Bhushan Bharat, Sardana Vijay, Maheshwari Dilip, Ojha Piyush, Mohan Sankalp, Moon Parag, Kamble Sumit, Jain Nishtha, Sharma Sunil K
Department of Neurology, Government Medical College Kota, Rajasthan, India.
Neurol India. 2018 Nov-Dec;66(6):1634-1643. doi: 10.4103/0028-3886.246273.
Our aim was to study dengue-related immune-mediated neurological complications (IMNC) during the recent epidemic.
This was a cross-sectional observational study of 79 IMNC cases from 1627 laboratory confirmed dengue cases from January 2015 to January 2016 and their follow-up for 3 months. According to the World Health Organization, cases were categorized into those having dengue fever (DF), and those having a severe syndrome that includes dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Laboratory as well as clinicoradiological data, the predictors of outcome, and the role of immunomodulation in determining the final result were analyzed.
Out of the 1627 confirmed dengue cases, 14.6% developed neurological complications and only 4.86% cases had IMNC. Among the IMNC seen, the majority of the patients had the onset of their manifestations in the subacute (7-30 days) latency period; however, there was no mortality seen. We found Miller Fisher syndrome (MFS), limbic encephalitis, and immune-mediated cerebellar demyelination (IMCD) as the new findings in the IMNC spectrum. Patients with DF were more prone to developing brachial plexus neuritis and polyneuritis cranialis, whereas those patients with a severe syndrome were more commonly associated with Guillain-Barre syndrome (GBS). Significant (P < 0.001) predictors of central nervous system involvement were anemia, an elevated hematocrit, and the presence of DSS, whereas patients with a higher mean body temperature, DF, and elevated hematocrit were more prone to developing peripheral nervous system manifestations. The platelets counts and the hemoglobin levels had a negative correlation whereas the hematocrit value, the mean body temperature, and the alanine aminotransferase levels had a moderately significant positive correlation for the development of IMNC. The immunomodulatory therapy (IMT), if initiated after fever abatement led to a significant clinically favorable outcome at 3 months, especially in patients with GBS, polyneuritis cranialis, and brachial plexus neuritis.
The spectrum of IMNC is vast and may include MFS, limbic encephalitis and IMCD. Early initiation of IMT, in the presence of significant predictors, may reduce the IMNC-related morbidity.
我们的目的是研究近期疫情期间登革热相关的免疫介导性神经并发症（IMNC）。
这是一项横断面观察性研究，对2015年1月至2016年1月1627例实验室确诊的登革热病例中的79例IMNC病例进行了研究，并对其进行了3个月的随访。根据世界卫生组织的标准，病例被分为登革热（DF）患者以及患有严重综合征（包括登革出血热（DHF）和登革休克综合征（DSS））的患者。分析了实验室及临床放射学数据、预后预测因素以及免疫调节在决定最终结果中的作用。
在1627例确诊的登革热病例中，14.6%出现了神经并发症，仅有4.86%的病例患有IMNC。在观察到的IMNC病例中，大多数患者在亚急性（7 - 30天）潜伏期出现症状；然而，未观察到死亡病例。我们发现米勒费雪综合征（MFS）、边缘性脑炎和免疫介导的小脑脱髓鞘（IMCD）是IMNC谱中的新发现。DF患者更容易发生臂丛神经炎和颅神经炎，而患有严重综合征的患者更常与吉兰 - 巴雷综合征（GBS）相关。中枢神经系统受累的显著（P < 0.001）预测因素是贫血、血细胞比容升高和DSS的存在，而平均体温较高、DF和血细胞比容升高的患者更容易出现周围神经系统表现。血小板计数和血红蛋白水平呈负相关，而血细胞比容值、平均体温和丙氨酸转氨酶水平与IMNC的发生呈中度显著正相关。免疫调节治疗（IMT）如果在退热后开始，在3个月时会带来显著的临床良好结果，尤其是对于GBS、颅神经炎和臂丛神经炎患者。
IMNC谱很广，可能包括MFS、边缘性脑炎和IMCD。在存在显著预测因素的情况下尽早开始IMT可能会降低与IMNC相关的发病率。
