Content area
Full Text
ABSTRACT
BACKGROUND: Stroke is a severe neurologic complication of dengue fever, described in only a few case reports. The incidence and risk factors for stroke in patients with dengue remain unclear. We conducted a population-based retrospective cohort study to investigate the risk of stroke in patients with dengue.
METHODS: Using data from the Taiwan National Health Insurance Research Database, we included a total of 13787 patients with dengue newly diagnosed between 2000 and 2012. The control cohort consisted of patients who did not have dengue, matched 1:1 by demographic characteristics and stroke-related comorbidities. We calculated the cumulative incidences and hazard ratios (HRs) of stroke in both cohorts using Kaplan-Meier curves and Cox proportional hazards regression.
RESULTS: The overall incidence rate of stroke was 5.33 per 1000 person-years in the dengue cohort and 3.72 per 1000 person-years in the control cohort, with an adjusted HR of 1.16 (95% confidence interval [CI] 1.01-1.32). The risk of stroke among patients with dengue was highest in the first 2 months after diagnosis (25.53 per 1000 person-years, adjusted HR 2.49, 95% CI 1.48-4.18).
INTERPRETATION: Dengue fever was associated with an increased risk of stroke in the first few months after diagnosis. The effect of dengue on stroke may be acute rather than chronic.
Dengue is a globally important mosquito-borne viral infection, with about 4 billion people at risk and 100 million symptomatic cases annually.1 In 1997, the World Health Organization (WHO) classified symptomatic dengue as dengue fever and dengue hemorrhagic fever, with the latter having 4 grades of severity, where grades III and IV were considered to represent dengue shock syndrome.2 Dengue hemorrhagic fever is a more severe form of dengue fever, with evident plasma leakage leading to spontaneous bleeding, organ failure or hypovolemic shock. In 2009, the WHO published a new classification for dengue, adding central nervous system (CNS) involvement as a criterion for severe dengue.3 Complications of CNS involvement in severe dengue include dengue encephalopathy or encephalitis, post-dengue immune-mediated syndromes and cerebrovascular complications.4 The mediators released during dengue infection, such as cytokines, chemokines and complement, have vasoactive or procoagulant effects leading to thrombocytopenia, disseminated intravascular coagulation and vasculitis, which may result in stroke.4 It is challenging to treat stroke in patients with dengue because of the difficulty...