Manifestaciones neurológicas del dengue hemorrágico en niños en el Hospital Universitario de Santander durante 1992 a 2006. Bucaramanga, Colombia.

Abstract

Bucaramanga and its metropolitan area (Santander, Colombia) is today an endemoepidemic region of dengue. Dengue represents a great spectrum of clinical manifestations including neurological manifestations. 

OBJECTIVES: Describe the different  neurological manifestations of Dengue Hemorrhagic Fever (DHF) in children under 12 years old admitted to the Department of Pediatrics of the University Hospital of Santander (HUS-UIS). Correlate neurological manifestations of DHF according to its clinical presentation with the phases of the disease in which they present. Alert the health personal and medical community in the endemic areas of dengue about the neurological manifestations of this entity. 

METHODS: Descriptive study of cases, realized in the department of pediatrics UIS-HUS in children under 12 years old. Retrospective review of the data base EpiInfo, of patients discarded from the hospital with diagnose of Dengue Hemorrhagic Fever (DHF) since January 1992 to December 2006. Selection of patients that presented neurological manifestations and immunologic confirmation (serologic diagnosis by IgM). The neurological manifestations where classified in 4 groups: Encephalitis, Encephalopathy, Seizures and others. 

RESULTS: In the period analyzed, were discarded from the hospital with diagnose of DHF 1246 patients under 12 years old. Of this patients, 106 presented neurological manifestations. Group classification: 10 with encephalitis, died 1 patient; 35 with encephalopathy (secondary to shock 19 and to hepatitis 16), in this group 7 patients died; 42 with seizures (39 febrile and 3 with previous diagnose of epilepsy) and 19 patients with other manifestations. 

CONCLUSIONS: 1) Patients during the acute phase of fever of the DHF presented altered sensorium and/or behavior, seizures and/or signs of focalization, the first diagnose possibility is encephalitis. 2) Patients during the defervescence period that presents persistent neurological manifestations characterized by seizures, sensorium and/or behavior alteration, associated to shock, hepatitis or acute renal failure, encephalopathy must be suspected. 3) Isolated seizures during the acute phase of fever of DHF, in most cases correspond to febrile seizures without neurologic compromise. 4) In patients with DHF, the transitory alterations of sensorium or behavior with fast resolution are explained by fever and metabolic syndrome. 5) In endoepidemic areas of dengue in patients with neurological manifestations and fever, this disease must be consider as a differential diagnose. 

Keywords: Dengue. Dengue hemorrhagic fever. Neurologic manifestations.