Neurological Disease Associated with Chikungunya in Indonesia

Abstract

Chikungunya virus (CHIKV) is recognized but rarely considered as a cause of central nervous system infection in endemic areas. A total of 244 patients with acute meningoencephalitis in Indonesia were retrospectively tested to identify whether any CHIKV infection was associated with neurological manifestations, especially in provinces known for CHIKV endemicity. Cerebrospinal fluid and blood specimens were tested using CHIKV-specific real-time reverse transcription polymerase chain reaction and IgM ELISA, alongside a panel of neurotropic viruses. We report four cases of suspected or confirmed CHIKV-associated neurological disease, including CHIKV RNA detection in cerebrospinal fluid (CSF) of one patient and in acute serum of another, and CHIKV IgM in CSF of three patients and in serum of a fourth. In conclusion, CHIKV should be considered as a cause of neurologic disease in endemic areas and especially during outbreaks, in addition to the more common arboviral diseases such as dengue and Japanese encephalitis viruses.

Pathophysiology of chikungunya virus infection associated with fatal outcomes

“…However, since this mutation was identified in both fatal and survival cases, it is unlikely to be responsible for fatal outcomes. Indeed, CNS infection and fatal CHIK do not appear to be restricted to a particular CHIKV lineage and have been reported in patients from several regions affected by different CHIKV lineages, such as Asian, 15 , 59 ECSA, 11 , 12 , 41 and the Indian Ocean lineage. 60 , 61 Nevertheless, the effects of E2-R242 mutation on CHIKV infection should be further investigated.…”

Central nervous system infections in the tropics

“…A case-control study from Mexico however, did not support the association of GBS with chikungunya, though laboratory confirmation of chikungunya was rare in both cases and controls [51]. Since then, chikungunya is increasingly being reported as a common cause of CNS syndromes in children in coastal Kenya [52], adults in south-eastern Brazil [53], and individuals in Indonesia [54]. Diagnosis of chikungunya is by PCR or serological tests, primarily serum immunoglobulin M (IgM) antibodies, though some propose use of CSF IgM antibody detection for CNS disease [14].…”

Seroprevalence of Chikungunya in an Asymptomatic Adult Population in North and South Sulawesi, Indonesia

“…8,25 The current study recorded two positive low blood donor samples by qRT-PCR without positive IgM response, presumably from the initial phase of viremia and likely to be infectious. Whole-genome sequencing attempts were unsuccessful, 26 likely due to low virus concentration. Although transfusion-related CHIKV infection has not been documented, further studies using sensitive viral nucleic acid detection and IgM assays are required to assess transfusion safety threats during outbreaks and in highly endemic areas.…”