Abstract
Background
Dengue is commonly associated with myalgia, but there is paucity of studies on the frequency, severity, and basis of muscle involvement. The aim of this study was to document the clinical, electromyographic, and histological changes in dengue-associated muscle dysfunction.
Materials and methods
Seropositive dengue patients admitted to the neurology ward during 2010 were enrolled in this study. Detailed medical history, including bleeding diathesis and organomegaly, were noted. Muscle power on a 0–5 scale, muscle tone, reflex, sensations and coordination were tested. Blood counts, hemoglobin, and serum chemistry, including creatine kinase (CK) evaluations, were carried out. Concentric needle electromyography (EMG) and muscle biopsy were performed when clinical conditions were suitable.
Results
The study cohort comprised 39 patients with dengue, with a median age of 28 years. Of these, 31 patients showed evidence of muscle involvement—16 with clinical and 15 with subclinical muscle involvement. Eight of these patients had severe weakness and five had hyporeflexia. Thrombocytopenia was present in 26 patients, elevated serum creatinine in three patients and liver dysfunction in 31 patients. The median CK level was 837 (range 194–3,832) U/L. The EMG revealed polyphasic normal to short duration motor unit potentials, but spontaneous activity was absent. Muscle biopsy in three patients revealed interstitial hemorrhage with occasional necrosis and myophagocytosis. There was no vasculitis, but subtle inflammatory changes were present in one patient. The severity of muscle weakness correlated with the platelet count and CK level. All patients improved by 15 days of treatment initiation.
Conclusion
Dengue commonly results in benign and self-limiting transient muscle dysfunction.
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References
Halstead SB, Suaya JA, Shepard DS. The burden of dengue infection. Lancet. 2007;369:1410–1.
Solomon T, Dung NM, Vaughn DW et al. Neurological manifestations of dengue infection. Lancet. 2000;355:1053–9.
Cam BV, Fonsmark L, Hue NB et al. Prospective case–control study of encephalopathy in children with dengue hemorrhagic fever. Am J Trop Med Hyg. 2001;65:848–51.
Kalita J, Misra UK, Mahadevan A, et al. Acute pure motor quadriplegia: is it dengue myositis? Electromyogr Clin Neurophysiol. 2005;45:357–61.
Misra UK, Kalita J, Syam UK, et al. Neurological manifestations of dengue virus infection. J Neurol Sci. 2006;244:117–22.
Malheiros SM, Oliveira AS, Schmidt B, et al. Dengue. Muscle biopsy findings in 15 patients. Arq Neuropsiquiatr. 1993;51:159–64.
Sangle SA, Dasgupta A, Ratnalikar SD, et al. Dengue myositis and myocarditis. Neurol India. 2010;58:598–9.
Acharya S, Shukla S, Mahajan SN, et al. Acute dengue myositis with rhabdomyolysis and acute renal failure. Ann Indian Acad Neurol. 2010;13:221–2.
Ahmad R, Abdul Latiff AK, Abdul Razak S. Myalgia Cruris Epidemica: an unusual presentation of dengue fever. Southeast Asian J Trop Med Public Health. 2007;38:1084–7.
Finsterer J, Kongchan K. Severe, persisting, steroid-responsive dengue myositis. J Clin Virol. 2006;35:426–8.
Beauvais P, Quinet B, Richardet JM. Dengue. Apropos of 2 cases. Arch Fr Pediatr. 1993;50:905–7.
Zaki SA, Shanbag P. Clinical manifestations of dengue and leptospirosis in children in Mumbai: an observational study. Infection. 2010;38(4):285–91.
Warke RV, Becerra A, Zawadzka A, et al. Efficient dengue virus (DENV) infection of human muscle satellite cells upregulates type I interferon response genes and differentially modulates MHC I expression on bystander and DENV-infected cells. J Gen Virol. 2008;89:1605–15.
Chaturvedi UC, Tandon P, Mathur A, et al. Host defence mechanisms against dengue virus infection of mice. J Gen Virol. 1978;39:293–302.
Acknowledgments
We thank the Council of Science and Technology, Uttar Pradesh, India for sponsoring the Center of Excellence for Encephalitis Research under which this study was conducted. We also thank Mr. Rakesh Kumar Nigam for secretarial help.
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Misra, U.K., Kalita, J., Maurya, P.K. et al. Dengue-associated transient muscle dysfunction: clinical, electromyography and histopathological changes. Infection 40, 125–130 (2012). https://doi.org/10.1007/s15010-011-0203-8
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DOI: https://doi.org/10.1007/s15010-011-0203-8