Zika Virus Meningoencephalitis in an Immunocompromised Patient

Schwartzmann, Pedro Vellosa; Ramalho, Leandra Náira Zambelli; Neder, Luciano; Vilar, Fernando Crivelenti; Ayub‐Ferreira, Silvia Moreira; Romeiro, Marília Farignoli; Takayanagui, Osvaldo Massaiti; Santos, Antônio Carlos dos; Schmidt, André; Figueiredo, Luíz Tadeu Moraes; Arena, Ross; Simões, Marcus Vinícius

doi:10.1016/j.mayocp.2016.12.019

Cited by 71 publications

(66 citation statements)

References 18 publications

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“…ZIKV was diagnosed by RT‐PCR analysis and positive viral culture from the cerebrospinal fluid (CSF). In another case, ZIKV caused fatal meningoencephalitis in an adult under an immunosuppressive regimen after heart transplant (Schwartzmann et al, ). These reports highlight a possible outcome for ZIKV infection in human adult brain.…”

Section: Experimental Findings That Clarified Zikv Pathology In the Cnsmentioning

confidence: 99%

Zika infection and the development of neurological defects

Russo

Jungmann

Beltrão-Braga

2017

Cellular Microbiology

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SummaryStarting with the outbreak in Brazil, Zika virus (ZIKV) infection has been correlated with severe syndromes such as congenital Zika syndrome and Guillain-Barré syndrome. Here, we review the status of Zika virus pathogenesis in the central nervous system (CNS). One of the main concerns about ZIKV exposure during pregnancy is abnormal brain development, which results in microcephaly in newborns. Recent advances in in vitro research show that ZIKV can infect and obliterate cells from the CNS, such as progenitors, neurons, and glial cells. Neural progenitor cells seem to be the main target of the virus, with infection leading to less cell migration, neurogenesis impairment, cell death and, consequently, microcephaly in newborns. The downsizing of the brain can be directly associated with defective development of the cortical layer. In addition, in vivo investigations in mice reveal that ZIKV can cross the placenta and migrate to fetuses, but with a significant neurotropism, which results in brain damage for the pups. Another finding shows that hydrocephaly is an additional consequence of ZIKV infection, being detected during embryonic and fetal development in mouse, as well as after birth in humans. In spite of the advances in ZIKV research in the last year, the mechanisms underlying ZIKV infection in the CNS require further investigation particularly as there are currently no treatments or vaccines against ZIKV infection.

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Section: Experimental Findings That Clarified Zikv Pathology In the Cnsmentioning

confidence: 99%

Zika infection and the development of neurological defects

Russo

Jungmann

Beltrão-Braga

2017

Cellular Microbiology

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“…Previous reports showed a lower frequency of classic symptoms and a higher incidence of severe disease and mortality among dengue‐infected solid organ transplant recipients, without infection‐related graft rejection . Little is known about the natural history of Zika virus infection in organ recipients, with some fatal cases reported . Chikungunya infection otherwise was associated with a benign course in solid organ transplant recipients, without chronic recurrent arthritis, possibly due to the effect of immunosuppressive drugs .…”

Section: Discussionmentioning

confidence: 99%

Yellow fever disease in a renal transplant recipient: Case report and literature review

Sousa

Zollner

Stucchi

et al. 2019

Transplant Infectious Dis

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Yellow fever (YF) is a viral disease, with clinical presentation among immunosuppressed patients not fully understood. YF vaccination (YFV), a live vaccine, is contraindicated in patients receiving immunosuppressive treatment due to the risk of developing the disease after vaccination. We report a case of a 50‐year‐old male recipient who presented wild‐type YF five years after a deceased donor kidney transplant. He lived in a YF endemic area and inadvertently received YFV. One day after YFV, the patient presented nausea, vomiting, fever, diarrhea, polyarthralgia, thrombocytopenia, and increased levels of liver function enzymes. The serological test was compatible with YF disease, and quantitative viral load confirmed the diagnosis of wild‐type YF. The patient received supportive care for twelve days, with hospital discharge in good clinical condition and stable renal function. One month after discharge, the patient developed de novo donor‐specific anti‐HLA antibodies (DSA) and histological evidence of endothelial lesion, with a diagnosis of acute antibody‐mediated rejection (AMR), treated with plasmapheresis and human IVIg therapy. Six months after therapy, he presented normal renal function with a reduction of DSA MFI. In the reported case, we observed a clinical wild‐type YF diagnosed even after YF vaccine administration, with good clinical outcome. De novo DSA and AMR occurred after the recovering of disease, with an adequate response to therapy and preserved allograft function. We reviewed the published literature on YF and YFV in solid organ transplantation.

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“…A recent report of DENV, ZIKV, and CHIKV infections diagnosed in hematopoietic stem cell transplant recipients and oncohematologic patients found prolonged viremia in those with DENV and viruria in those with ZIKV; the most common complication was thrombocytopenia, but all patients survived without sequelae (24). However, other case reports reveal less favorable outcomes and even atypical presentations: a fatal pseudotumoral form of ZIKV meningoencephalitis in a heart transplant recipient has been reported (25). With respect to arbovirus infection in HIV-positive patients, data are scarce, although favorable outcomes have been reported (20,26,27).…”

Section: Discussionmentioning

confidence: 99%