Badat Nafisa, Abdulhussein Dalia, Oligbu Peter, Ojubolamo Olakunle, Oligbu Godwin
School of Medicine, Imperial College London, London SW7 2AZ, UK.
Department of Family Medicine, University of Benin Teaching Hospital (UBTH), Benin City, Nigeria.
Pharmacy (Basel). 2018 Dec 23;7(1):3. doi: 10.3390/pharmacy7010003.
Dengue virus (DENV) is one of the most common arbovirus diseases, with a wide spectrum of presentation. Spinal cord involvement in dengue infection (DF) is rare. However, the risk of transverse myelitis (TM) following Dengue has not been systematically assessed.
We undertook a systematic review of published English literature from January 1974 to December 2017 to assess risk of TM and outcomes following DF. Data sources included EMBASE, MEDLINE, Cochrane library, ISI web of knowledge, conference proceedings and references within identified articles.
We identified 242 potential studies, 62 were duplicates. A further 136 were excluded on the basis of title and abstract and 19 studies did not meet the eligibility criteria on full text screening. We included 25 publications involving 2672 cases of DF. A small proportion (10.8%, (289/2672)) had neurological complications, of which 2.3% (61/2672) was TM. For articles reporting epidemiological data, the neurological complication was twice in males compared to female 67.7% (130/192) vs. 32.7% (62/192) and 1.5-fold increase TM for males 59.3% (32/54) vs 40.7% (22/54). The mean age at presentation was 33.1years (range 0.75⁻61), with onset at 11.7days. The method of diagnosing TM due to DF was mainly IgM seropositivity 92% (n = 23/25) and the commonest treatment modality was steroid 78.3% (n = 18/23). Only half had full recovery 50.8% (n = 31/61). There was no mortality following dengue, however, the crude case fatality rate following TM was 3.3% (n = 2/61).
This review highlights the risk of TM following dengue. Although neurological complications are rare, especially TM, once set in, it is associated with a significant morbidity.
登革病毒（DENV）是最常见的虫媒病毒疾病之一，临床表现多样。登革热感染（DF）累及脊髓的情况罕见。然而，登革热后发生横贯性脊髓炎（TM）的风险尚未得到系统评估。
我们对1974年1月至2017年12月发表的英文文献进行了系统综述，以评估登革热后发生横贯性脊髓炎的风险及预后。数据来源包括EMBASE、MEDLINE、Cochrane图书馆、ISI知识网络、会议论文集以及已识别文章中的参考文献。
我们识别出242项潜在研究，其中62项为重复研究。根据标题和摘要又排除了136项，19项研究在全文筛选时不符合纳入标准。我们纳入了25篇涉及2672例登革热病例的文献。一小部分（10.8%，（289/2672））有神经系统并发症，其中2.3%（61/2672）为横贯性脊髓炎。对于报告流行病学数据的文章，男性的神经系统并发症发生率是女性的两倍，分别为67.7%（130/192）和32.7%（62/192），男性发生横贯性脊髓炎的几率增加1.5倍，分别为59.3%（32/54）和40.7%（22/54）。发病时的平均年龄为33.1岁（范围0.75⁻61岁），发病时间为11.7天。因登革热诊断横贯性脊髓炎的主要方法是IgM血清学阳性92%（n = 23/25），最常见的治疗方式是使用类固醇78.3%（n = 18/23）。只有一半患者完全康复50.8%（n = 31/61）。登革热后无死亡病例，然而，横贯性脊髓炎后的粗病死率为3.3%（n = 2/61）。
本综述强调了登革热后发生横贯性脊髓炎的风险。虽然神经系统并发症罕见，尤其是横贯性脊髓炎，但一旦发生，会导致显著的发病率。
