Background and Aims
 Dengue virus (DENV) is the most common arbovirus disease, with wide spectrum of presentation. It is estimated that 100 million cases of symptomatic dengue occur annually. Spinal cord involvement in dengue infection (DF) is rare. However, the risk of transverse myelitis (TM) following Dengue has not been systematically assessed.
Methods
We undertook a systematic review of the English literature published from January 1974 to December 2017 to assess risk of TM and outcomes following DF. Data sources included MEDLINE, EMBASE Cochrane library, and references within identified articles.
Results
We identified 226 potential studies, 58 were duplicates. A further 114 were excluded on the basis of title and abstract and 29 studies did not meet the eligibility criteria on full text screening. We included 25 publications involving 2672 of DF. 10.8% (289/2672) had neurological complications, of which 2.3% (61/2672) was TM. For articles reporting epidemiological data, the neurological complication was twice in males compared to female 67.7% (130/192) vs 32.7% (62/192) and 1.5 fold increase TM for males 59.3% (32/54) vs 40.7% (22/54) respectively. The mean age at presentation was 33.1 years (Range 0.75 – 61) with onset of TM at 11.7 days (Range 3 – 15).
Apart from radiological investigations, the method of diagnosing TM due to DF was mainly IgM seropositivity (92% (n=23/25) and the commonest treatment modality was steroid 78.3% (n=18/23). Only half had full recovery 50.8% (n=31/61). There was no mortality following dengue, however, the crude case fatality rate following TM was 3.3% (n=2/61) compared to other neurological complications of 9.4% (n=18/192).
Conclusions
This review highlights the risk of TM following dengue to physicians in TM endemic areas. Since DENV remains a significant public health concern, although neurological complications are rare – especially TM, once set in, it is associated with a significant morbidity and mortality.   Other measures are needed to curb and prevent this devastating disease

RISK OF TRANSVERSE MYELITIS FOLLOWING DENGUE INFECTION: A SYSTEMATIC REVIEW OF THE LITERATURE