Neurological manifestations of Chikungunya and Zika infections

Talys J. Pinheiro; Luis F. Guimarães; Marcus Tulius T. Silva; Cristiane N. Soares

doi:10.1590/0004-282X20160138

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(11): 937-943
DOI: 10.1590/0004-282X20160138

VIEWS AND REVIEWS

Neurological manifestations of Chikungunya and Zika infections

Manifestações neurológicas das infecções pelos vírus Zika e Chikungunya

Authors

Talys J. Pinheiro

¹Hospital dos Servidores do Estado, Serviço de Neurologia, Rio de Janeiro RJ, Brasil;
Luis F. Guimarães

¹Hospital dos Servidores do Estado, Serviço de Neurologia, Rio de Janeiro RJ, Brasil;
Marcus Tulius T. Silva

²Laboratório de Pesquisa Clínica em Doenças Neuroinfecciosas, Instituto Nacional de Doenças Infecciosas Evandro Chagas/ Fundação Oswaldo Cruz, RJ, Brasil.
Cristiane N. Soares

¹Hospital dos Servidores do Estado, Serviço de Neurologia, Rio de Janeiro RJ, Brasil;

Abstract

ABSTRACT

The epidemics of Chikungunya virus (CHIKV) and Zika virus (ZIKV) infections have been considered the most important epidemiological occurrences in the Americas. The clinical picture of CHIKV infection is characterized by high fever, exanthema, myalgia, headaches, and arthralgia. Besides the typical clinical picture of CHIKV, atypical manifestations of neurological complications have been reported: meningo-encephalitis, meningoencephalo-myeloradiculitis, myeloradiculitis, myelitis, myeloneuropathy, Guillain-Barré syndrome and others. The diagnosis is based on clinical, epidemiological, and laboratory criteria. The most common symptoms of ZIKV infection are skin rash (mostly maculopapular), fever, arthralgia, myalgia, headache, and conjunctivitis. Some epidemics that have recently occurred in French Polynesia and Brazil, reported the most severe conditions, with involvement of the nervous system (Guillain-Barré syndrome, transverse myelitis, microcephaly and meningitis). The treatment for ZIKV and CHIKV infections are symptomatic and the management for neurological complications depends on the type of affliction. Intravenous immunoglobulin, plasmapheresis, and corticosteroid pulse therapy are options.

RESUMO

As epidemias provocadas pelo vírus Chikungunya (CHIK) e Zika vírus (ZIKV) têm sido consideradas as ocorrências epidemiológicas mais importantes da América. O quadro clínico da infecção por CHIK caracteriza-se por febre alta, exantema, mialgia, cefaléia e artralgia. Além do quadro clínico típico, manifestações atípicas como complicações neurológicas foram relatadas: meningo-encefalite, mielorradiculopatia, mielorradiculite, mielite, mieloneuropatia, síndrome de Guillain-Barre (GBS), entre outras. O diagnóstico é baseado em critérios clínicos, epidemiológicos e laboratoriais. Em relação aos sinais e sintomas da infecção pelo ZIKV, erupção cutânea (principalmente maculopapular), febre, artralgia, mialgia, cefaléia e conjuntivite são os mais comuns. Algumas epidemias que ocorreram recentemente na Polinésia Francesa e Brasil relataram condições mais severas, com envolvimento do sistema nervoso (GBS, mielite transversa, microcefalia e meningite). O tratamento para ZIKV e CHIK é sintomático, e o manejo das complicações neurológicas dependerá do tipo da afecção. Imunoglobulina venosa, plasmaférese, e pulsoterapia com corticosteróides são opções.

Guillain-Barre syndrome - Zika virus - Chikungunya virus

síndrome de Guillain-Barré - Zika vírus - vírus Chikungunya

Full Text

References

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