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.
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DOI：
10.1371/journal.pntd.0006212
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发表时间：
2018-03
影响因子：
3.8
通讯作者：
Solomon T
中科院分区：
文献类型：
--
作者：
Mehta R;Soares CN;Medialdea-Carrera R;Ellul M;da Silva MTT;Rosala-Hallas A;Jardim MR;Burnside G;Pamplona L;Bhojak M;Manohar R;da Silva GAM;Adriano MV;Brasil P;Nogueira RMR;Dos Santos CC;Turtle L;de Sequeira PC;Brown DW;Griffiths MJ;de Filippis AMB;Solomon T
在2015-16年期间，巴西经历了有史以来最大的寨卡病毒疫情。这种节肢动物传播的病毒（虫媒病毒）与成年人的格林-巴利综合征（GBS）有关，但其他神经学联系尚不确定。自2014年以来，基孔肯雅病毒在巴西引起了疫情，但相关的神经系统疾病在巴西很少报道。我们调查了患有寨卡病毒、基孔肯雅病毒和登革热（另一种在巴西流行的虫媒病毒）的急性神经系统疾病的成年人。我们研究了2015年11月1日至2016年6月1日期间疑似寨卡病毒感染后出现新的神经系统疾病的成年人。对脑脊液（CSF）、血清和尿液进行了寨卡病毒、基孔肯雅病毒和登革热病毒的检测。在研究的35名患者中，22名有近期虫媒病毒感染的证据。12人对寨卡病毒呈PCR或IgM阳性，其中5人也有基孔肯雅病毒的证据，3人有登革热，1人有所有三种病毒。其中5例表现为GBS; 7例表现为GBS以外的其他表现，包括脑膜脑炎、肌萎缩、神经根炎或这些综合征的组合。此外，10名基孔肯雅病毒阳性患者，其中两人也有登革热病毒的证据，表现出类似的神经系统疾病。寨卡病毒与广泛的神经系统表现有关，包括中枢神经系统疾病。在巴西，基孔肯雅病毒似乎与神经系统疾病有同样重要的联系，许多患者有双重感染。为了充分了解寨卡病毒的负担，我们必须超越GBS，并调查其他共同传播的虫媒病毒，特别是基孔肯雅病毒。在2015-16年期间，巴西经历了有史以来最大规模的蚊媒寨卡病毒爆发，随后格林-巴利综合征（GBS）病例增加，这是一种周围神经系统疾病（大脑和脊髓外的神经），可能导致瘫痪，有时甚至死亡。在对巴西里约热内卢疑似寨卡病毒相关神经系统疾病的成年人进行评估时，我们增加了越来越多的证据，将寨卡病毒与更广泛的神经系统疾病联系起来，包括中枢神经系统疾病（脑和脊髓）。我们还表明，许多最初被认为患有与寨卡病毒相关的神经系统疾病的患者实际上感染了基孔肯雅病毒，这是另一种节肢动物传播的病毒（虫媒病毒），也与广泛的神经系统疾病有关。重要的是，许多患者有感染一种以上病毒的证据。我们讨论了诊断感染的挑战，以及如何使用不同的体液样本来帮助促进这一点。我们的研究结果表明，如果我们要充分了解寨卡病毒的疾病负担，临床医生和公共卫生官员必须超越GBS。此外，我们强调需要调查其他共循环虫媒病毒，特别是基孔肯雅病毒的急性神经系统综合征患者。
During 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. We 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. Of 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. Zika 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. During 2015–16, Brazil experienced the largest outbreak of the mosquito-borne Zika virus ever reported and saw a subsequent increase in cases of Guillain-Barré syndrome (GBS), a disorder of the peripheral nervous system (nerves outside the brain and spinal cord) that can result in paralysis and sometimes death. In this assessment of adults presenting with suspected Zika virus-associated neurological disease in Rio de Janeiro, Brazil, we add to the growing body of evidence linking Zika to a wider range of neurological disease, including disease of the central nervous system (brain and spinal cord). We also show that many patients initially thought to have neurological disease associated with Zika virus were in fact infected with chikungunya virus, another arthropod-borne virus (arbovirus) that is also associated with a wide range of neurological disease. Importantly, many patients had evidence of infection with more than one virus. We discuss the challenges in diagnosing the infections and how different body fluid samples can be used to help facilitate this. Our results suggest that clinicians and public health officials must look beyond GBS if we are to understand fully the disease burden of Zika virus. In addition, we highlight the need to investigate patients with acute neurological syndromes for other co-circulating arboviruses, particularly chikungunya.
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影响因子：
30.5
作者：
Dejnirattisai W;Supasa P;Wongwiwat W;Rouvinski A;Barba-Spaeth G;Duangchinda T;Sakuntabhai A;Cao-Lormeau VM;Malasit P;Rey FA;Mongkolsapaya J;Screaton GR
通讯作者：
Screaton GR
影响因子：
5.2
作者：
Acevedo, Nathalie;Waggoner, Jesse;Zambrano, Hector
通讯作者：
Zambrano, Hector
影响因子：
11.8
作者：
Prat, Christine M.;Flusin, Olivier;Leparc-Goffart, Isabelle
通讯作者：
Leparc-Goffart, Isabelle
影响因子：
34.3
作者：
Mallewa, Macpherson;Vallely, Pam;Solomon, Tom
通讯作者：
Solomon, Tom
影响因子：
3.7
作者：
Arias, Arturo;Torres-Tobar, Lilian;Castellanos, Gabriel
通讯作者：
Castellanos, Gabriel