Dengue and chikungunya infection in neurologic disorders from endemic areas in Brazil

Mello, Cíntia da Silva; Cabral‐Castro, Mauro Jorge; Faria, Luiz Claudio Silva de; Peralta, José Mauro; Puccioni-Sohler, Márzia

doi:10.1212/cpj.0000000000000776

Cited by 17 publications

(20 citation statements)

References 8 publications

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“…In a previous study, our group found 31% of cases of neuroinvasive arboviruses (DENV/CHIKV) by RT-PCR and specific IgM in the CSF and/or serum in patients with suspected infectious or post-infectious neurological disorders (encephalitis, GBS, optic neuritis, neuromyelitis optic spectrum disorder, polyneuropathy, and myelitis). This analysis showed the importance of routine CSF investigations in endemic areas 36 .…”

Section: Discussionmentioning

confidence: 73%

Use of Cerebrospinal Fluid for the Diagnosis of Neuroinvasive Dengue, Zika, and Chikungunya: A 19-year systematic review

Mello

Cabral‐Castro

Faria

et al. 2021

Rev. Soc. Bras. Med. Trop.

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Introduction: Cerebrospinal fluid analysis contributes to the diagnosis and neuropathogenesis of neuroinvasive arboviruses. Neurological complications caused by dengue, Zika, and chikungunya infections have high clinical relevance because of their high potential to cause death or neurological deficits. We aimed to evaluate the use of cerebrospinal fluid assays for diagnostic support in neurological disorders associated with dengue, chikungunya, and Zika infections. Methods: A systematic review was carried out by searching the electronic databases LILACS, PubMed, Scopus, and Embase for articles written in English, Portuguese, or Spanish in the last 19 years. Published studies were reviewed using the terms "dengue," "Zika", "chikungunya", alone or in combination with "cerebrospinal fluid" in the period from 2000 to 2019. Results: A total of 98,060 studies were identified; of these, 1.1% (1,041 studies, 58,478 cases) used cerebrospinal fluid assays for neurological investigations. The most frequent neurological disorders included encephalitis (41.4%), congenital syndromes (17%), and microcephaly associated with Zika virus infections (8.9%). Neuroinvasive disorders were confirmed in 8.03% of 58,478 cases by specific cerebrospinal fluid analyses. The main methods used were IgM-specific antibodies (66%) and reverse transcription-polymerase chain reaction (10%). The largest number of scientific papers (29%) originated from Brazil, followed by India (18.4%) and the United States (14.4%). Conclusions: Although cerebrospinal fluid analysis is of great importance for increasing neurological diagnostic accuracy and contributes to the early diagnosis of neuroinvasive dengue, chikungunya, and Zika infections, it is underused in routine laboratory investigations worldwide.

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Section: Discussionmentioning

confidence: 73%

Use of Cerebrospinal Fluid for the Diagnosis of Neuroinvasive Dengue, Zika, and Chikungunya: A 19-year systematic review

Mello

Cabral‐Castro

Faria

et al. 2021

Rev. Soc. Bras. Med. Trop.

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“…On the other hand, we found normal leukocyte counts instead of the classical leukopenia of dengue with warning signs or severe dengue, which pose a difficulty to early diagnosis, although there was thrombocytopenia only at day six of hospitalization with no changes in ALT and AST transaminases as reported previously. Recently, 11/36 patients from a Brazilian endemic area were diagnosed with neurologic manifestations and confirmed for arbovirus infection using CSF or sera [ 32 ] (5 DENV and 6 CHIKV), posing an additional warning about involvement of these viruses in severe disease presentation in Latin-American countries where there is cocirculation.…”

Section: Discussionmentioning

confidence: 99%

A Case Series of Severe Dengue with Neurological Presentation in Children from a Colombian Hyperendemic Area

Castellanos

Esteban

Panqueba-Salgado

et al. 2021

Case Reports in Medicine

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Dengue transmission is sustained in Colombia with increasing prevalence mainly in children. This work aimed to describe a case series of children diagnosed with dengue presenting neurological disease in Huila Province of Colombia. Eleven pediatric febrile patients confirmed for dengue disease and presenting neurological signs were studied in the University Hospital of Neiva, Huila Province. Clinical and laboratory findings, CSF cytochemical analysis, neurology images, and serology and molecular studies were performed. Viral RNA was detected in all patients’ sera by RT-PCR. Nine out of 11 were primary infections. Tonic-clonic seizures (73%), consciousness alterations (27%), irritability (27%), and ataxia (18%) were the most frequent neurological signs. None of the patients had plasma leakage, hypovolemic shock, or liver disease, confirming the encephalitis diagnosis. Diagnostic images did not show abnormal findings, but neither bacterial nor fungal infections were detected in CSF analysis. All patients survived without sequelae except for one patient that presented ataxia for months. In conclusion, we described a group of children with neurological signs during severe dengue disease as the main finding, indicating the importance to including dengue as a differential diagnosis in neurological patients from endemic areas.

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“…Dengue is not considered a neurotropic virus. However, neurotropism and neuro-invasion have been reported previously [ 55 , 69 ], and encephalitis and encephalopathy are the most common neurological presentations of DENV infections [ 70 , 71 , 72 ]. It is estimated that 0.5–21% of DENV-infected patients develop neurologic manifestations, with DENV-2 and DENV-3 most frequently associated with cases of myelitis, meningitis, and encephalitis [ 70 ].…”

Section: Viruses Commonly Associated With Cns Infection In Brazilmentioning

confidence: 99%

Viral and Prion Infections Associated with Central Nervous System Syndromes in Brazil

Sousa

Santos

Paula

et al. 2021

Viruses

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Virus-induced infections of the central nervous system (CNS) are among the most serious problems in public health and can be associated with high rates of morbidity and mortality, mainly in low- and middle-income countries, where these manifestations have been neglected. Typically, herpes simplex virus 1 and 2, varicella-zoster, and enterovirus are responsible for a high number of cases in immunocompetent hosts, whereas other herpesviruses (for example, cytomegalovirus) are the most common in immunocompromised individuals. Arboviruses have also been associated with outbreaks with a high burden of neurological disorders, such as the Zika virus epidemic in Brazil. There is a current lack of understanding in Brazil about the most common viruses involved in CNS infections. In this review, we briefly summarize the most recent studies and findings associated with the CNS, in addition to epidemiological data that provide extensive information on the circulation and diversity of the most common neuro-invasive viruses in Brazil. We also highlight important aspects of the prion-associated diseases. This review provides readers with better knowledge of virus-associated CNS infections. A deeper understanding of these infections will support the improvement of the current surveillance strategies to allow the timely monitoring of the emergence/re-emergence of neurotropic viruses.

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Dengue and chikungunya infection in neurologic disorders from endemic areas in Brazil

Cited by 17 publications

References 8 publications

Use of Cerebrospinal Fluid for the Diagnosis of Neuroinvasive Dengue, Zika, and Chikungunya: A 19-year systematic review

Use of Cerebrospinal Fluid for the Diagnosis of Neuroinvasive Dengue, Zika, and Chikungunya: A 19-year systematic review

A Case Series of Severe Dengue with Neurological Presentation in Children from a Colombian Hyperendemic Area

Viral and Prion Infections Associated with Central Nervous System Syndromes in Brazil

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