The spectrum of neurological disease associated with Zika and chikungunya viruses in adults in Rio de Janeiro, Brazil: A case series



Mehta, Ravi, Soares, Cristiane Nascimento, Medialdea-Carrera, Raquel, Ellul, Mark ORCID: 0000-0002-6115-8245, Texeira da Silva, Marcus Tulius, Rosala-Hallas, Anna ORCID: 0000-0001-8012-9995, Jardim, Marcia Rodrigues, Burnside, Girvan ORCID: 0000-0001-7398-1346, Pamplona, Luciana, Bhojak, Maneesh
et al (show 12 more authors) (2018) The spectrum of neurological disease associated with Zika and chikungunya viruses in adults in Rio de Janeiro, Brazil: A case series. PLoS Neglected Tropical Diseases, 12 (2).

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Abstract

Background During 2015–16 Brazil experienced the largest epidemic of Zika virus ever reported. This arthropod-borne virus (arbovirus) has been linked to Guillain-Barré 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 an equally important association with neurological disease in Brazil, and many 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.

Item Type: Article
Depositing User: Symplectic Admin
Date Deposited: 24 Apr 2018 10:27
Last Modified: 16 Sep 2021 11:10
DOI: 10.1371/journal.pntd.0006212
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3020558