Role of Vascular Endothelial Growth Factor (VEGF) in the Neurological Manifestations of Dengue: A Preliminary Study
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Role of Vascular Endothelial Growth Factor (VEGF) in the Neurological Manifestations of Dengue: A Preliminary Study Usha Kant Misra,1,2 Jayantee Kalita,1 and Avadhesh Pratap Singh1
Abstract—This study reports on vascular endothelial growth factor (VEGF) in dengue patients with neurological manifestations. Their bleeding diathesis, hypotension, edema, flushing, and hepatosplenomegaly were noted. Complete blood counts, serum chemistry, coagulation profile, liver and kidney function tests, creatine kinase (CK), and MRI in encephalopathic patients were carried out. Serum VEGF was estimated by ELISA in 21 dengue patients and 14 controls. Twelve patients had dengue fever (DF), eight dengue hemorrhagic fever (DHF), and one dengue shock syndrome (DSS). Fifteen patients had neurological manifestation, 12 had muscle involvement (raised CK with or without weakness), and 3 had encephalopathy. The VEGF level in dengue patients was 50.0±56.1 pg/mL and in the controls, 60.6± 20.3 pg/mL. The VEGF level neither correlated with the severity nor with the neurological involvement. Thrombocytopenia, however, correlated with the severity of dengue and neurological manifestations. The VEGF level is not related to the severity of dengue and neurological syndrome. KEY WORDS: dengue; VEGF; dengue hemorrhagic fever; dengue shock syndrome; encephalopathy; myopathy.
INTRODUCTION Dengue is one of the most important arboviral infections in humans. About 50–100 million dengue patients occur annually, and 2.5 billion people are at risk of developing dengue [1]. Dengue is prevalent in Asia, Africa, Australia, Americas, and southern Europe. The critical determinants of clinical manifestations in dengue are platelet dysfunction, coagulopathy, and capillary leakage. The resulting manifestations are dengue fever, dengue hemorrhage fever (DHF), and dengue shock syndrome (DSS). Vascular endothelial growth factor has been reported to be responsible for capillary leakage in dengue and has shown to express more frequently in dengue shock syndrome compared to dengue fever [2, 3]. The neurological manifestations in dengue are diverse and include encephalopathy, seizure, and transient muscle dysfunction [4–6]. The neurological manifestations of dengue may be due to 1
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow 226014, India 2 To whom correspondence should be addressed at Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow 226014, India. E-mail: [email protected]; [email protected]
hypotension, hypovolemia, liver and kidney dysfunction, and intracerebral hemorrhage, but in some patients, primary encephalitis has been reported [6–8]. VEGF, however, is critical in the pathogenesis of dengue by producing change in vascular permeability, but its relationship with various neurological manifestations of dengue virus infection has not been evaluated. In this preliminary communication, we report on the role of VEGF in patients with deng
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