Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Guest Editorial
3 (
1
); 1-1
doi:
10.4103/0976-3147.91919

Dengue infection: An emerging cause of neuromuscular weakness

Department of Medicine, Christian Medical College, Ludhiana, Punjab, India
Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
Address for correspondence: Dr. Jeyaraj D Pandian, Department of Neurology, Betty Cowan Research and Innovation Centre, Christian Medical College, Ludhiana, Punjab-141 008, India. E-mail: jeyarajpandian@hotmail.com
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Dengue fever is caused by dengue virus which belongs to the family filoviridae and genus flavi virus. Aedes aegypti is the vector responsible for transmission of the viral infection. Clinical spectrum ranges from an uncomplicated febrile illness to devastating hemorrhages and refractory shock. Hemorrhagic manifestations in dengue hemorrhagic fever (DHF) range from petechial hemorrhages to the life-threatening gastrointestinal, pulmonary, and cerebral or genitourinary hemorrhages.

Neurological manifestations have been increasingly recognized over the last many epidemics. Various neurological involvements reported in dengue virus infection are encephalitis, acute disseminated encephalomyelitis, transverse myelitis, Guillain–Barré syndrome (GBS), myositis, and stroke.[18]

Though dengue virus has been considered a non neurotropic virus, neuroinvasion has been reported in five fatal cases of dengue encephalopathy in which dengue virus antigen was detected in the brain by immunochemistry.[7] In patients with dengue encephalitis, CSF pleocytosis and positive IgM and polymerase chain reaction (PCR) tests have also been reported, suggesting neuroinvasion.

Neuromuscular complications have been reported in patients with dengue infection. They are GBS, acute quadriparesis due to hypokalemia, and myositis.[58] Hira et al. in this issue reported 12 patients with different neuromuscular problems such as hypokalemic periodic paralysis, GBS, and myositis.[9] The proposed mechanism of hypokalemia is due to redistribution of potassium in cells or transient renal tubular abnormalities leading to increased urinary potassium wasting. Hypokalemia in dengue fever responds well to potassium correction with complete recovery.[8] Antecedent infection which evokes an immune response which affects the myelin or the axon of peripheral nerves has been elucidated as the mechanism for GBS in these patients.[4] The diagnosis of myositis is based on clinical presentation, raised creatinine phosphokinase (CPK), electromyography (EMG) evidence, and muscle biopsy. Misra et al., reported five patients presenting with acute pure motor weakness with raised CPK.[5] EMG and muscle biopsy were consistent with myositis in one of those patients.

Neurological manifestations in dengue fever are not uncommon. Clinicians should be aware of these manifestations particularly who present with quadriparesis and most of these patients make full recovery.

References

  1. , , , , , , . Neurological manifestations of dengue infection. Lancet. 2000;25:1053-9.
    [Google Scholar]
  2. , , . Acute disseminating encephalomyelitis with hemorrhage following dengue. Neurol India. 2010;58:595-6.
    [Google Scholar]
  3. , , , . Acute transverse myelitis following dengue virus infection. J Clin Virol. 2006;35:310-2.
    [Google Scholar]
  4. , , , , , . Guillain Barre syndrome in the course of dengue: Case report. Arq Neuropsiquiatr. 2004;62:144-6.
    [Google Scholar]
  5. , , , , . Neurological manifestations of dengue virus infection. J Neurol Sci. 2006;244:117-22.
    [Google Scholar]
  6. , , . Stroke in patients with dengue. J Stroke Cerebrovasc Dis. 2010;19:253-6.
    [Google Scholar]
  7. , , , , , , . Retrospective study on dengue fatal cases. Clin Neuropathol. 1997;16:204-8.
    [Google Scholar]
  8. , , . Dengue infection causing acute hypokalemic quadriparesis. Neurol India. 2010;58:592-4.
    [Google Scholar]
  9. , , , . Acute neuromuscular weakness associated with dengue infection. J Neurosci Rural Pract. 2012;3:36-9.
    [Google Scholar]

    Fulltext Views
    324

    PDF downloads
    390
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections