title: Central nervous system involvement in dengue: a study in fatal cases from a dengue endemic area.
abstract: OBJECTIVE
  This study aimed to determine the frequency of CNS infection by dengue virus (DENV) in individuals with fatal outcomes.
  
  
  METHODS
  Samples of 150 individuals suspect of an infection disease and with fatal outcomes were investigated for evidence of the presence of DENV. The sampling was made up of 150 CSF, 120 tissue samples, and 109 blood specimens. The tests used were viral isolation, reverse transcriptase PCR, immunohistochemistry, nonstructural 1 antigen, and immunoglobulin M detection.
  
  
  RESULTS
  Out of 150 studied patients, 84 were dengue positive. Evidence of the presence of DENV was found in 41 CSF, showing the following neurologic diagnosis: 46.3% encephalitis, 34.1% meningoencephalitis, and 19.5% meningitis, giving a frequency of 48.8% of the 84 dengue-positive cases. The major clinical manifestations observed on these individuals were fever, headache, mental irritability, breathless, vomiting, muscle pain, tiredness, abdominal pain, somnolence, restlessness, dizziness, cough, seizure, coma, and neck stiffness.
  
  
  CONCLUSIONS
  Clinical manifestations and laboratory-positive results in CSF that may indicate the presence of DENV led to consider the invasion of CNS by DENV in these fatal cases studied, and showed that neurologic pathology was an important fatal complication in dengue cases.
authors.affiliation: Central Public Health Laboratory, Virology Section, State Health Secretariat of Ceará, Ceará, Brazil. fernanda.montenegro@lacen.ce.gov.br
authors.forename: F M C
authors.initials: FM
authors.lastname: Araújo
authors.forename: M S
authors.initials: MS
authors.lastname: Araújo
authors.forename: R M R
authors.initials: RM
authors.lastname: Nogueira
authors.forename: R S N
authors.initials: RS
authors.lastname: Brilhante
authors.forename: D N
authors.initials: DN
authors.lastname: Oliveira
authors.forename: M F G
authors.initials: MF
authors.lastname: Rocha
authors.forename: R A
authors.initials: RA
authors.lastname: Cordeiro
authors.forename: R M C
authors.initials: RM
authors.lastname: Araújo
authors.forename: J J C
authors.initials: JJ
authors.lastname: Sidrim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020805:Central Nervous System Viral Diseases / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000150:complications / Q000175:diagnosis*; D003716:Dengue Virus / Q000302:isolation & purification*; D018792:Encephalitis, Viral / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008590:Meningoencephalitis / Q000175:diagnosis* / Q000821:virology; D008875:Middle Aged