title: Incidence and Predictive Factors of Central Nervous System Dysfunction in Patients Consulting for Dengue Fever in Cayenne Hospital, French Guiana.
abstract: BACKGROUND
  The frequency, the clinical characteristics, and the prognosis of dengue is highly variable. Dengue fever is associated with a range of neurological manifestations. The objective of the present study was to determine the incidence of neurological signs and their predictive factors using data from cases of dengue seen and followed in Cayenne Hospital during the Dengue 2 epidemic in 2013.
  
  
  METHODS
  In 2013, a longitudinal study using data from all cases of dengue seen in Cayenne hospital was collected. Medical records used a standardized form to collect demographic information, clinical signs and biological results and the date at which they were present. The analysis used Cox proportional modeling to obtain adjusted Hazard ratios.
  
  
  RESULTS
  A total of 1574 patients were included 221 of whom developed central nervous system signs. These signs were spontaneously resolutive. There were 9298person days of follow-up and the overall incidence rate for central nervous system signs was 2.37 per 100 person-days. The variables independently associated with central nervous system anomalies were headache, Adjusted Hazard ratio (AHR) = 1.9(95%CI = 1.4-2.6), bleeding AHR = 2 ((95%CI = 1.3-3.1), P = 0.001, abdominal pain AHR = 1.9 ((95%CI = 1.4-2.6), P<0.001, aches AHR = 2.1 ((95%CI = 1.5-2.9), P<0.001, and fatigue AHR = 1.5 ((95%CI = 1.3-1.7), P<0.001.
  
  
  CONCLUSIONS
  Overall, the present study suggests that neurological signs of dengue are not exceptional even in patients without the most severe features of dengue. These manifestations were spontaneously resolutive. Here it was not possible to distinguish between encephalitis or encephalopathy. Further studies would require more in depth exploration of the patients.
authors.affiliation: Department of Infectious and Tropical Diseases, Centre Hospitalier de Cayenne, Cayenne, French Guiana.|Equipe d'Accueil EA3593 Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Cayenne, French Guiana.
authors.forename: Félix
authors.initials: F
authors.lastname: Djossou
authors.affiliation: Department of Infectious and Tropical Diseases, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Vesin
authors.affiliation: Department of Infectious and Tropical Diseases, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Bastien
authors.initials: B
authors.lastname: Bidaud
authors.affiliation: Department of Infectious and Tropical Diseases, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Emilie
authors.initials: E
authors.lastname: Mosnier
authors.affiliation: Laboratory, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Christine
authors.initials: C
authors.lastname: Simonnet
authors.affiliation: Laboratoire de virologie, Institut Pasteur de la Guyane, Cayenne, French Guiana.
authors.forename: Séverine
authors.initials: S
authors.lastname: Matheus
authors.affiliation: Department of Infectious and Tropical Diseases, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Christelle
authors.initials: C
authors.lastname: Prince
authors.affiliation: Department of Pediatrics, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: John
authors.initials: J
authors.lastname: Balcaen
authors.affiliation: Service d'accueil des Urgences/Service d'aide médicale urgente, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Gerd
authors.initials: G
authors.lastname: Donutil
authors.affiliation: Service d'accueil des Urgences/Service d'aide médicale urgente, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Gérald
authors.initials: G
authors.lastname: Egmann
authors.affiliation: Laboratory, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Antoine
authors.initials: A
authors.lastname: Okandze
authors.affiliation: Unité des Maladies Tropicales et du Voyageur, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Malvy
authors.affiliation: Equipe d'Accueil EA3593 Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Cayenne, French Guiana.|Centre d'Investigation Clinique Antilles Guyane, INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Nacher
mesh_terms: D002493:Central Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology; D003715:Dengue / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D005616:French Guiana / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D011379:Prognosis