BACKGROUND
Amazon, the largest tropical
forest of the world, has suffered from
dengue outbreaks since 1998.
Cerebrospinal fluid (CSF) of
patients, from Amazonas
state, suspected of
central nervous system (CNS)
viral infection was studied using molecular and immunological
methods. OBJECTIVE To evaluate the importance of CSF investigation in
patients with acute
dengue virus (DENV)
infection of CNS.
METHODS CSF samples of 700
patients were analysed by
reverse transcription polymerase chain reaction (RT-PCR) to detect the presence of
dengue virus (DENV)
RNA and by
enzyme-linked immunosorbent assay (
ELISA) to detect presence of DENV specific
IgM. FINDINGS DENV
infection was detected in 4.3% of the CSF samples; 85.7% (24/28) by DENV
IgM and 14.3% (4/28) by
viral RNA. DENV detected by
viral RNA were to be found
serotypes DENV-2 (three
patients) and DENV-1 (one
patient). The neurological
diagnosis in
patients CNS infection of DENV included
encephalitis (10),
meningoencephalitis (10),
meningitis (6), acute
myelitis (1), and
encephalomyelitis (1). The majority (89.3%) had intrathecal
inflammation pleocytosis, hyperproteinorrachia and DENV
IgM antibodies. Hypoglycorrhachia and/or high levels of
lactate in CSF were found in 36% of the
patients.
Co-infection (CMV,
HIV,
EBV, and/or
Mycobacterium tuberculosis) was observed in eight (28.6%) cases. CONCLUSIONS We found intense inflammatory CSF that is unusual in CNS disorders caused by
dengue infection. It may be due
co-infections or the
immunogenetic background of the local Amerindian Brazilian
population. CSF examination is an important diagnostic support tool for neurological
dengue diagnosis.