ABSTRACT

The aim was to assess neurological complications in children with an invasive neurological disease by dengue virus (DENV) and the time to resolve symptoms after hospital discharge. A prospective study was conducted at a referral hospital for infectious diseases in Brazil between March 2014 and July 2019. All children hospitalized with neurologic manifestations and DENV RNA detected by real-time reverse transcription-polymerase chain reaction (RT-qPCR) in cerebrospinal fluid (CSF) were followed up until complete resolution of neurological complications. On average, they were followed up for 16 months. Among 56 DENV-positive children, 39% had some neurologic complications after hospital discharge and found that 19.6% were discharged with anticonvulsants due to seizures, 10.7% developed motor complications (e.g. muscle weakness, paresis, ataxia, and walking disability), 5.4% had headaches, and 14.3% had sleep disorders. Among the 56 children, only three had a clinical diagnosis of dengue because the symptoms are nonspecific and 35% showed no change in cerebrospinal fluid (CSF). The average time to resolve complications was 5.9 months (ranging from 1 m to 32 m). These results should alert physicians to the difficulties of a clinical diagnosis of an infection that causes neurological complications after discharge in a significant number of children. RT-qPCR’s etiological diagnosis of DENV infection enabled better clinical follow-up for early intervention in children with neurological complications.

摘要

目的是评估患有登革热病毒（DENV）侵袭性神经系统疾病的儿童的神经系统并发症以及出院后症状消失的时间。2014 年 3 月至 2019 年 7 月在巴西一家传染病转诊医院进行了一项前瞻性研究。所有因神经系统表现而住院的儿童均通过实时逆转录聚合酶链反应 (RT-qPCR) 检测脑脊液中的 DENV RNA（对脑脊液（CSF）进行随访，直至神经系统并发症完全解决。平均而言，他们接受了 16 个月的随访。在 56 名 DENV 阳性儿童中，39% 出院后出现一些神经系统并发症，并发现 19.6% 出院时因癫痫发作服用抗惊厥药物，10.7% 出现运动并发症（如肌肉无力、偏瘫、共济失调和行走障碍），5.4% 出现运动并发症（如肌肉无力、偏瘫、共济失调和行走障碍）。有头痛，14.3%有睡眠障碍。在 56 名儿童中，只有 3 名儿童被临床诊断为登革热，因为症状不具有特异性，并且 35% 的儿童脑脊液 (CSF) 没有变化。解决并发症的平均时间为 5.9 个月（范围从 1 m 到 32 m）。这些结果应该提醒医生注意临床诊断感染的困难，这种感染会导致大量儿童出院后出现神经系统并发症。RT-qPCR 对 DENV 感染的病原学诊断能够更好地进行临床随访，以便对患有神经系统并发症的儿童进行早期干预。