Diaphragmatic paralysis: a rare consequence of dengue fever

Ratnayake, Eranda C; Shivanthan, Chrishan; Wijesiriwardena, Bandula

doi:10.1186/1471-2334-12-46

Cited by 18 publications

(14 citation statements)

References 4 publications

(5 reference statements)

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“…All 3 developed progressive respiratory failure and died on days of life 2, 10, and 86. Unilateral diaphragmatic paralysis has been described following herpes zoster, poliovirus, West Nile virus, human immunodeficiency virus, and dengue infection in adults [28,29] but, to our knowledge, has not been reported previously with CZS. The exact mechanism of phrenic neuropathy associated with ZIKV infection has not been elucidated.…”

Section: Discussionmentioning

confidence: 76%

Lessons Learned at the Epicenter of Brazil’s Congenital Zika Epidemic: Evidence From 87 Confirmed Cases

Meneses

Ishigami

Mello

et al. 2017

Clinical Infectious Diseases

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Congenital Zika virus infection has stimulated great international concern. A prospective case series of 87 infants with laboratory-confirmed congenital Zika syndrome (CZS) at the epicenter of the Brazilian Zika epidemic in Pernambuco state is presented. Mothers were interviewed for symptoms of possible Zika virus (ZIKV) infection during pregnancy, and fetal ultrasounds were obtained. Infant cerebrospinal fluid (CSF) samples were tested for ZIKV-specific antibodies, and sera were screened for other congenital infections. Neuroimaging and ophthalmologic evaluations were also performed. Sixty-six mothers (76%) reported symptoms of ZIKV infection during gestation. Fetal ultrasounds were available from 90% of the mothers, and all demonstrated brain structural abnormalities. All of the CSF samples tested positive for ZIKV immunoglobulin M. The majority of infants (89%) were term; the mean birth weight was 2577 ± 260 g, and the mean head circumference was 28.1 ± 1.8 cm. Severe microcephaly, defined as head circumference 3 SD below the mean for sex and gestational age, was found in 72 (82%) infants. All infants had an abnormal neurological exam, and 18 (20.7%) had arthrogryposis. The main abnormalities detected in computed tomography scans were calcifications (99%), followed by ventricular enlargement (94%), cortical hypogyration (81%), and less commonly, cerebellar hypoplasia (52%). Unilateral diaphragm paralysis was identified in 3 infants. Maternal young age, term infant, small for gestational age, and the presence of ophthalmologic abnormalities were significantly associated with a smaller head circumference Z score. Our findings, based on laboratory-confirmed ZIKV infection, add valuable evidence for the understanding of CZS.

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Section: Discussionmentioning

confidence: 76%

Lessons Learned at the Epicenter of Brazil’s Congenital Zika Epidemic: Evidence From 87 Confirmed Cases

Meneses

Ishigami

Mello

et al. 2017

Clinical Infectious Diseases

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“…They usually occur later than CNS manifestations (Oehler et al, 2012 ). The associated peripheral syndromes mainly include Guillain-Barre syndrome, hypokalemic quadriparesis or plegia, mononeuritis multiplex, brachial plexitis, diaphragmatic paralysis, and myositis (Jha and Ansari, 2010 ; Sharma et al, 2011 ; Verma et al, 2011b ; Gutch et al, 2012 ; Ratnayake et al, 2012 ; Jain et al, 2014 ; Table 2 ).…”

Section: Peripheral Nervous System Complicationsmentioning

confidence: 99%

Neurological Manifestations of Dengue Infection

Zhang

Liu

et al. 2017

Front. Cell. Infect. Microbiol.

156

146

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Dengue counts among the most commonly encountered arboviral diseases, representing the fastest spreading tropical illness in the world. It is prevalent in 128 countries, and each year >2.5 billion people are at risk of dengue virus infection worldwide. Neurological signs of dengue infection are increasingly reported. In this review, the main neurological complications of dengue virus infection, such as central nervous system (CNS), peripheral nervous system, and ophthalmic complications were discussed according to clinical features, treatment and possible pathogenesis. In addition, neurological complications in children were assessed due to their atypical clinical features. Finally, dengue infection and Japanese encephalitis were compared for pathogenesis and main clinical manifestations.

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“…Other congenital infections have not been implicated as causes of either diaphragmatic paralysis or eventration. Of note, infectious causes of acquired diaphragmatic paralysis include viruses within the same genus as ZIKV (i.e., Flavivirus ) including dengue virus (Ratnayake, Shivanthan, & Wijesiriwardena, ) and West Nile virus (Rudrappa, Kokatnur, & Chernyshev, ), but also other infectious agents as the Borrelia burgdorferi bacterium (Reddy, McCannon, & Venna, ). This is the fifth report of associated diaphragmatic paralysis perhaps consistent with ZIKV's ability to affect both the central and peripheral nervous systems.…”

Section: Discussionmentioning

confidence: 99%

Diaphragmatic paralysis: Evaluation in infants with congenital Zika syndrome

Linden¹,

Lins

Petribu³

et al. 2019

Birth Defects Research

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Background: Paralysis of the diaphragm in newborn infants can lead to recurrent infections and life-threatening respiratory insufficiency. The clinical diagnosis of unilateral diaphragmatic paralysis has been reported in infants with laboratory evidence of congenital Zika virus infection and/or the congenital Zika syndrome (CZS) phenotype but no evaluation of phrenic nerve function has been described.All reported infants have had accompanying arthrogryposis. High infant mortality is reported. Methods: The causal mechanism of congenital diaphragmatic paralysis was evaluated in three infants with arthrogryposis as a manifestation of CZS (two of the three infants had laboratory evidence of ZIKV infection shortly after birth; the remaining infant had negative serology for ZIKV when first tested at 7 months of age). Electromyography and phrenic nerve compound muscle action potential (CMAP) were performed in all infants with diaphragmatic paralysis demonstrated on imaging studies. Results: All infants had evidence of moderate chronic involvement of peripheral motor neurons. Phrenic nerve CMAP was reduced on the side of the diaphragmatic paralysis in two infants and reduced bilaterally in the remaining infant who had primarily anterior involvement of the diaphragm. All three infants had multiple medical complications and one infant died at 18 months of age. Conclusion: Evaluation of three infants with CZS and diaphragmatic paralysis demonstrated phrenic nerve dysfunction. In these and other affected infants, arthrogryposis appears to be a constant co-occurring condition and health problems are significant; both conditions are likely due to involvement of the peripheral nervous system in some infants with CZS. K E Y W O R D S arthrogryposis, congenital infection, diaphragmatic paralysis, phrenic nerve, Zika virus

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Diaphragmatic paralysis: a rare consequence of dengue fever

Cited by 18 publications

References 4 publications

Lessons Learned at the Epicenter of Brazil’s Congenital Zika Epidemic: Evidence From 87 Confirmed Cases

Lessons Learned at the Epicenter of Brazil’s Congenital Zika Epidemic: Evidence From 87 Confirmed Cases

Neurological Manifestations of Dengue Infection

Diaphragmatic paralysis: Evaluation in infants with congenital Zika syndrome

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