Emerging Neurological Infections in Brazil and Beyond

Lant, Suzannah ORCID: 0000-0003-0852-7803
(2023) Emerging Neurological Infections in Brazil and Beyond. PhD thesis, University of Liverpool.

[thumbnail of 201315500_May2023.pdf] Text
201315500_May2023.pdf - Author Accepted Manuscript
Access to this file is embargoed until 1 January 2028.

Download (12MB)


Chikungunya, Zika and dengue are types of arthropod-borne viruses (arboviruses). They have emerged in recent decades causing outbreaks of disease with global spread. Principally transmitted by an Aedes aegypti mosquito vector, infection mostly manifests as a fever-arthralgia-rash syndrome. However, a link between these viruses and neurological disease is becoming increasingly clear. Whilst it may be a relatively rare manifestation of infection, neurological involvement often results in severe consequences, causing disability and death. This is an important global public health concern.   These viruses co-circulate, and dual infection can occur. The spectrum of neurological manifestations linked to these viruses, and the importance of dual arbovirus infection are not fully understood. The research aimed to study i) the association between Zika, chikungunya, dengue and neurological disease in children and adults ii) the spectrum of neurological disease associated with infection iii) the clinical outcomes of patients with arbovirus-associated neurological disease in Brazil.   Initially, I studied adults with arboviral neurological disease in Pernambuco, Northeast Brazil, recruited during the 2015–16 Zika and chikungunya outbreaks. I subsequently conducted a multicentre case-control study in Brazil. The study ran between 2017-19, in the context of falling Zika case numbers nationally.  However, there were chikungunya outbreaks in Rio de Janeiro and Pernambuco over this time. I investigated the arbovirus-positive cases from this study in more detail, with a descriptive analysis of clinical outcomes. Through this work, I modified and refined criteria to define the strength of an association between defined neurological syndromes and viral infection and proposed approaches to use of outcome measures. Responding to the emerging COVID-19 pandemic, I modified and applied these criteria to patients with COVID-19 and neurological presentations for use in a global individual patient data meta-analysis, this characterised clinical presentations and outcomes.   These findings advance current understanding and provide methodological approaches for clinical and epidemiological characterisation in the field of emerging and zoonotic infections.

Item Type: Thesis (PhD)
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 08 Feb 2024 15:54
Last Modified: 08 Feb 2024 15:54
DOI: 10.17638/03176927
  • Solomon, Tom
  • Turtle, Lance
URI: https://livrepository.liverpool.ac.uk/id/eprint/3176927