Neurological manifestations of Chikungunya and Zika infections

Abstract

The epidemics of Chikungunya virus (CHIKV) and Zika virus (ZIKV) infections have been considered the most important epidemiological occurrences in the Americas. The clinical picture of CHIKV infection is characterized by high fever, exanthema, myalgia, headaches, and arthralgia. Besides the typical clinical picture of CHIKV, atypical manifestations of neurological complications have been reported: meningo-encephalitis, meningoencephalo-myeloradiculitis, myeloradiculitis, myelitis, myeloneuropathy, Guillain-Barré syndrome and others. The diagnosis is based on clinical, epidemiological, and laboratory criteria. The most common symptoms of ZIKV infection are skin rash (mostly maculopapular), fever, arthralgia, myalgia, headache, and conjunctivitis. Some epidemics that have recently occurred in French Polynesia and Brazil, reported the most severe conditions, with involvement of the nervous system (Guillain-Barré syndrome, transverse myelitis, microcephaly and meningitis). The treatment for ZIKV and CHIKV infections are symptomatic and the management for neurological complications depends on the type of affliction. Intravenous immunoglobulin, plasmapheresis, and corticosteroid pulse therapy are options.

Neurologic manifestations in emerging arboviral diseases in Rio de Janeiro City, Brazil, 2015-2016

“…Neurologic-related conditions cause death and disabilities following CHIKV infection. Neurologic symptoms after CHIKV infection onset occur within a shorter period than after Zika infection onset, like within 2 or 3 days, with seizures and mental confusion [8][9][10] .…”

“…Treatment with Ig or plasmapheresis is indicated only in patients with GBS, and Ig and intravenous methylprednisolone therapy in patients with myelitis 8,15 . However, the lethal outcome and need for intensive care contrasted with the benign evolution observed in other viral meningitis cases, reinforcing the great potential for brain damage of arboviruses.…”

Selected mosquito-borne illnesses—Chikungunya

“…These include optic neuritis, encephalitis, facial paralysis, sensorineural deafness, and Guillain Barre Syndrome (GBS)these can be mistaken for other infectious or non-infectious etiologies, so a good history and exam are needed. 11,32,33 Myocarditis, cardiac dysrhythmia, sepsis including shock have on occasion been reported. 32 Of note, Zika has been associated with GBS.…”

“…Almost all patients infected with CHIKV will develop some symptoms according to the CDC and reports of illness from various regions. 7,8,10,11,[27][28][29][30][31][32][33] Symptoms associated with Chikungunya appear between 3 and 7 days after the patient has been bitten by the infected mosquito and these include:…”

What We Can Find Beyond the Classic Neuroimaging Findings of Congenital Zika Virus Syndrome?

“…After dengue, West Nile virus, and chikungunya, of which worldwide outbreaks were recorded in 1990, 1999, and 2013, respectively [1], Zika virus (ZIKV) is responsible for the most recent pandemic of arthropod-borne viral disease. ZIKV is an arbovirus of the Flaviviridae family, discovered in Uganda in 1947 and composed of ribonucleic acid; the first case in humans was described in 1952 [1][2][3][4][5][6][7][8]. It typically occurs in tropical and subtropical zones, with main African and Asian lineages originating from a common ancestor [1][2][3][4][5][6][7][8].…”