Misra Usha Kant, Kalita Jayantee, Mani Vinita Elizabeth, Chauhan Prashant Singh, Kumar Pankaj
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow 226014, India.
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow 226014, India.
J Clin Virol. 2015 Nov;72:146-51. doi: 10.1016/j.jcv.2015.08.021. Epub 2015 Sep 3.
Neurological involvement in dengue virus (DENV) infection is being increasingly reported. There is paucity of studies evaluating the relative frequency of central nervous system (CNS) and muscle involvement in dengue.
To evaluate the frequency and prognosis of neurological and muscle involvement in dengue, and correlate these with dengue subtypes.
Consecutive dengue patients were included, and their clinical features, laboratory investigations and cerebrospinal fluid (CSF) findings were recorded. Cranial MRI was done in unconscious patients and electromyography and nerve conduction study in patients with flaccid weakness. Patients were categorized into encephalopathy, encephalitis, immune mediated and dengue associated muscle dysfunction (DAMD). Outcome at 1 month and its predictors were evaluated.
116 patients aged 5-70 years were included; 82 had dengue fever (DF), 18 had dengue hemorrhagic fever (DHF), and 16 had dengue shock syndrome (DSS). Neurological manifestations were present in 92 (79%); encephalopathy in 17 (15%), encephalitis in 22 (19%), transverse myelitis in 1 (1%) and DAMD in 52 (45%) patients. Central nervous system (CNS) involvement was commoner in DHF/DSS compared to DF (44% vs 26%). 10 patients with CNS involvement died versus 1 with DAMD. The patients in the CNS group had more frequent hypotension, renal dysfunction and respiratory failure compared to the DAMD group, and had worse outcome. DENV2 and DENV3 were the commonest serotypes, but serotypes did not differ between CNS and DAMD groups.
DAMD is commoner than CNS involvement in dengue. CNS involvement however, is associated with more serious illness and predicts poorer outcome.
登革热病毒（DENV）感染所致神经系统受累的报道日益增多。评估登革热中枢神经系统（CNS）和肌肉受累相对频率的研究较少。
评估登革热神经系统和肌肉受累的频率及预后，并将其与登革热亚型相关联。
纳入连续的登革热患者，记录其临床特征、实验室检查及脑脊液（CSF）检查结果。对昏迷患者进行头颅MRI检查，对弛缓性肌无力患者进行肌电图和神经传导研究。患者分为脑病、脑炎、免疫介导性及登革热相关肌肉功能障碍（DAMD）。评估1个月时的结局及其预测因素。
纳入116例年龄5至70岁的患者；82例为登革热（DF），18例为登革出血热（DHF），16例为登革休克综合征（DSS）。92例（79%）有神经系统表现；17例（15%）为脑病，22例（19%）为脑炎，1例（1%）为横贯性脊髓炎，52例（45%）为DAMD。与DF相比，DHF/DSS中中枢神经系统（CNS）受累更为常见（44%对26%）。10例CNS受累患者死亡，而DAMD患者中1例死亡。与DAMD组相比，CNS组患者低血压、肾功能不全和呼吸衰竭更为常见，且结局更差。DENV2和DENV3是最常见的血清型，但CNS组和DAMD组血清型无差异。
登革热中DAMD比CNS受累更常见。然而，CNS受累与更严重的疾病相关，且预示预后较差。
