title: Central nervous system and muscle involvement in dengue patients: A study from a tertiary care center.
abstract: BACKGROUND
  Neurological involvement in dengue virus (DENV) infection is being increasingly reported. There is paucity of studies evaluating the relative frequency of central nervous system (CNS) and muscle involvement in dengue.
  
  
  OBJECTIVE
  To evaluate the frequency and prognosis of neurological and muscle involvement in dengue, and correlate these with dengue subtypes.
  
  
  METHODS
  Consecutive dengue patients were included, and their clinical features, laboratory investigations and cerebrospinal fluid (CSF) findings were recorded. Cranial MRI was done in unconscious patients and electromyography and nerve conduction study in patients with flaccid weakness. Patients were categorized into encephalopathy, encephalitis, immune mediated and dengue associated muscle dysfunction (DAMD). Outcome at 1 month and its predictors were evaluated.
  
  
  RESULTS
  116 patients aged 5-70 years were included; 82 had dengue fever (DF), 18 had dengue hemorrhagic fever (DHF), and 16 had dengue shock syndrome (DSS). Neurological manifestations were present in 92 (79%); encephalopathy in 17 (15%), encephalitis in 22 (19%), transverse myelitis in 1 (1%) and DAMD in 52 (45%) patients. Central nervous system (CNS) involvement was commoner in DHF/DSS compared to DF (44% vs 26%). 10 patients with CNS involvement died versus 1 with DAMD. The patients in the CNS group had more frequent hypotension, renal dysfunction and respiratory failure compared to the DAMD group, and had worse outcome. DENV2 and DENV3 were the commonest serotypes, but serotypes did not differ between CNS and DAMD groups.
  
  
  CONCLUSIONS
  DAMD is commoner than CNS involvement in dengue. CNS involvement however, is associated with more serious illness and predicts poorer outcome.
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow 226014, India. Electronic address: drukmisra@rediffmail.com.
authors.forename: Usha Kant
authors.initials: UK
authors.lastname: Misra
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow 226014, India.
authors.forename: Jayantee
authors.initials: J
authors.lastname: Kalita
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow 226014, India.
authors.forename: Vinita Elizabeth
authors.initials: VE
authors.lastname: Mani
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow 226014, India.
authors.forename: Prashant Singh
authors.initials: PS
authors.lastname: Chauhan
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow 226014, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D001927:Brain Diseases / Q000453:epidemiology* / Q000473:pathology*; D002490:Central Nervous System / Q000473:pathology; D002555:Cerebrospinal Fluid / Q000737:chemistry; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D004576:Electromyography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology; D009135:Muscular Diseases / Q000453:epidemiology* / Q000473:pathology*; D009431:Neural Conduction; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Dengue; Encephalitis; Encephalopathy; Myopathy; Outcome; Serotype; Transverse myelitis