Lum L C, Lam S K, Choy Y S, George R, Harun F
Department of Pediatrics, University Hospital, Kuala Lumpur, Malaysia.
Am J Trop Med Hyg. 1996 Mar;54(3):256-9. doi: 10.4269/ajtmh.1996.54.256.
Involvement of the central nervous system in dengue fever and dengue hemorrhagic fever has always been thought to be secondary to vasculitis with resultant fluid extravasation, cerebral edema, hypoperfusion, hyponatremia, liver failure, and/or renal failure. Thus, the condition has been referred to as dengue encephalopathy. Encephalitis or direct involvement of the brain by the virus was thought to be unlikely. This paper reports on six children who were seen over a period of two years presenting on the second or third day of illness with dengue encephalitis. The diagnosis was based upon a clinical picture of encephalitis and confirmed by cerebrospinal fluid (CSF) microscopy and electroencephalography changes. All six cases were confirmed dengue infections. Dengue 3 virus was isolated from the CSF of four cases and in one case, dengue 2 was detected by the polymerase chain reaction in both the CSF and blood. In the sixth case, virologic evidence was negative but dengue immunoglobulin M was detected in the CSF and blood. Since the onset of encephalitis appears early in the course of illness coinciding with the viremic phase, we postulate that the virus crosses the blood-brain barrier and directly invades the brain causing encephalitis. This study provides strong evidence that dengue 2 and 3 viruses have neurovirulent properties and behave similarly to other members of the Flaviviridae.
登革热和登革出血热累及中枢神经系统一直被认为是血管炎继发的结果，会导致液体外渗、脑水肿、灌注不足、低钠血症、肝衰竭和/或肾衰竭。因此，这种情况被称为登革热脑病。人们认为脑炎或病毒直接侵犯大脑的可能性不大。本文报告了两年来诊治的6例儿童登革热脑炎患者，均在发病第二天或第三天就诊。诊断依据脑炎的临床表现，并经脑脊液显微镜检查和脑电图改变得以证实。所有6例均确诊为登革热感染。4例患者的脑脊液中分离出登革热3型病毒，1例患者的脑脊液和血液中通过聚合酶链反应检测到登革热2型病毒。第6例病毒学证据为阴性，但脑脊液和血液中检测到登革热免疫球蛋白M。由于脑炎在病程早期出现，与病毒血症期一致，我们推测病毒穿过血脑屏障直接侵犯大脑导致脑炎。本研究提供了有力证据，证明登革热2型和3型病毒具有神经毒性，其表现与黄病毒科的其他成员相似。
