Importance of cerebrospinal fluid investigation during dengue infection in Brazilian Amazonia Region
Open Access
- 1 January 2019
- journal article
- research article
- Published by FapUNIFESP (SciELO) in Memórias do Instituto Oswaldo Cruz
- Vol. 114, e180450
- https://doi.org/10.1590/0074-02760180450
Abstract
BACKGROUND Amazon, the largest tropical forest of the world, has suffered from dengue outbreaks since 1998. Cerebrospinal fluid (CSF) of patients, from Amazonas state, suspected of central nervous system (CNS) viral infection was studied using molecular and immunological methods. OBJECTIVE To evaluate the importance of CSF investigation in patients with acute dengue virus (DENV) infection of CNS. METHODS CSF samples of 700 patients were analysed by reverse transcription polymerase chain reaction (RT-PCR) to detect the presence of dengue virus (DENV) RNA and by enzyme-linked immunosorbent assay (ELISA) to detect presence of DENV specific IgM. FINDINGS DENV infection was detected in 4.3% of the CSF samples; 85.7% (24/28) by DENV IgM and 14.3% (4/28) by viral RNA. DENV detected by viral RNA were to be found serotypes DENV-2 (three patients) and DENV-1 (one patient). The neurological diagnosis in patients CNS infection of DENV included encephalitis (10), meningoencephalitis (10), meningitis (6), acute myelitis (1), and encephalomyelitis (1). The majority (89.3%) had intrathecal inflammation: pleocytosis, hyperproteinorrachia and DENV IgM antibodies. Hypoglycorrhachia and/or high levels of lactate in CSF were found in 36% of the patients. Co-infection (CMV, HIV, EBV, and/or Mycobacterium tuberculosis) was observed in eight (28.6%) cases. CONCLUSIONS We found intense inflammatory CSF that is unusual in CNS disorders caused by dengue infection. It may be due co-infections or the immunogenetic background of the local Amerindian Brazilian population. CSF examination is an important diagnostic support tool for neurological dengue diagnosis.Keywords
This publication has 29 references indexed in Scilit:
- Neurological complications of dengue virus infectionThe Lancet Neurology, 2013
- Dengue in Patients with Central Nervous System Manifestations, BrazilEmerging Infectious Diseases, 2012
- MEGA5: Molecular Evolutionary Genetics Analysis Using Maximum Likelihood, Evolutionary Distance, and Maximum Parsimony MethodsMolecular Biology and Evolution, 2011
- Dengue em criança: aspectos clínicos e epidemiológicos, Manaus, Estado do Amazonas, no período de 2006 e 2007Revista da Sociedade Brasileira de Medicina Tropical, 2009
- Genetic and Serologic Properties of Zika Virus Associated with an Epidemic, Yap State, Micronesia, 2007Emerging Infectious Diseases, 2008
- Duplex Reverse Transcription-PCR Followed by Nested PCR Assays for Detection and Identification of Brazilian Alphaviruses and FlavivirusesJournal of Clinical Microbiology, 2005
- Doenças exantemáticas e primeira epidemia de dengue ocorrida em Manaus, Amazonas, no período de 1998-1999Revista da Sociedade Brasileira de Medicina Tropical, 2004
- Ethnic Admixture Composition of Two Western Amazonian PopulationsHuman Biology, 2002
- Laboratory Diagnosis of Common Herpesvirus Infections of the Central Nervous System by a Multiplex PCR AssayJournal of Clinical Microbiology, 2001
- Blood polymorphisms and racial admixture in two Brazilian populationsAmerican Journal of Physical Anthropology, 1982