Tabla I. Criterios diagnósticos de infección por virus del dengue (Organización Mundial de la Salud, 2009). |
Dengue sin signos de alarma |
Dengue con signos de alarma Signos clínicos:
Hallazgos de laboratorio:
|
Dengue grave Extravasación grave de plasma que resulta en:
o sangrado grave según criterio clínico o afectación orgánica grave:
|
ALT: alanina transaminasa; AST: aspartato transaminasa. a Tres o más vómitos en una hora o cuatro en seis horas. |
Tabla II. Complicaciones neurológicas del dengue. |
|
Encefalopatía |
|
Encefalitis aguda/meningitis/encefalomielitis |
|
Síndromes (posiblemente) inmunomediados |
Encefalomielitis aguda diseminada |
Cerebelitis |
|
Parkinsonismo postencefalítico |
|
Mononeuritis: neuritis óptica, parálisis del III par (oculomotor), parálisis del VI par (abducens), parálisis del nervio torácico largo, parálisis del nervio frénico |
|
Polirradiculoneuritis (síndrome de Guillain-Barré) |
|
Síndrome de Miller Fisher |
|
Neuritis braquial |
|
Plexopatía lumbosacra |
|
Mielitis transversa aguda/postinfecciosa |
|
Ictus isquémico/hemorrágico |
|
Complicaciones neuromusculares |
Disfunción muscular transitoria |
Miositis/rabdomiólisis |
|
Parálisis hipopotasémica |
|
Complicaciones neurooftalmológicas |
Maculopatía |
Hemorragia retiniana |
|
Vitritis |
Neurological complications associated with dengue virus infection Introduction. Dengue is an arboviral infection caused by the dengue virus. The neurological complications associated with this infection are reviewed. Development. The neurotropic nature of dengue virus has been confirmed in epidemiological studies, case series and histopathological studies. The range of neurological complications is 5.6-14.6%, and they are more frequent in serotypes 1 and 3. Encephalopathy is the most common neurological syndrome (0.5-6%) and its prevalence is higher in children and adolescents. The detection of the viral antigen in brain tissue and the presence of pleocytosis or RNA in cerebrospinal fluid are evidence of the neurotropic nature of dengue virus, which manifests itself in the form of encephalitis. Neurological syndromes during convalescence (disseminated acute cerebellitis, opsoclonus-myoclonus syndrome, mononeuritis, polyradiculoneuritis and plexitis) appear to be immunomediated. Myelitis can occur during acute dengue virus infection and through an immunomediated mechanism in the convalescence phase. Myalgias, myositis, rhabdomyolysis and hypokalemic paralysis are examples of muscular dysfunction associated with the dengue virus. The incidence of stroke is 0.26%, and may be ischaemic or haemorrhagic. Ophthalmological complications include maculopathy, retinal haemorrhage, optic neuropathy and vitritis. Conclusions. The spectrum of neurological complications from dengue virus is broad. There are no reliable data on its real incidence because most of the studies published to date are isolated series or cases. Key words. Aedes. Arbovirus. Dengue. Encephalitis. Encephalopathy. Myelitis. |