Infection of the central nervous system with dengue virus 3 genotype I causing neurological manifestations in Brazil

A case of dengue virus 3 (DENV-3) genotype I infection with neurological manifestations occurred in Belo Horizonte, Minas Gerais in October 2012. The serotype was detected by PCR, and the genotype was assessed by sequencing and phylogenetic analysis of the C-prM region. The virus causing neurological manifestations clustered with other sequences of DENV-3 genotype I. Because neurological manifestations of DENV are possibly misdiagnosed in Brazil, this study serves as an alert of the importance of DENV diagnoses in CNS infections.

Keywords:
Central nervous system; Neurologic manifestations of dengue vírus; Dengue virus 3 genotype I

Authorship

Danilo Bretas de Oliveira

Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. Universidade Federal de Minas GeraisBrazilBelo Horizonte, Minas Gerais, BrazilUniversidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Guilherme Machado

Hospital Risoleta Tolentino Neves, Belo Horizonte, Minas Gerais, Brazil.Hospital Risoleta Tolentino NevesBrazilBelo Horizonte, Minas Gerais, BrazilHospital Risoleta Tolentino Neves, Belo Horizonte, Minas Gerais, Brazil.

Gabriel Magno de Freitas Almeida

Paulo César Peregrino Ferreira

Cláudio Antônio Bonjardim

Giliane de Souza Trindade

Jônatas Santos Abrahão

Erna Geessien Kroon

Corresponding author : Dra. Erna Geessien Kroon. e-mail: kroone@icb.ufmg.br I ernagkroon@gmail.com

The authors declare that there is no conflict of interest.

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Figures (3)

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Figure 1:
Map of dengue virus 3 (DENV-3) genotype I distribution. Map of Minas Gerais indicating the cities where DENV-3 genotype I was detected. Human symbol= human cases: Belo Horizonte [2003-dengue fever (DF) ]; 2004, dengue hemorrhagic fever-DHF; 2012 dengue infection with neurologic manifestations)⁶6. Figueiredo LB, Batista Cecílio A, Ferreira GP, Drumond BP, de Oliveira JG, Bonjardim CA, et al. Dengue virus 3 genotype 1 associated with dengue fever and dengue hemorrhagic fever, Brazil. Emerg Infect Dis 2008; 14:314-316.; Caetanópolis (2002-DF)⁶6. Figueiredo LB, Batista Cecílio A, Ferreira GP, Drumond BP, de Oliveira JG, Bonjardim CA, et al. Dengue virus 3 genotype 1 associated with dengue fever and dengue hemorrhagic fever, Brazil. Emerg Infect Dis 2008; 14:314-316.; Contagem (2013-DF) (not published); Sabará (2003-DF)⁶6. Figueiredo LB, Batista Cecílio A, Ferreira GP, Drumond BP, de Oliveira JG, Bonjardim CA, et al. Dengue virus 3 genotype 1 associated with dengue fever and dengue hemorrhagic fever, Brazil. Emerg Infect Dis 2008; 14:314-316.. Mosquito symbol=detection in Aedes aegypti mosquitoes: Caratinga (2005 and 2006)⁷7. Vilela AP, Figueiredo LB, dos Santos JR, Eiras AE, Bonjardim CA, Ferreira PCP et al. Dengue virus 3 genotype I in Aedes aegypti mosquitoes and eggs, Brazil, 2005-2006. Emerg Infect Dis2010; 16:989-992..

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Figure 2:
Timeline of the dengue virus 3 genotype I infection disease course, including signs, symptoms, and clinical management. CMV: human herpes virus 5 (cytomegalovirus); HSV- 1: human herpes virus 1; PCR: polymerase chain reaction.

Thumbnail

Figure 3:
Phylogenetic analysis of the C-prM region of dengue virus (DENV). Phylogenetic analysis of the C-prM of DENV (451bp). DENV-3 sequences deposited in GenBank were analyzed using the neighbor-joining method with the Kimura 2-parameter algorithm in MEGA5 (www.megasoftware.net). DENV-1 was used as an external group. The rate of variation among sites was modeled with a gamma distribution (shape parameter = 1). Bootstrap confidence limits (from 1,000 replicates) are indicated at each node.

Figure 1: Map of dengue virus 3 (DENV-3) genotype I distribution. Map of Minas Gerais indicating the cities where DENV-3 genotype I was detected. Human symbol= human cases: Belo Horizonte [2003-dengue fever (DF) ]; 2004, dengue hemorrhagic fever-DHF; 2012 dengue infection with neurologic manifestations)⁶6. Figueiredo LB, Batista Cecílio A, Ferreira GP, Drumond BP, de Oliveira JG, Bonjardim CA, et al. Dengue virus 3 genotype 1 associated with dengue fever and dengue hemorrhagic fever, Brazil. Emerg Infect Dis 2008; 14:314-316.; Caetanópolis (2002-DF)⁶6. Figueiredo LB, Batista Cecílio A, Ferreira GP, Drumond BP, de Oliveira JG, Bonjardim CA, et al. Dengue virus 3 genotype 1 associated with dengue fever and dengue hemorrhagic fever, Brazil. Emerg Infect Dis 2008; 14:314-316.; Contagem (2013-DF) (not published); Sabará (2003-DF)⁶6. Figueiredo LB, Batista Cecílio A, Ferreira GP, Drumond BP, de Oliveira JG, Bonjardim CA, et al. Dengue virus 3 genotype 1 associated with dengue fever and dengue hemorrhagic fever, Brazil. Emerg Infect Dis 2008; 14:314-316.. Mosquito symbol=detection in Aedes aegypti mosquitoes: Caratinga (2005 and 2006)⁷7. Vilela AP, Figueiredo LB, dos Santos JR, Eiras AE, Bonjardim CA, Ferreira PCP et al. Dengue virus 3 genotype I in Aedes aegypti mosquitoes and eggs, Brazil, 2005-2006. Emerg Infect Dis2010; 16:989-992..

Figure 2: Timeline of the dengue virus 3 genotype I infection disease course, including signs, symptoms, and clinical management. CMV: human herpes virus 5 (cytomegalovirus); HSV- 1: human herpes virus 1; PCR: polymerase chain reaction.

Figure 3: Phylogenetic analysis of the C-prM region of dengue virus (DENV). Phylogenetic analysis of the C-prM of DENV (451bp). DENV-3 sequences deposited in GenBank were analyzed using the neighbor-joining method with the Kimura 2-parameter algorithm in MEGA5 (www.megasoftware.net). DENV-1 was used as an external group. The rate of variation among sites was modeled with a gamma distribution (shape parameter = 1). Bootstrap confidence limits (from 1,000 replicates) are indicated at each node.

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Infection of the central nervous system with dengue virus 3 genotype I causing neurological manifestations in Brazil

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[1] Corresponding author : Dra. Erna Geessien Kroon. e-mail: kroone@icb.ufmg.br I ernagkroon@gmail.com