Carod-Artal F J
Universitat Internacional de Catalunya, Barcelona, Espana.
Raigmore Hospital, Inverness, Reino Unido.
Rev Neurol. 2019 Aug 1;69(3):113-122. doi: 10.33588/rn.6903.2019140.
Dengue is an arboviral infection caused by the dengue virus. The neurological complications associated with this infection are reviewed.
The neurotropic nature of dengue virus has been confirmed in epidemiological studies, case series and histopathological studies. The range of neurological complications is 5.6-14.6%, and they are more frequent in serotypes 1 and 3. Encephalopathy is the most common neurological syndrome (0.5-6%) and its prevalence is higher in children and adolescents. The detection of the viral antigen in brain tissue and the presence of pleocytosis or RNA in cerebrospinal fluid are evidence of the neurotropic nature of dengue virus, which manifests itself in the form of encephalitis. Neurological syndromes during convalescence (disseminated acute cerebellitis, opsoclonus-myoclonus syndrome, mononeuritis, poly-radiculoneuritis and plexitis) appear to be immunomediated. Myelitis can occur during acute dengue virus infection and through an immunomediated mechanism in the convalescence phase. Myalgias, myositis, rhabdomyolysis and hypokalemic paralysis are examples of muscular dysfunction associated with the dengue virus. The incidence of stroke is 0.26%, and may be ischaemic or haemorrhagic. Ophthalmological complications include maculopathy, retinal haemorrhage, optic neuropathy and vitritis.
The spectrum of neurological complications from dengue virus is broad. There are no reliable data on its real incidence because most of the studies published to date are isolated series or cases.
登革热是由登革病毒引起的虫媒病毒感染。本文对与该感染相关的神经并发症进行综述。
登革病毒的嗜神经性已在流行病学研究、病例系列和组织病理学研究中得到证实。神经并发症的发生率为5.6 - 14.6%,在血清型1和3中更为常见。脑病是最常见的神经综合征(0.5 - 6%),在儿童和青少年中患病率更高。脑组织中病毒抗原的检测以及脑脊液中细胞数增多或RNA的存在是登革病毒嗜神经性的证据,其以脑炎形式表现出来。恢复期的神经综合征(播散性急性小脑炎、眼阵挛 - 肌阵挛综合征、单神经炎、多神经根神经炎和神经丛炎)似乎是免疫介导的。脊髓炎可在急性登革病毒感染期间发生,并在恢复期通过免疫介导机制出现。肌痛、肌炎、横纹肌溶解和低钾性麻痹是与登革病毒相关的肌肉功能障碍的例子。中风的发生率为0.26%,可能是缺血性或出血性。眼科并发症包括黄斑病变、视网膜出血、视神经病变和玻璃体炎。
登革病毒引起的神经并发症范围广泛。由于迄今为止发表的大多数研究都是孤立的系列或病例,因此尚无关于其实际发病率的可靠数据。