Isolation of dengue 2 virus from a patient with central nervous system involvement (transverse myelitis)

Abstract

A dengue fever case is described in a 58-year-old male patient with febrile illness and thrombocytopenia complicated by neurological involvement characterized by transverse myelitis followed by weakness of both legs and flaccid paralysis. Muscle strength was much diminished and bilateral areflexia was observed. Dengue 2 (DEN-2) virus was isolated and the patient sero-converted by hemagglutination-inhibition and IgM-ELISA tests. The RT-PCR test was positive to DEN-2 in acute phase serum and culture supernatant, but negative in the cerebrospinal fluid. After three weeks of hospitalization the patient was discharged. No other infectious agent was detected in the blood and cerebrospinal fluid samples. The patient had full recovery from paralysis six months after the onset of DEN-2 infection. Key-words: Dengue fever. Transverse myelitis. Dengue 2. Virus isolation. RT-PCR.Resumo Um caso de febre clássica de dengue é descrito em paciente masculino de 58 anos de idade que desenvolveu quadro febril acompanhado de trombocitopenia complicado com envolvimento neurológico caracterizado por mielite transversa, a qual se seguiu de fraqueza de ambos os membros inferiores e paralisia flácida. A força muscular do paciente ficou bastante diminuída e arreflexia bilateral também foi observada. O sorotipo dengue 2 (DEN-2) foi isolado e o paciente também soro-converteu em testes de inibição de hemaglutinação e IgM-ELISA. Da mesma amostra de soro da fase aguda da qual o vírus foi isolado, teste de RT-PCR foi positivo para DEN-2. RT-PCR foi igualmente positivo utilizando o sobrenadante da cultura positiva, mas foi negativo usando-se o líquido cefalo-raquidiano (LCR) obtido com 12 dias de doença. Nenhum outro agente infeccioso foi isolado ou identificado em testes sorológicos utilizando as amostras séricas e o LCR. O paciente foi hospitalizado por três semanas, tendo recebido alta do quadro de dengue ainda com problemas da paralisia que foi sanada após seis meses do início da infeção pelo DEN-2. Palavras-chaves: Febre clássica do dengue. Mielite transversa. Dengue 2. Isolamento viral. RT-PCR.

Resistance to Dengue Virus Infection in Mice Is Potentiated by CXCL10 and Is Independent of CXCL10-Mediated Leukocyte Recruitment

“…Individuals infected with DENV may develop dengue fever, an acute febrile illness; however, a life-threatening syndrome, dengue hemorrhagic fever/dengue shock syndrome, frequently occurs after a second DENV infection (4). In addition, neurologic manifestations of DENV infection have also been reported in a number of cases, including encephalitis (5, 6), encephalopathy (6)(7)(8), and myelitis (9,10). Although the mechanism of DENV-induced disease is not well understood, chemokines and chemokine receptors are thought to play important roles in DENV infection.…”

Acute Transverse Myelitis and Dengue: A Systematic Review

“…The polymerase chain reaction (PCR) technique for detection of the viral genome was performed only by Leao et al [12], however, this technique is not used routinely for epidemiological purposes [1,2].…”

“…The normal MRI was found in two thirds of the patients surveyed by Miranda de Sousa et al [11], in one case described by Leao et al [12], in one by Seet et al [13] and in other by Puccioni Sohler et al [10], a normal MRI does not invalidate the clinical diagnosis of transverse myelitis. The thoracic spinal cord was the most affected and T9 segment was slightly more associated with the disease compared to other spinal segments.…”

An Unusual Presentation of Dengue Fever: Association with Longitudinal Extensive Transverse Myelitis

“…[5][6][7][8] There is only a single case report of myelitis in the postinfectious phase, occurring 16 days after the onset of illness. 9 The pathogenesis of myelitis in our case is likely direct spinal neuronal involvement of the dengue virus, but the exact mechanism is not clear.…”