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

Abstract

BackgroundDuring 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.MethodsWe 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.ResultsOf 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.ConclusionsZika 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.

Neurological complications associated with emerging viruses in Brazil

“…These results support previous findings indicating an association between arboviruses and neuropathies in Brazil during the Zika virus epidemic . The rates of rash, facial paralysis, and paraparesis in patients with GBS in Metropolitan Area II are similar to those previously reported for GBS cases in Latin America and the Caribbean .…”

“…Although the most frequent causes of GBS are Campylobacter jejuni , Cytomegalovirus , and influenza A, the disorder has also been associated with dengue virus and Zika virus . During the Zika virus epidemic in Rio de Janeiro, Brazil, during the period 2015–2016, it was shown that neuropathies increased . However, until now there has not been a baseline of GBS cases prior to the Zika virus epidemic to provide a comparison with GBS rates reported during the epidemic.…”

Natural Infection of Aedes aegypti by Chikungunya and Dengue type 2 Virus in a Transition Area of North-Northeast Brazil

“…The similar pathogenicity shared by those viruses resulted in difficulties in the diagnosis and clinical management [6]. In addition, congenital abnormalities, such as microcephaly and Guillain-Barré syndrome, were associated with infection by ZIKV and CHIKV [16][17][18][19][20][21][22].…”

Hypothetical Human Immune Genome Complex Gradient May Help to Explain the Congenital Zika Symdrome Catastrophe in Brazil: A New Theory

“…The dramatic increase in the incidence of microcephaly concomitant with the ZIKV epidemic in Brazil alerted the scientific community to a potential causal association, leading the Brazilian Ministry of Health to declare the ZIKV epidemic to be a "national public health emergency"; and then, the World Health Organization (WHO) to declarate it to be a "public health emergency of international concern" (Albuquerque et al 2018). Retrospective observational studies reinforced the suspicion of a causal of ZIKV infection with microcephaly Brasil et al 2016;Cauchemez et al 2016), and with non-congenital neuroinflammatory diseases, such GBS, encephalitis and myelitis (Cao-Lormeau et al 2016;Parra et al 2016;Styczynski et al 2017;Salinas et al 2017;Mehta et al 2018). Several reports where instrumental in establishing the association between ZIKV and microcephaly.…”