable etiological agent of meningitis. Regular monitoring of platelet count can be an invaluable diagnostic screening tool. In appropriate clinical settings detection of anti-dengue IgM both in serum and in CSF may lead to correct diagnosis.
登革热是一种由黄病毒引起的蚊媒疾病,在120多个国家都有发现,有36亿人生活在有风险的地区。神经系统表现作为登革热感染的临床后果鲜有报道。虽然重症登革热可能与脑膜脑炎有关,但脑膜炎是无并发症的登革热发热罕见的初始表现。我们报告了两名成年患者,他们表现出发热、头痛和颈部强直,没有登革热感染的典型症状。脑脊液(CSF)分析显示,其中一名患者为淋巴细胞增多,另一名患者为轻度中性粒细胞增多,葡萄糖值正常,细菌培养阴性。怀疑为登革热是因为一名患者有血小板减少症状且在住院期间得到证实,并且在两例患者的脑脊液样本中均通过检测到针对登革热的特异性IgM抗体而得到确诊。我们的报告表明,伴有或不伴有脑炎的脑膜炎可能是登革热感染的首发表现。在流行地区,应将登革热感染视为脑膜炎可能的病因。定期监测血小板计数可能是一种非常有价值的诊断筛查工具。在适当的临床环境中,检测血清和脑脊液中的抗登革热IgM可能有助于正确诊断。