Ana-Claire Meyer, MD, MSHS
The central and peripheral nervous systems can be involved in patients hospitalized with dengue virus infection and are more often affected in those with severe infection.
Dengue is among the most common arboviral infections worldwide and is endemic in many tropical regions. Outside of endemic areas, dengue viral infections are seen primarily in individuals with recent travel to endemic areas as well as in rare autochthonous outbreaks. Dengue is a flavivirus and is closely related to viruses known to have significant neurological involvement, such as West Nile virus, Japanese encephalitis virus, and St. Louis encephalitis virus.
Researchers compared clinical factors and outcomes among dengue patients with no neurologic involvement, those with central nervous system (CNS) involvement, and those with peripheral nervous system (PNS) involvement in a hospital-based, prospective cohort study of 486 adults and children with laboratory-confirmed dengue virus infections in northern India. Individuals were assessed using standardized case definitions for complications localizable to the CNS (encephalitis, encephalopathy, or myelitis) and the PNS (Guillain-Barré syndrome, neuralgic amyotrophy/brachial neuritis, hypokalemic paralysis, or dengue myositis). Investigations included neuroimaging, cerebrospinal fluid analysis, electrophysiologic studies, and muscle biopsy as appropriate.
More than 9% of individuals hospitalized with dengue had neurologic complications in the CNS or PNS. Nearly half of the individuals with neurologic complications were younger than 20 years. Individuals with neurologic complications were more likely to have severe disease, defined as dengue hemorrhagic fever, high temperature, presence of myalgias and arthralgias, rash, thrombocytopenia, hemoconcentration, or elevated alanine aminotransferase. Consistent with other case series, the most common neurologic complications were encephalitis and encephalopathy. Mortality rates were higher in individuals with CNS involvement, although prognosis at 3 months was good in individuals with neurologic complications.
Citation(s):
Sahu R et al. Neurologic complications in dengue virus infection: A prospective cohort study. Neurology 2014 Sep 24; [e-pub ahead of print].
