Neurological manifestations of Chikungunya and Zika infections
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Furcifer 38 Clinical and neurological manifestations The most common signs and symptoms of ZIKV infection are skin rash mostly maculopapularfever, arthralgia, myalgia, headache, and conjunctivitis. Other symptoms such as articular oedema, sore throat, cough, and vomiting are also reported 45 Despite the generally benign course of the disease, some epidemics that recently occurred in French Polynesia and Brazil reported the most severe conditions with involvement of the nervous system GBS, transverse myelitis, microcephaly and meningitis.
During the Zika outbreak in French Polynesia, the first case of GBS developed seven days after a flu-like illness, bringing to mind Zika infection. It has been found that the simultaneous epidemics of dengue virus type 1 and 3 could also be a predisposing factor for the development of GBS during Zika fever, since infection by the dengue virus had also been associated with GBS 54 This fact raised the possibility of an immune stimulation by sequential arboviruses that could be responsible for such an unusual clustering of GBS cases during simultaneous Zika infection and two dengue serotypes.
The risk of GBS development would be increased by a specific sequence of dengue virus infections and Zika. Hence, in endemic areas, physicians should be aware of the risk of demyelinating diseases in cases of Zika infection.
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In a Polynesia Epi Bulletin there were neurological or autoimmune complications found in 70 patients studied between November and February, Thirty-eight patients had GBS after ZIKV infection and 25 had other neurological complications such as encephalitis, meningoencephalitis-encephalitis, facial paralysis, and myelitis. All the patients with GBS developed neurological symptoms after the development of a disease with symptoms consistent with ZIKV infection in previous days. Patients with GBS had electrophysiological findings consistent with acute motor axonal neuropathy, characterized by the distal involvement of motor nerves.
The recovery was faster than normally observed in typical GBS He presented with an acute myelitis, suggesting that the virus is neurotropic and it should be considered in patients living in, or traveling to, endemic areas There was a history of a transient rash 48 hours before the neurological symptoms.
The Brazilian Ministry of Health, in Novemberdeclared a public health emergency concerning an abnormal increase of children born with microcephaly duringin the state of Pernambuco. Until that date, cases of microcephaly in newborns had been reported in the same state, compared with an average of 10 cases per year from Their babies presented with microcephaly 57 and these women had symptoms compatible with ZIKV infection during pregnancy. Between mid and Januarythere were 4, cases of suspected microcephaly, cases had brain abnormalities found on imaging, and ZIKV was detected in 17 babies It had become a major public health concern, as the incidence of Zika virus in the general population may be very high during outbreaks.
Thus, these findings highlight the need to inform pregnant women to protect themselves from mosquito bites and avoid traveling to affected countries Samples obtained within 10 days after the onset of the disease should have PCR performed. In general, the diagnostic tests for flaviviruses should include an acute phase serum sample, taken as soon as possible after the onset of disease and a second sample taken two to three weeks after the first This should show an increase of antibody titer in paired samples with an interval of about two weeks.
Confirmation of the positive results should be confirmed with the plaque reduction neutralization test, showing at least a fourfold increase in titer of neutralizing antibodies to ZIKV. It is known that cross-reactivity with other flaviviruses can occur, especially dengue, yellow fever and, less frequently, with the West Nile virus. Therefore, the results should be interpreted with caution 37 Urine samples for the detection of viral genomes by RT-PCR may be the diagnostic method of choice, since the disappearance of the genome in serum has been shown to be within 10 days for ZIKV, but in urine samples it can be detected until fifteen days after the onset of infection 585960 Table 2.
Serology is usually performed on serum; however, viral antibodies may also be detected in the CSF 5859 It includes antipyretic, analgesic, anti-inflammatory drugs to reduce joint and muscle pain, three to six eye drops twice daily as a lubricant, anti-allergy drugs, among others. In the case of pruritic eruptions, anti-histamines may be considered. Medicines containing aspirin should not be used, as well as in cases of dengue fever, because they may increase the risk of bleeding There is no vaccine against these diseases.
The Aedes mosquito outbreaks, typical of urban areas of tropical and subtropical climates, should be eliminated. Chikungunya virus in the Caribbean: J Pediatric Infect Dis Soc. Reemergence of chikungunya virus. Garg M, Alcalde V. Update on emerging infections: Reappearance of chikungunya, formerly called dengue, in the Americas. Carbajo AE, Vezzani D. Waiting for chikungunya fever in Argentina: Mem Inst Oswaldo Cruz.
Cases of Chikungunya Fever in the Americas, for week. Pan American Health Organization; [acess Apr 8]. Chikungunya risk for Brazil. CNS infection and pathologies of a re-emerging arbovirus.
Post chikungunya brain stem encephalitis. J Assoc Physicians India. Rampal SM, Meena H. Neurological complications in Chikungunya Fever. Neurological complications in Chikungunya infection.Dengue and Chikungunya in Our Backyard: Preventing Aedes Mosquito-Borne Diseases