Article
The spectrum of neurological disease associated with Zika and chikungunya viruses in adults in Rio de Janeiro, Brazil: A case series
Registro en:
MEHTA, Ravi et al. The spectrum of neurological disease associated with Zika and chikungunya viruses in adults in Rio de Janeiro, Brazil: A case series. PLoS Negl. Trop. Dis., v. 12, n. 2, p. 1-20, Feb. 2018.
1935-2727
10.1371/journal.pntd.0006212
1935-2735
Autor
Mehta, Ravi
Soares, Cristiane Nascimento
Medialdea-Carrera, Raquel
Ellul, Mark
Silva, Marcus Tulius Texeira da
Rosala-Hallas, Anna
Jardim, Marcia Rodrigues
Burnside, Girvan
Pamplona, Luciana
Bhojak, Maneesh
Manohar, Radhika
Silva, Gabriel Amorelli Medeiros da
Adriano, Marcus Vinicius
Brasil, Patrícia
Nogueira, Rita Maria Ribeiro
Santos, Carolina Cardoso dos
Turtle, Lance
Sequeira, Patricia Carvalho de
Brown, David W.
Griffiths, Michael J.
Filippis, Ana Maria Bispo de
Solomon, Tom
Resumen
Background: During 2015–16 Brazil experienced the largest epidemic of Zika virus ever reported. This arthropod-borne virus (arbovirus) has been linked to Guillain-Barre´ syndrome (GBS) in adults but other neurological associations are uncertain. Chikungunya virus has caused outbreaks in Brazil since 2014 but associated neurological disease has rarely been reported here. We investigated adults with acute neurological disorders for Zika, chikungunya and dengue, another arbovirus circulating in Brazil.
Methods: We studied adults who had developed a new neurological condition following suspected Zika virus infection between 1st November 2015 and 1st June 2016. Cerebrospinal fluid (CSF), serum, and urine were tested for evidence of Zika, chikungunya, and dengue viruses. Results: Of 35 patients studied, 22 had evidence of recent arboviral infection. Twelve had positive PCR or IgM for Zika, five of whom also had evidence for chikungunya, three for dengue, and one for all three viruses. Five of them presented with GBS; seven had presentations other than GBS, including meningoencephalitis, myelitis, radiculitis or combinations of these syndromes. Additionally, ten patients positive for chikungunya virus, two of whom also had evidence for dengue virus, presented with a similar range of neurological conditions. Conclusions: Zika virus is associated with a wide range of neurological manifestations, including central nervous system disease. Chikungunya virus appears to have and equally important association with neurological disease in Brazil, and any patients had dual infection. To understand fully the burden of Zika we must look beyond GBS, and also investigate for other co-circulating arboviruses, particularly chikungunya.
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