Central nervous system involvement in dengue A study in fatal cases from a dengue endemic area

Objective: This study aimed to determine the frequency of CNS infection by dengue virus (DENV) in individuals with fatal outcomes. Methods: Samples of 150 individuals suspect of an infection disease and with fatal outcomes were investigated for evidence of the presence of DENV. The sampling was made up of 150 CSF, 120 tissue samples, and 109 blood specimens. The tests used were viral isolation, reverse transcriptase PCR, immunohistochemistry, nonstructural 1 antigen, and immunoglobulin M detection. Results: Out of 150 studied patients, 84 were dengue positive. Evidence of the presence of DENV was found in 41 CSF, showing the following neurologic diagnosis: 46.3% encephalitis, 34.1% meningoencephalitis, and 19.5% meningitis, giving a frequency of 48.8% of the 84 dengue-positive cases. The major clinical manifestations observed on these individuals were fever, headache, mental irritability, breathless, vomiting, muscle pain, tiredness, abdominal pain, somnolence, restlessness, dizziness, cough, seizure, coma, and neck stiffness. Conclusion: Clinical manifestations and laboratory-positive results in CSF that may indicate the presence of DENV led to consider the invasion of CNS by DENV in these fatal cases studied, and showed that neurologic pathology was an important fatal complication in dengue cases. Neurology (R) 2012;78:736-742