Zika virus infection and myasthenia gravis: report of 2 cases

Molko, Nicolas; Simon, Olivier; Guyon, D.; Biron, Antoine; Dupont‐Rouzeyrol, Myrielle; Gourinat, Ann-Claire

doi:10.1212/wnl.0000000000003697

Cited by 27 publications

(14 citation statements)

References 6 publications

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“…With 84 countries or territories now affected by Zika virus,[ 29 ] increasing reports of associated neurological disease other than GBS,[ 10 – 13 , 15 , 16 ] and growing concern about coinfections with other arboviruses,[ 30 ] there is an urgent need to determine the full spectrum of Zika’s neurological complications and its relationship with other arboviruses. In our study, which begins to address these questions, over half of the patients with Zika virus infection had presentations other than GBS, suggesting that these complications may be more important than recognised previously.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, a study from Colombia has shown a strong temporal association between GBS and Zika virus, with viral RNA detected in samples from 17 patients. [ 5 ] A few case reports have described Zika virus-associated myelitis,[ 10 ] encephalitis,[ 11 , 12 ] meningoencephalitis,[ 13 ] acute disseminated encephalomyelitis,[ 14 ] Miller-Fisher syndrome,[ 15 ] and myasthenia gravis,[ 16 ] suggesting that the spectrum of neurological disease may be broader than initially thought. A preliminary epidemiological report from the French Polynesian outbreak indicated a possible increase in other neurological manifestations associated with Zika virus, but gave few details.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…Zika fever is a predominantly mosquito-borne disease, although rarer forms of ZIKV transmission have been described, including sexual or blood-borne transmission and vertical transmission from mother to child 7 . During the recent emergence, ZIKV infection has been associated with a dramatic increase in congenital abnormalities, including microcephaly and neurological disorders, especially in Brazil and in French Polynesia 8 – 11 . Previous phylogenic studies identified two distinct lineages for ZIKV, African, and Asian, which circulated in these two geographic contexts.…”

Section: Introductionmentioning

confidence: 99%

Differential transmission of Asian and African Zika virus lineages by Aedes aegypti from New Caledonia

Calvez

O’Connor

Pol

et al. 2018

Emerging Microbes & Infections

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Zika virus (ZIKV) is a Flavivirus that is transmitted to humans by Aedes mosquitoes. ZIKV is divided into two phylogenetic lineages, African and Asian. In the Asian lineage, Pacific and American clades have been linked to the recent worldwide outbreak of ZIKV. The aim of this study was to measure the vector competence of Aedes aegypti for seven ZIKV strains belonging to both lineages. We demonstrate that Ae. aegypti from New Caledonia (NC), South Pacific region, is a low-competence vector for Asian ZIKV (<10% transmission efficiency). No significant differences were observed in vector competence with respect to the sampling date and collection site of Asian ZIKV strains used (2014 and 2015 for New Caledonia, Pacific clade, and 2016 for French Guiana, American clade). The ability of the New Caledonian Ae. aegypti to transmit ZIKV is significantly greater for the earlier viral isolates belonging to the African lineage (>37% transmission efficiency after 9 days post-infection) compared to recent ZIKV isolates from African (10% transmission efficiency) and Asian lineages (<10% transmission efficiency). The results of this study demonstrate that Ae. aegypti from NC can become infected and replicate different ZIKV strains belonging to all lineages. Our data emphasize the importance of studying the interaction between vectors and their arboviruses according to each local geographic context. This approach will improve our understanding of arbovirus transmission to prevent their emergence and improve health surveillance.

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“…Myasthenia gravis (MG) has been associated with a number of viral infections, such as Epstein-Barr virus (EBV), 2 poliovirus, 3 and Zika virus. 4 One study described a woman suffering with MG as a complication of acute HEV infection. 5 In this pilot study, the frequency of current/recent HEV infection in a cohort of Chinese patients with MG was determined in relation to their clinical phenotypes.…”

Section: Association Of Hepatitis E Virus Infection and Myasthenia Grmentioning

confidence: 99%

Association of hepatitis E virus infection and myasthenia gravis: A pilot study

Wang

Gao

Lin

et al. 2018

Journal of Hepatology

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Zika virus infection and myasthenia gravis: report of 2 cases

Cited by 27 publications

References 6 publications

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

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

Differential transmission of Asian and African Zika virus lineages by Aedes aegypti from New Caledonia

Association of hepatitis E virus infection and myasthenia gravis: A pilot study

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