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Volume 18, Number 4—April 2012


Dengue in Patients with Central Nervous System Manifestations, Brazil

Fernanda AraújoComments to Author , Rita Nogueira, Maurício de Sousa Araújo, Anne Perdigão, Luciano Cavalcanti, Raimunda Brilhante, Marcos Rocha, Dina Feitosa Vilar, Suzana Silveira Holanda, Deborah de Melo Braga, and José Sidrim
Author affiliations: State Health Secretariat of Ceará, Fortaleza, Ceará, Brazil (F.M.C. Araújo, A.C.B. Perdigão, D.C.L. Feitosa Vilar, S.G. Silveira Holanda and D.N. de Melo Braga); Oswaldo Cruz Institute, Rio de Janeiro, Rio de Janeiro, Brazil (R.M.R. Nogueira); Dr. José Frota Institute, Fortaleza (M. de Sousa Araújo); Federal University of Ceará, Fortaleza (L.P.G., Cavalcanti, F.M. de Carvalho Araújo, J.J. da Costa Sidrim, R.S.N. Brilhante, M.F.G. Rocha); State University of Ceará, Fortaleza (A.C.B. Perdigão); College Christus, Fortaleza (L.P.G. Cavalcanti)

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Table 1

Clinical features and virologic findings for 8 patients with meningitis/meningoencephalitis and confirmed cases of dengue, Brazil, 2005–2008*

Patient no. Age, y/sex Initial symptoms and signs Progress and outcome RT-PCR NS1Ag IgM IgG ND
1 45/M Fever, headache, sweating, thorax pain, seizure, coma, chronic hypertension. Cerebral edema and congestion; mononuclear cells in meninges; death after 6 d + ME
2 32/F Fever, vomiting, neck stiffness, myalgia, abdominal pain, asthenia, somnolence, confusion Meningitis, sixth nerve palsy; death after 14 d DENV-3 + ME
3 1/M Fever, tremors, rigidity of limbs, otitis Intracranial hypertension, meningitis; death after 24 h + + M
4 6/F Fever, headache, malaise, vomiting, drowsiness, neck stiffness CSF: clear, 133 cells/mm3, 42% lymphocytes, 2% monocytes, 53% neutrophils, 3% eosinophils; protein 58 g/L, glucose 54 g/L; recovery after 9 d + + M
5 58/M Fever, headache, severe malaise, vomiting, lowering of consciousness, delirium CSF: 300 cells/mm3; lymphocytes, 87%, monocytes 5%, neutrophils 4%, protein 112 g/L, glucose 59 g/L; serum: AST 127 U/L, ALT 74 U/L; CT scan: expansible lesion measuring 4 × 2 x 2.3 cm; referred for surgical treatment + + Brain tumor; M
6 5/F Fever, headache, vomiting, neck stiffness CSF: 490 cells/mm3, 2% monocytes, 5% lymphocytes, 93% neutrophils, protein 45 g/L, glucose 110 g/L; recovery after 8 d + M
7 15/M Fever, headache, arthralgia, severe malaise, dry cough, dyspnea, epigastric pain IHC result positive for dengue.
CSF: clear; cerebrum and cerebellum with marked edema and vasocongestion of meninges and nerve tissue; death after 5 d + ME
8 24/M Fever, headache, vomiting, and neck stiffness CSF: 426 cells/mm3; protein 136 g/L, glucose 55 g/L; recovery + + M

*RT-PCR, reverse transcription PCR; NS1Ag, nonstructural protein 1 antigen; ND, neurologic diagnosis; –, negative; +, positive; ME, meningoencephalitis; DENV, dengue virus; M, meningitis; CSF, cerebrospinal fluid; AST, aspartate aminotransferase; ALT, alanine aminotransferase; CT, computed tomography; IHC, immunohistochemical test.

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