28
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Neurological disease in adults with Zika and chikungunya virus infection in Northeast Brazil: a prospective observational study

      research-article
      , MD a , , PhD b , , Prof, PhD d , , PhD c , , MD a , , MD a , a , , PhD f , , PhD a , , PhD b , , MRCP f , , MD a , , MD g , , MRCP f , i , , MSc j , , PhD j , , PhD f , k , , DPhil f , l , , Prof, PhD g , h , , FRCR i , , Prof, FRCP m , , PhD c , , MD n , , Prof, PhD e , , Prof, PhD b , , Prof, MRCPath o , p , , PhD c , , MBChB f , , Prof, FRCP f , i , k , *
      The Lancet. Neurology
      Elsevier Ltd.

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Since 2015, the arthropod-borne viruses (arboviruses) Zika and chikungunya have spread across the Americas causing outbreaks, accompanied by increases in immune-mediated and infectious neurological disease. The spectrum of neurological manifestations linked to these viruses, and the importance of dual infection, are not known fully. We aimed to investigate whether neurological presentations differed according to the infecting arbovirus, and whether patients with dual infection had a different disease spectrum or severity.

          Methods

          We report a prospective observational study done during epidemics of Zika and chikungunya viruses in Recife, Pernambuco, a dengue-endemic area of Brazil. We recruited adults aged 18 years or older referred to Hospital da Restauração, a secondary-level and tertiary-level hospital, with suspected acute neurological disease and a history of suspected arboviral infection. We looked for evidence of Zika, chikungunya, or dengue infection by viral RNA or specific IgM antibodies in serum or CSF. We grouped patients according to their arbovirus laboratory diagnosis and then compared demographic and clinical characteristics.

          Findings

          Between Dec 4, 2014, and Dec 4, 2016, 1410 patients were admitted to the hospital neurology service; 201 (14%) had symptoms consistent with arbovirus infection and sufficient samples for diagnostic testing and were included in the study. The median age was 48 years (IQR 34–60), and 106 (53%) were women. 148 (74%) of 201 patients had laboratory evidence of arboviral infection. 98 (49%) of them had a single viral infection (41 [20%] had Zika, 55 [27%] had chikungunya, and two [1%] had dengue infection), whereas 50 (25%) had evidence of dual infection, mostly with Zika and chikungunya viruses (46 [23%] patients). Patients positive for arbovirus infection presented with a broad range of CNS and peripheral nervous system (PNS) disease. Chikungunya infection was more often associated with CNS disease (26 [47%] of 55 patients with chikungunya infection vs six [15%] of 41 with Zika infection; p=0·0008), especially myelitis (12 [22%] patients). Zika infection was more often associated with PNS disease (26 [63%] of 41 patients with Zika infection vs nine [16%] of 55 with chikungunya infection; p≤0·0001), particularly Guillain-Barré syndrome (25 [61%] patients). Patients with Guillain-Barré syndrome who had Zika and chikungunya dual infection had more aggressive disease, requiring intensive care support and longer hospital stays, than those with mono-infection (median 24 days [IQR 20–30] vs 17 days [10–20]; p=0·0028). Eight (17%) of 46 patients with Zika and chikungunya dual infection had a stroke or transient ischaemic attack, compared with five (6%) of 96 patients with Zika or chikungunya mono-infection (p=0·047).

          Interpretation

          There is a wide and overlapping spectrum of neurological manifestations caused by Zika or chikungunya mono-infection and by dual infections. The possible increased risk of acute cerebrovascular disease in patients with dual infection merits further investigation.

          Funding

          Fundação do Amparo a Ciência e Tecnologia de Pernambuco (FACEPE), EU's Horizon 2020 research and innovation programme, National Institute for Health Research.

