Data from: Long-term outcome in neuroZika: when biological diagnosis matters

Objectives: To characterize the full spectrum, relative frequency and
prognosis of the neurological manifestations in Zika virus (ZIKV)
postnatal infection. Methods: We conducted an observational study in
consecutive ZIKV-infected patients presenting with neurological
manifestations during the French West Indies 2016 outbreak. Results:
Eighty-seven patients, including 6 children, were enrolled. Ninety-five
percent of all cases required hospitalization. Guillain-Barré syndrome was
the most frequent manifestation (46.0%) followed by encephalitis or
encephalomyelitis (20.7%), isolated single or multiple cranial nerve
palsies (9.2%), other peripheral manifestations (6.9%), and stroke (1.1%).
Fourteen patients (16.1%) including one child, developed a mixed disorder
involving both the central and peripheral nervous system. Mechanical
ventilation was required in 21 cases all of whom had ZIKV RNA in at least
one biological fluid. Two adult patients died due to neuroZika. Clinical
follow-up (median 14 months; interquartile range, 13-17) was available for
76 patients. Residual disability (modified Rankin scale ≥2) was identified
in 19 (25.0%) patients, in 6 cases (7.9%), disability was severe (modified
Rankin scale ≥4). Amongst patients with ZIKV RNA detected in one
biological fluid, the risk of residual disability or death was higher (odd
ratio 9.19; CI 1.12-75.22; p = 0.039). Conclusions: NeuroZika spectrum
represents a heterogenous group of clinical neurological manifestations.
During an outbreak, clinicians should consider neuroZika in patients
presenting with cranial nerve palsies and a mixed neurological disorder.
Long-term sequelae are frequent in NeuroZika. ZIKV reverse-transcription
PCR status at admission can inform prognosis and should therefore be taken
into consideration in the management of hospitalised patients.

研究目的：明确寨卡病毒（Zika virus, ZIKV）产后感染神经系统表现的完整谱、相对发生率及预后特征。

研究方法：于2016年法属西印度群岛寨卡病毒疫情期间，对出现神经系统表现的连续ZIKV感染患者开展观察性研究。

研究结果：共纳入87例患者，其中6例为儿童。95%的病例需住院治疗。吉兰-巴雷综合征（Guillain-Barré syndrome）是最常见的表现（46.0%），其次为脑炎或脑脊髓炎（20.7%）、孤立性单神经或多颅神经麻痹（9.2%）、其他外周表现（6.9%）及脑卒中（1.1%）。14例患者（16.1%，含1例儿童）出现累及中枢及外周神经系统的混合性病变。21例患者需机械通气，且所有这些患者至少一种生物体液中检测到ZIKV RNA。2例成人患者因神经寨卡病毒病（NeuroZika）死亡。76例患者完成临床随访（中位时间14个月，四分位间距13-17个月）。19例（25.0%）患者存在残留残疾（改良Rankin量表（modified Rankin scale）评分≥2），其中6例（7.9%）为重度残疾（改良Rankin量表评分≥4）。在至少一种生物体液中检测到ZIKV RNA的患者中，残留残疾或死亡的风险更高（比值比9.19；置信区间1.12-75.22；p=0.039）。

研究结论：神经寨卡病毒病谱系（NeuroZika spectrum）是一组异质性的临床神经系统表现。疫情期间，临床医生应对出现颅神经麻痹及混合性神经系统病变的患者考虑神经寨卡病毒病的可能。神经寨卡病毒病常伴有长期后遗症。入院时ZIKV逆转录聚合酶链反应（reverse-transcription PCR）检测结果可提示预后，因此在住院患者管理中应予以考虑。