We thank Dr. Shubhakaran for his interest and comments in our studies.1 Our goal was to demonstrate that the combined use of immunological and molecular tests in cerebrospinal fluid and serum increases the accuracy of neuroinvasive dengue and chikungunya diagnosis. We found positive cases of encephalitis, Guillain-Barré Syndrome, neuromyelitis optica spectrum disorder (NMOSD), polyneuropathy, myelitis, and optic neuritis.
In addition, Dr. Shubhakaran comments on his experience in India on the variety of neurological presentations associated with dengue such as of non-compressive myelopathy, encephalitis, Guillain-Barré Syndrome (GBS), Acute Disseminated EncephaloMyelitis, opsoclonus myoclonus, brachial neuritis, hyperkalemic paralysis, etc.2,3,4 He also highlights a case of longitudinally extensive transverse myelitis (LETM). Indeed, his observation supports our findings. Although not cited in this paper, we previously reported LETM in the case of NMOSD associated with DENV-1 infection.5
Dr Shubhakaran also points about his experience of Dengue and Malaria co-infections in cases of GBS. In fact, the spread of mosquito vectors associated with climate change and urbanization have contributed to the emergence of co-infections and neurological diseases with high mortality and morbidity rates.
We agree with Dr. Shubhakaran that Dengue infection should be investigated as an important cause of acute neurologic illnesses in endemic areas.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Mello CDS, Cabral-Castro MJ, Silva de Faria LC, Peralta JM, Puccioni-Sohler M. Dengue and chikungunya infection in neurologic disorders from endemic areas in Brazil. Neurol Clin Pract. 2020;10(6):497-502. doi:10.1212/CPJ.0000000000000776
Shubhakaran K, Bhargava A, Nitti K K, Awasthi P, Modi D. Longitudinally Extensive Transverse Myelitis with Dengue Virus Infection. EC Neurology 2018;10.7:536-538.
Kamble S, Sardana V, Maheshwari D, Bhushan B, Ojha P. Etiological Spectrum of Non-compressive Myelopathies in Tertiary Care Centre. J Assoc Physicians India. 2019;67(9):14-16.
Mehta S. Ocular lesions in severe dengue hemorrhagic fever (DHF). J Assoc Physicians India. 2005;53:656-657.
Puccioni-Sohler M, Ornelas AMM, de Souza AS, et al. First report of persistent dengue-1-associated autoimmune neurological disturbance: neuromyelitis optica spectrum disorder. J Neurovirol. 2017;23(5):768-771. doi:10.1007/s13365-017-0555-7
We thank Dr. Shubhakaran for his interest and comments in our studies.1 Our goal was to demonstrate that the combined use of immunological and molecular tests in cerebrospinal fluid and serum increases the accuracy of neuroinvasive dengue and chikungunya diagnosis. We found positive cases of encephalitis, Guillain-Barré Syndrome, neuromyelitis optica spectrum disorder (NMOSD), polyneuropathy, myelitis, and optic neuritis.
In addition, Dr. Shubhakaran comments on his experience in India on the variety of neurological presentations associated with dengue such as of non-compressive myelopathy, encephalitis, Guillain-Barré Syndrome (GBS), Acute Disseminated EncephaloMyelitis, opsoclonus myoclonus, brachial neuritis, hyperkalemic paralysis, etc.2,3,4 He also highlights a case of longitudinally extensive transverse myelitis (LETM). Indeed, his observation supports our findings. Although not cited in this paper, we previously reported LETM in the case of NMOSD associated with DENV-1 infection.5
Dr Shubhakaran also points about his experience of Dengue and Malaria co-infections in cases of GBS. In fact, the spread of mosquito vectors associated with climate change and urbanization have contributed to the emergence of co-infections and neurological diseases with high mortality and morbidity rates.
We agree with Dr. Shubhakaran that Dengue infection should be investigated as an important cause of acute neurologic illnesses in endemic areas.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References