Oligosymptomatic dengue infection: a potential cause of Guillain Barré syndrome

Abstract

-Background: Dengue infection may cause neurological manifestations such as encephalitis, myelitis, mononeuropathies, acute disseminated encephalomyelitis, and Guillain Barré syndrome (GBS). In endemic regions, the infection course can be oligosymptomatic making difficult the diagnosis of the neurological picture associated with dengue infection. Objective: To report dengue infection and GBS association, even in oligosymptomatic cases of this infection. Method: During the dengue epidemic in Rio de Janeiro city we looked for GBS cases, testing IgM antibodies for dengue and dengue polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF) and serum. Results: We report seven cases (46.6%), presenting dengue positive IgM in serum but with poor or without clinical symptoms of the previous infection. Two of them had also positive IgM antibodies in CSF. Conclusion: These data show that search for dengue infection should be a routine in GBS cases living in endemic areas.Key WoRDS: dengue, polyradiculoneuritis, radiculoneuropathy, CSF, Guillain Barré syndrome. Dengue oligossintomática: causa potencial de síndrome de Guillain BarréResumo -Introdução: o vírus da dengue pode determinar várias manifestações neurológicas como: encefalite, mielite, mononeuropatias, encefalomielite disseminada aguda e a síndrome de Guillain Barré (SGB). em regiões endêmicas a infecção pode ser oligosintomática dificultando o diagnóstico neurológico associado a infecção por dengue. Objetivo: Relatar a associação entre SGB e o vírus da dengue, principalmente em formas oligosintomáticas da infecção. Método: Durante epidemia pelo vírus da dengue na cidade do Rio de Janeiro, casos de SGB foram selecionados e tiveram suas amostras de soro e líquido cefalorraqueano (LCR) testadas para anticorpos dengue IgM e PCR para dengue. Resultados: Descrevemos sete casos (46,6%) com diagnóstico de SGB, apresentando IgM positiva para dengue no soro, porém com poucos ou nenhum sintoma infeccioso prévio. Dois pacientes também apresentavam IgM positiva no LCR. Conclusão: estes dados sugerem que a pesquisa para o vírus da dengue deve ser realizada em todos os casos de SGB em áreas endêmicas.PALAvRAS-ChAve: dengue, polirradiculoneurite, radiculoneuropatia, líquido cefalorraqueano e síndrome de

Neurological complications of dengue fever: Experience from a tertiary center of north India

“…According to the authors, dengue infection should be routinely looked for in Guillain barre syndrome cases in an endemic zone. [18]…”

Post dengue Guillain Barre syndrome: a rare case scenario

“…4 However, dengue infection may have been underestimated as a causative agent of GBS. 5 It is suggested that the clinical manifestations of GBS are the result of cell-mediated immunological responses to nonself-antigens (infectious agents, vaccines) that misdirect to host nerve tissue through a resemblance of epitope (molecular mimicry) mechanism. 3,6 The activated T cells cross the vascular endothelium (bloodbrain barrier) and recognize an antigen in the endoneural compartment.…”

Dengue: a new challenge for neurology

“…27 However, dengue infection may have been underestimated as a causative agent of GBS. 40 The authors reported seven cases (46.6% of all included GBS cases), presenting with dengue positive IgM in serum but with little to no clinical symptoms of the previous infection. The neurological picture of GBS cases induced by dengue infection is similar to that described in the literature concerning GBS caused by other infections in which ascending paraparesis is the principal manifestation.…”