Carod-Artal Francisco Javier
Neurology Department, Raigmore hospital, Inverness, UK.
Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
Res Rep Trop Med. 2014 Oct 29;5:95-104. doi: 10.2147/RRTM.S55372. eCollection 2014.
Dengue is the most common mosquito-borne viral infection worldwide. There is increased evidence for dengue virus neurotropism, and neurological manifestations could make part of the clinical picture of dengue virus infection in at least 0.5%-7.4% of symptomatic cases. Neurological complications have been classified into dengue virus encephalopathy, dengue virus encephalitis, immune-mediated syndromes (acute disseminated encephalomyelitis, myelitis, Guillain-Barré syndrome, neuritis brachialis, acute cerebellitis, and others), neuromuscular complications (hypokalemic paralysis, transient benign muscle dysfunction and myositis), and dengue-associated stroke. Common neuro-ophthalmic complications are maculopathy and retinal vasculopathy. Pathogenic mechanisms include systemic complications and metabolic disturbances resulting in encephalopathy, direct effect of the virus provoking encephalitis, and postinfectious immune mechanisms causing immune-mediated syndromes. Dengue viruses should be considered as a cause of neurological disorders in endemic regions. Standardized case definitions for specific neurological complications are still needed.
登革热是全球最常见的蚊媒病毒感染。越来越多的证据表明登革热病毒具有嗜神经性,在至少0.5%-7.4%的有症状病例中,神经表现可能成为登革热病毒感染临床症状的一部分。神经并发症已被分为登革热病毒脑病、登革热病毒脑炎、免疫介导综合征(急性播散性脑脊髓炎、脊髓炎、格林-巴利综合征、臂神经炎、急性小脑炎等)、神经肌肉并发症(低钾性麻痹、短暂性良性肌肉功能障碍和肌炎)以及登革热相关性中风。常见的神经眼科并发症是黄斑病变和视网膜血管病变。致病机制包括导致脑病的全身并发症和代谢紊乱、病毒引发脑炎的直接作用以及引起免疫介导综合征的感染后免疫机制。在流行地区,应将登革热病毒视为神经系统疾病的一个病因。仍需要针对特定神经并发症的标准化病例定义。