Neurological manifestations due to dengue virus infection in children: clinical follow-up

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.

KEYWORDS:

• Dengue virus
• encephalitis
• meningitis
• myelitis
• neurologic complication
• children

Acknowledgments

We especially thank the children and their families who participated in this research. We thank colleagues from the Hospital Infantil João Paulo II for helping collect CSF from children with neurological manifestations. We thank all the team of Laboratório de Vírus for their excellent technical support.

Conflicts of interest

No potential conflict of interest was reported by the author(s).

Author contributions

All authors have made substantial contributions. Professors Aline A Bentes, Roberta MC Romanelli and Erna G. Kroon conceived and designed the study, performed analysis and interpretation of data, drafted the article and revised it critically. Ana Paula C Crispim, Paula EM Marinho and Karina S Loutfi performed analysis and interpretation of data and revised it critically. Isabela, Sara, Luciana, Alice and Marcele, medical students, contributed to acquisition of data. All authors approved the final version to be submitted.

Additional information

Funding

This work was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico [CNPq - 440911/2015 and 2058/2016], Departamento de Ciência e Tecnologia do Ministério da Saúde do Brasil (DECIT) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) finance code 001 and Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG). EGK is a fellow from CNPq and FAPEMIG.