Is there a real increased risk of stroke in patients with dengue fever?

We read the article on risk of stroke in patients with dengue fever with great interest.¹ Li and colleagues concluded, “In this population-based study, the presence of dengue was associated with an increased risk of stroke. The effect of dengue on stroke may be acute rather than chronic.”¹

We would like to share ideas and experience from our country in Indochina, where there is an extremely high prevalence of dengue. Neurologic complication from dengue is possible, but stroke is extremely uncommon.² It is unlikely that the present study adequately controlled for the other confounding factors that might result in the occurrence of stroke. If there is an actual increased risk, there should be a plausible pathomechanism. In fact, the main problem in dengue is hemostatic disorder, and the only possible mechanism is hemorrhage. Nevertheless, hemorrhagic stroke is rare, and good clinical supportive care for acute dengue infection is usually sufficient to prevent complications.³