          Translations

          For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

          Related collections

          Most cited references19

          • Record: found
          • Abstract: found
          • Article: found

          Neurological associations of COVID-19

          Summary Background The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is of a scale not seen since the 1918 influenza pandemic. Although the predominant clinical presentation is with respiratory disease, neurological manifestations are being recognised increasingly. On the basis of knowledge of other coronaviruses, especially those that caused the severe acute respiratory syndrome and Middle East respiratory syndrome epidemics, cases of CNS and peripheral nervous system disease caused by SARS-CoV-2 might be expected to be rare. Recent developments A growing number of case reports and series describe a wide array of neurological manifestations in 901 patients, but many have insufficient detail, reflecting the challenge of studying such patients. Encephalopathy has been reported for 93 patients in total, including 16 (7%) of 214 hospitalised patients with COVID-19 in Wuhan, China, and 40 (69%) of 58 patients in intensive care with COVID-19 in France. Encephalitis has been described in eight patients to date, and Guillain-Barré syndrome in 19 patients. SARS-CoV-2 has been detected in the CSF of some patients. Anosmia and ageusia are common, and can occur in the absence of other clinical features. Unexpectedly, acute cerebrovascular disease is also emerging as an important complication, with cohort studies reporting stroke in 2–6% of patients hospitalised with COVID-19. So far, 96 patients with stroke have been described, who frequently had vascular events in the context of a pro-inflammatory hypercoagulable state with elevated C-reactive protein, D-dimer, and ferritin. Where next? Careful clinical, diagnostic, and epidemiological studies are needed to help define the manifestations and burden of neurological disease caused by SARS-CoV-2. Precise case definitions must be used to distinguish non-specific complications of severe disease (eg, hypoxic encephalopathy and critical care neuropathy) from those caused directly or indirectly by the virus, including infectious, para-infectious, and post-infectious encephalitis, hypercoagulable states leading to stroke, and acute neuropathies such as Guillain-Barré syndrome. Recognition of neurological disease associated with SARS-CoV-2 in patients whose respiratory infection is mild or asymptomatic might prove challenging, especially if the primary COVID-19 illness occurred weeks earlier. The proportion of infections leading to neurological disease will probably remain small. However, these patients might be left with severe neurological sequelae. With so many people infected, the overall number of neurological patients, and their associated health burden and social and economic costs might be large. Health-care planners and policy makers must prepare for this eventuality, while the many ongoing studies investigating neurological associations increase our knowledge base.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            ZIKA VIRUS INFECTION IN MAN.

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Dengue Virus-Specific Antibodies Enhance Brazilian Zika Virus Infection.

              Anti-Flavivirus antibodies are highly cross-reactive and may facilitate Zika virus (ZIKV) infection through the antibody-dependent enhancement (ADE) mechanism. We demonstrate that dengue-specific antibodies enhance the infection of a primary Brazilian ZIKV isolate in a FcγRII-expressing K562 cell line. In addition, we demonstrate that serum samples from dengue-immune pregnant women enhanced ZIKV infection. These findings highlight the need for epidemiological studies and animal models to further confirm the role of ADE in the development of congenital and neurological complications associated with ZIKV infections.
                Bookmark

                Author and article information

                Journal
                Lancet Neurol
                Lancet Neurol
                The Lancet. Neurology
                Elsevier Ltd.
                1474-4422
                1474-4465
                16 September 2020
                October 2020
                16 September 2020
                : 19
                : 10
                : 826-839
                Affiliations
                [a ]Department of Neurology, Hospital da Restauração, Recife, Brazil
                [b ]Department of Collective Health, Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Brazil
                [c ]Department of Virology, Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Brazil
                [d ]Department of Clinical Medicine, Federal University of Pernambuco, Recife, Brazil
                [e ]Department of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil
                [f ]National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
                [g ]Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
                [h ]Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
                [i ]The Walton Centre NHS Foundation Trust, Liverpool, UK
                [j ]Department of Biostatistics, University of Liverpool, Liverpool, UK
                [k ]Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
                [l ]Alder Hey Children's NHS Foundation Trust, Liverpool, UK
                [m ]Department of Neurology and Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
                [n ]Department of Neurology, Division of Neuroimmunology and Neuroinfectious Disorders, Johns Hopkins University School of Medicine, Baltimore, MD, USA
                [o ]Blood Borne Virus Unit, Virus Reference Department, Public Health England, London, England
                [p ]Flavivirus Reference Laboratory, Evandro Chagas National Infectious Disease Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
                Author notes
                [* ]Correspondence to: Prof Tom Solomon, NIHR Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK
                Article
                S1474-4422(20)30232-5
                10.1016/S1474-4422(20)30232-5
                7494308
                32949543
                b8abb306-3e7d-4301-8ea9-f3c28046156a
                © 2020 Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Categories
                Articles

                Neurology
                Neurology

                Comments

                Comment on this article