Dengue virus encephalitis: A systematic review and critique

• Main Authors: Fong, Si-Lei, Tan, Chong-Tin, Wong, Kum-Thong
• Format: Article
• Published: ASEAN Neurological Association 2022
• Subjects: RA Public aspects of medicine; RC Internal medicine
• Online Access: http://eprints.um.edu.my/40284/

Background & Objective: Neurological manifestations were reported in dengue fever. We hypothesize that the diagnosis of DEN virus (DENY) encephalitis based on current clinical diagnostic criteria has been made too liberally. We conducted a systematic review of the literature to clarify this, and to characterize DENY encephalitis better. Methods: We systematically review the literature using MEDLINE and PubMed databases papers published from 1st January 1960 to 31st March 2020. We grouped the cases into definite and probable DENY encephalitis. Definite DENY encephalitis required demonstration of DENY (live virus, viral antigens, RNA) in the central nervous system or CSF whereas probable DENY encephalitis required positive anti-DENY IgM in the CSF and evidence of virus or anti-DENY IgM in the serum. Results: Of the 230 publications obtained from literature search, 121 case reports and series appeared relevant to DENY encephalitis. After applying our inclusion criteria, only 42 cases (34.7%) were acceptable as DENY encephalitis: 30 (24.8%) definite and 12 (9.9%) probable cases. Our findings suggest that DENY encephalitis is more uncommon than previously thought. Part of the reason for non-inclusion may be because many studies relied solely on DENY serology for diagnosis. Cross-reactivities of anti-DENY with anti-JE virus immunoglobulins in serum or CSF occur and this limits their usefulness to distinguish DENY encephalitis from JE. Conclusions: The majority of DENY encephalitis cases reported in the literature did not satisfy a more stringent inclusion criteria. Further investigations including autopsy studies are warranted to better characterize and to understand the pathology and pathogenesis of DENY encephalitis.