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EXPERT COMMENTARY  
Year : 2013  |  Volume : 6  |  Issue : 1  |  Page : 3-4
Paralytic squint in dengue fever- a report of three cases: Further reports of a rare, once before reported phenomenon of abducens palsy in dengue


Department of General Medicine, University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka

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Date of Web Publication18-Jul-2013
 

   Abstract 

With dengue becoming endemic, more complications are being recognized including a variety of neurological complications such as mononeuropathies. Abducens palsy causing paralytic squint has been reported only once previously in medical literature. Demyelinating infective and immune-mediated mechanisms are believed to be the pathogenesis behind mononeuropathies. Neither an effective vaccine against dengue nor proven treatment for dengue neuropathy is currently available. Further studies are needed to elucidate the exact mechanism and develop effective treatment for dengue neuropathy.

Keywords: Dengue, abducens, palsy, neuropathy

How to cite this article:
Shivanthan M. Paralytic squint in dengue fever- a report of three cases: Further reports of a rare, once before reported phenomenon of abducens palsy in dengue. Ann Trop Med Public Health 2013;6:3-4

How to cite this URL:
Shivanthan M. Paralytic squint in dengue fever- a report of three cases: Further reports of a rare, once before reported phenomenon of abducens palsy in dengue. Ann Trop Med Public Health [serial online] 2013 [cited 2019 Dec 5];6:3-4. Available from: http://www.atmph.org/text.asp?2013/6/1/3/115165

   Introduction Top


Abducens palsy following dengue is very uncommon.Only one case report from Sri Lanka predates this brief case series documenting a proven case of spontaneously resolving abducens palsy following dengue during the mid-2011 epidemic in the island. [1] A variety of mononeuropathies following dengue have been observed in Sri Lanka as well as globally, but inadequate investigative facilities often fail to exclude other possible causes and hence reluctance by observers to report such cases.

Both infective and immune-medicated mechanisms are purported to responsible for neurological deficits. [2],[3],[4] Diplopia following dengue due to oculomotor palsy has been documented previously. [5] Though treatment with corticostroids and intravenous immunoglobulins have been anecdotally reported to be useful, routinely recommending same is difficult in the absence of trial evidence. [6]

Dengue has been a neglected tropical disease of poor nations, until very recently which had received step- motherly treatment for a long time in the development of an effective vaccine. [7] However, recent interest in the development of a vaccine for seems to show good promise with phase III trials currently underway with results expected by the end of 2012. [8] In any event, until and even after a safe and effective vaccine is available, medical practitioners in the tropics will have to deal with cases of dengue with complications, hence it is important to study effective means of treating or preventing disabling complications including neuropathy.

This article while highlighting the need to further study the pathophysiology of neurological complications following dengue, also illustrates the increasing frequency of such complications and the importance of developing efficacious treatment modalities. A global cooperative effort with a common trial register would be the way forward to faciltate quality research in dengue.

 
   References Top

1.Shivanthan MC, Ratnayake EC, Wijesiriwardena BC, Somaratna KC, Gamagedara LK. Paralytic squint due to abducens nerve palsy: A rare consequence of dengue fever. BMC Infect Dis 2012;12:156.  Back to cited text no. 1
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2.Chien J, Ong A, Low SY. An unusual complication of dengue infection. Singapore Med J 2008;49:e340-2.  Back to cited text no. 2
[PUBMED]    
3.Murthy JM. Neurological complication of dengue infection. Neurol India 2010; 58:581-4.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Palma-da Cunha-Matta A, Soares-Moreno SA, Cardoso-de Almeida A, Aquilera-de Freitas V, Carod-Artal FJ.Neurological complications arising from dengue virus infection. Rev Neurol 2004;39:233-7.  Back to cited text no. 4
[PUBMED]    
5.Donnio A, Beral L, Olindo S, Cabie A, Merle H. Dengue, a new etiology in oculomotor paralysis. Can J Ophthalmol 2010;45:183-4.  Back to cited text no. 5
    
6.Ansari MK, Jha S, Nath A. Unilateral diaphragmatic paralysis following dengue infection. Neurol India 2010;58:596-8.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.Feasey N, Wansbrough-Jones M, Mabey DC, Solomon AW. Neglected tropical diseases. Br Med Bull 2010;93:179-200.  Back to cited text no. 7
[PUBMED]    
8.Lang J. Development of Sanofi Pasteur tetravalent dengue vaccine. Rev Inst Med Trop Sao Paulo 2012;18:15-7.  Back to cited text no. 8
    

Top
Correspondence Address:
Mitrakrishnan Shivanthan
Department of General Medicine, University Medical Unit, National Hospital of Sri Lanka, Colombo
Sri Lanka
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.115165

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