Case Reports of Neuro-Chikungunya in Southern Thailand

Abstract

There has been a recent increase in reports of neurologic complications as major causes of morbidity and mortality in chikungunya virus infection. As a part of 2004–2009 global outbreaks, an unprecedented large chikungunya epidemic occurred in Southern Thailand during 2008–2009 in which 49,069 cases were reported. During this period, we encountered two patients with meningoencephalitis and another patient with myeloneuropathy among 1,018 cases diagnosed as chikungunya in our hospital. The clinical pictures are presented and the key points are used to recognize and differentiate chikungunya from Japanese encephalitis virus, dengue virus, and herpesvirus infections, which are more common causes of meningoencephalitis and myelitis in this region.

Encephalitis associated with inappropriate antidiuretic hormone secretion due to chikungunya infection in Recife, State of Pernambuco, Brazil

“…A further potential diagnosis was viral encephalitis, because CHIKV infection had already been confirmed by the detection of viral genome in the CSF. Viral encephalitis is associated with nonspecific neuroimaging findings, such as involvement of the basal ganglia and the thalamus, characterized by bilateral and symmetric high signal intensity on T2 FLAIR 8 .…”

“…Neurological manifestations occur in adults 8,9 and children 3,10 and may progress to partial or complete recovery or result in permanent dysfunction 8 . Mortality is related to the presence of co-morbidities in adults 6 and is associated with the severity of neurological manifestations and patient age in children 3 .…”

Cardiovascular involvement and manifestations of systemic Chikungunya virus infection: A systematic review

“…On the other hand, isolated cases have reported severe acute manifestations, far from the classic expected evolution of the disease, especially in areas with renowned late outbreaks such as India (2006) 1, 10 , La Réunion and Mayotte (France, 2006) 9, 11 , Malaysia (2008), Thailand (2008) 12, 13 and South America (Colombia, Venezuela and later Brazil, from 2014 until now) 14, 15 . As a result, some authors have started to classify the clinical progression of CHIKV into either classical, severe or neurological (neuro-chikungunya) 10, 13 . The severe subtype of the disease contemplates an atypical systemic compromise, in which the liver, lungs, and even the eye are affected by the extra-articular intense inflammatory response 10, 16, 17 .…”

Outbreak of Neuro-Chikungunya in Northeastern Brazil

“…CHIKV characteristically manifests as fever, rash and arthralgia [3][4][5][6] and should always be considered in the differential diagnosis in sudden onset febrile polyarthralgia [7]. The word chikungunya means, "become twisted" in the Kimakonde language, an ethnic group in southeastern Tanzania and Northern Mozambique.…”

“…There has recently been a large increase in reports of neurologic complications in infected people [5,[8][9][10][11][12][13]. A very broad range of neurologic manifestations have been reported in CHIKV patients including seizures, speech disorders, motor dysfunction, sensorial disorders and altered mental status [5].…”