Background Since 2015, the arthropod-borne viruses (arboviruses) Zika and chikungunya have spread across the Americas causing outbreaks, accompanied by increases in immune-mediated and infectious neurological disease. The spectrum of neurological manifestations linked to these viruses, and the importance of dual infection, are not known fully. We aimed to investigate whether neurological presentations differed according to the infecting arbovirus, and whether patients with dual infection had a different disease spectrum or severity. Methods We report a prospective observational study done during epidemics of Zika and chikungunya viruses in Recife, Pernambuco, a dengue-endemic area of Brazil. We recruited adults aged 18 years or older referred to Hospital da Restauração, a secondary-level and tertiary-level hospital, with suspected acute neurological disease and a history of suspected arboviral infection. We looked for evidence of Zika, chikungunya, or dengue infection by viral RNA or specific IgM antibodies in serum or CSF. We grouped patients according to their arbovirus laboratory diagnosis and then compared demographic and clinical characteristics. Findings Between Dec 4, 2014, and Dec 4, 2016, 1410 patients were admitted to the hospital neurology service; 201 (14%) had symptoms consistent with arbovirus infection and sufficient samples for diagnostic testing and were included in the study. The median age was 48 years (IQR 34–60), and 106 (53%) were women. 148 (74%) of 201 patients had laboratory evidence of arboviral infection. 98 (49%) of them had a single viral infection (41 [20%] had Zika, 55 [27%] had chikungunya, and two [1%] had dengue infection), whereas 50 (25%) had evidence of dual infection, mostly with Zika and chikungunya viruses (46 [23%] patients). Patients positive for arbovirus infection presented with a broad range of CNS and peripheral nervous system (PNS) disease. Chikungunya infection was more often associated with CNS disease (26 [47%] of 55 patients with chikungunya infection vs six [15%] of 41 with Zika infection; p=0·0008), especially myelitis (12 [22%] patients). Zika infection was more often associated with PNS disease (26 [63%] of 41 patients with Zika infection vs nine [16%] of 55 with chikungunya infection; p≤0·0001), particularly Guillain-Barré syndrome (25 [61%] patients). Patients with Guillain-Barré syndrome who had Zika and chikungunya dual infection had more aggressive disease, requiring intensive care support and longer hospital stays, than those with mono-infection (median 24 days [IQR 20–30] vs 17 days [10–20]; p=0·0028). Eight (17%) of 46 patients with Zika and chikungunya dual infection had a stroke or transient ischaemic attack, compared with five (6%) of 96 patients with Zika or chikungunya mono-infection (p=0·047). Interpretation There is a wide and overlapping spectrum of neurologica...

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Dengue é a infecção arboviral humana mais f reqüente, com 50 milhões de casos por ano e 2,5 a 3 bilhões de pessoas em risco de contaminação, segundo estimativa da OMS 1 . A infecção se apre s e n t a classicamente como febre do dengue (DC), uma doença autolimitada, mas severa, semelhante à influenza, ou como febre hemorrágica do dengue ou dengue hemorrágico (FHD). No sudeste da Ásia, é doença predominantemente pediátrica e caracterizada pelo aumento da permeabilidade vascular, perda de plasma, manifestações hemorrágicas e t ro m b o c i t o p e n i a 2 . A sintomatologia do dengue depende da forma clínica, podendo variar de cefaléia a ampla gama de manifestações neuro l ó g i c a s . No dengue clássico, o quadro febril, agudo, com d uração de dois a sete dias, habitualmente associa-se a dois ou mais sinais ou sintomas, dentre: cefaléia grave, dor re t rorbital, mialgia grave, artralgia, r a s h característico, manifestações hemorrágicas e leucopenia. A mialgia do dengue deve-se à presença de infiltrado mononuclear perivascular leve a moderado e acúmulo de lipídeos, acarretando o sin-