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

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.研究背景 2015至2016年间，巴西暴发了有记录以来规模最大的寨卡病毒（Zika virus）疫情。这种经节肢动物传播的病毒（虫媒病毒，arbovirus）已被证实与成人吉兰-巴雷综合征（Guillain-Barré syndrome，GBS）相关，但其他神经系统关联尚未明确。基孔肯雅病毒（Chikungunya virus）自2014年起在巴西引发暴发，但该国鲜有报道其伴随神经系统疾病的病例。本研究针对急性神经系统疾病成人患者，开展寨卡病毒、基孔肯雅病毒及登革病毒（另一种在巴西流行的虫媒病毒）的检测。 研究方法 本研究纳入2015年11月1日至2016年6月1日期间，疑似感染寨卡病毒后新发神经系统疾病的成人患者。采集脑脊液（cerebrospinal fluid, CSF）、血清及尿液样本，检测寨卡病毒、基孔肯雅病毒及登革病毒的感染证据。 研究结果 共纳入35例患者，其中22例存在近期虫媒病毒感染证据。12例寨卡病毒聚合酶链式反应（PCR）或免疫球蛋白M（IgM）检测呈阳性，其中5例同时存在基孔肯雅病毒感染证据、3例存在登革病毒感染证据、1例同时感染三种病毒。5例患者表现为吉兰-巴雷综合征；7例表现为非吉兰-巴雷综合征的其他神经系统病症，包括脑膜脑炎、脊髓炎、神经根炎或上述综合征的混合类型。此外，10例基孔肯雅病毒检测阳性的患者（其中2例同时存在登革病毒感染证据）也表现出类似谱的神经系统疾病。 研究结论 寨卡病毒与多种神经系统表现相关，包括中枢神经系统疾病。在巴西，基孔肯雅病毒似乎也与神经系统疾病存在同等重要的关联，且不少患者存在双重感染。若要全面阐明寨卡病毒的疾病负担，需将研究视野拓展至吉兰-巴雷综合征之外，同时还需对其他共同流行的虫媒病毒（尤其是基孔肯雅病毒）开展检测研究。