Prospective case-control study of encephalopathy in children with dengue hemorrhagic fever
Prospective case-control study of encephalopathy in children with dengue hemorrhagic fever
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DOI：
10.4269/ajtmh.2001.65.848
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发表时间：
2001-12-01
影响因子：
3.3
通讯作者：
Heegaard, ED
中科院分区：
文献类型：
--
作者：
Cam, BV;Fonsmark, L;Heegaard, ED
我们提出了一项前瞻性病例对照研究，研究对象为27名血清学确诊的登革出血热(DHF)合并严重中枢神经系统症状的患者。登革热相关性脑病在5,400名登革热出血热患者中占0.5%。患有脑病的儿童死亡率为22%，幸存者完全康复。肝酶和胆红素在研究组显著升高。在对脑脊液(CSF)的分析中，逆转录聚合酶链式反应在一例评估病例中发现了登革3型特异性RNA。在22名可评估的患者中，有14名在脑脊液中检测到登革热特异性免疫球蛋白M，这表明是局部感染。磁共振成像扫描显示大多数患者存在脑水肿，尽管脑炎样变化不太常见。原发感染和继发感染平均分布。根据以前的报道和我们的研究结果，登革出血热可能包括一个不断扩大的临床谱系，由于登革热病毒的直接神经毒性作用，这种临床谱系很少涉及脑炎。
We present a prospective case-control study of 27 serologically confirmed dengue hemorrhagic fever (DHF) patients with severe central nervous system symptoms. Dengue associated encephalopathy accounted for 0.5% of 5,400 patients admitted with DHF. The mortality rate among children with encephalopathy was 22%, with the survivors experiencing a complete recovery. Liver enzymes and bilirubin were significantly elevated in the study group. In analysis of the cerebrospinal fluid (CSF), reverse transcriptase-polymerase chain reaction revealed dengue-3-specific RNA in one evaluated case. Dengue-specific immunoglobulin M was detected in CSF in 14 of 22 assessable patients, indicating a localized infection. Magnetic resonance imaging scans showed cerebral edema in the majority of patients, although encephalitis-like changes were less common. There was an equal distribution of primary and secondary infections. On the basis of previous reports and of the findings of our study, DHF probably encompasses an expanding clinical spectrum that infrequently involves encephalitis due to a direct neurotropic effect of dengue virus.