دورية أكاديمية
أعرض في EDS

Neurological disease in adults with Zika and chikungunya virus infection in Northeast Brazil: a prospective observational study.

التفاصيل البيبلوغرافية
العنوان: Neurological disease in adults with Zika and chikungunya virus infection in Northeast Brazil: a prospective observational study.
المؤلفون: Brito Ferreira ML; Department of Neurology, Hospital da Restauração, Recife, Brazil., Militão de Albuquerque MFP; Department of Collective Health, Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Brazil., de Brito CAA; Department of Clinical Medicine, Federal University of Pernambuco, Recife, Brazil., de Oliveira França RF; Department of Virology, Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Brazil., Porto Moreira ÁJ; Department of Neurology, Hospital da Restauração, Recife, Brazil., de Morais Machado MÍ; Department of Neurology, Hospital da Restauração, Recife, Brazil., da Paz Melo R; Department of Neurology, Hospital da Restauração, Recife, Brazil., Medialdea-Carrera R; National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK., Dornelas Mesquita S; Department of Neurology, Hospital da Restauração, Recife, Brazil., Lopes Santos M; Department of Collective Health, Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Brazil., Mehta R; National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK., Ramos E Silva R; Department of Neurology, Hospital da Restauração, Recife, Brazil., Leonhard SE; Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands., Ellul M; National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK., Rosala-Hallas A; Department of Biostatistics, University of Liverpool, Liverpool, UK., Burnside G; Department of Biostatistics, University of Liverpool, Liverpool, UK., Turtle L; National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK., Griffiths MJ; National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK; Alder Hey Children's NHS Foundation Trust, Liverpool, UK., Jacobs BC; Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands., Bhojak M; The Walton Centre NHS Foundation Trust, Liverpool, UK., Willison HJ; Department of Neurology and Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK., Pena LJ; Department of Virology, Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Brazil., Pardo CA; Department of Neurology, Division of Neuroimmunology and Neuroinfectious Disorders, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Ximenes RAA; Department of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil., Martelli CMT; Department of Collective Health, Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Brazil., Brown DWG; Blood Borne Virus Unit, Virus Reference Department, Public Health England, London, England; Flavivirus Reference Laboratory, Evandro Chagas National Infectious Disease Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil., Cordeiro MT; Department of Virology, Institute Aggeu Magalhães, Oswaldo Cruz Foundation, Recife, Brazil., Lant S; National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK., Solomon T; National Institute for Health Research Health Protection Research Unit on Emerging and Zoonotic Infections, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. Electronic address: tsolomon@liverpool.ac.uk.
المصدر: The Lancet. Neurology [Lancet Neurol] 2020 Oct; Vol. 19 (10), pp. 826-839. Date of Electronic Publication: 2020 Sep 16.
نوع المنشور: Journal Article; Observational Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Lancet Pub. Group Country of Publication: England NLM ID: 101139309 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1474-4465 (Electronic) Linking ISSN: 14744422 NLM ISO Abbreviation: Lancet Neurol Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London, UK ; New York, NY : Lancet Pub. Group, 2002-
مواضيع طبية MeSH: Chikungunya Fever/*diagnosis , Chikungunya Fever/*epidemiology , Nervous System Diseases/*diagnosis , Nervous System Diseases/*epidemiology , Zika Virus Infection/*diagnosis , Zika Virus Infection/*epidemiology, Adult ; Aged ; Brazil/epidemiology ; Chikungunya Fever/blood ; Female ; Humans ; Male ; Middle Aged ; Nervous System Diseases/blood ; Prospective Studies ; Zika Virus Infection/blood
مستخلص: Background: Since 2015, the arthropod-borne viruses (arboviruses) Zika and chikungunya have spread across the Americas causing outbreaks, accompanied by increases in immune-mediated and infectious neurological disease. The spectrum of neurological manifestations linked to these viruses, and the importance of dual infection, are not known fully. We aimed to investigate whether neurological presentations differed according to the infecting arbovirus, and whether patients with dual infection had a different disease spectrum or severity.
Methods: We report a prospective observational study done during epidemics of Zika and chikungunya viruses in Recife, Pernambuco, a dengue-endemic area of Brazil. We recruited adults aged 18 years or older referred to Hospital da Restauração, a secondary-level and tertiary-level hospital, with suspected acute neurological disease and a history of suspected arboviral infection. We looked for evidence of Zika, chikungunya, or dengue infection by viral RNA or specific IgM antibodies in serum or CSF. We grouped patients according to their arbovirus laboratory diagnosis and then compared demographic and clinical characteristics.
Findings: Between Dec 4, 2014, and Dec 4, 2016, 1410 patients were admitted to the hospital neurology service; 201 (14%) had symptoms consistent with arbovirus infection and sufficient samples for diagnostic testing and were included in the study. The median age was 48 years (IQR 34-60), and 106 (53%) were women. 148 (74%) of 201 patients had laboratory evidence of arboviral infection. 98 (49%) of them had a single viral infection (41 [20%] had Zika, 55 [27%] had chikungunya, and two [1%] had dengue infection), whereas 50 (25%) had evidence of dual infection, mostly with Zika and chikungunya viruses (46 [23%] patients). Patients positive for arbovirus infection presented with a broad range of CNS and peripheral nervous system (PNS) disease. Chikungunya infection was more often associated with CNS disease (26 [47%] of 55 patients with chikungunya infection vs six [15%] of 41 with Zika infection; p=0·0008), especially myelitis (12 [22%] patients). Zika infection was more often associated with PNS disease (26 [63%] of 41 patients with Zika infection vs nine [16%] of 55 with chikungunya infection; p≤0·0001), particularly Guillain-Barré syndrome (25 [61%] patients). Patients with Guillain-Barré syndrome who had Zika and chikungunya dual infection had more aggressive disease, requiring intensive care support and longer hospital stays, than those with mono-infection (median 24 days [IQR 20-30] vs 17 days [10-20]; p=0·0028). Eight (17%) of 46 patients with Zika and chikungunya dual infection had a stroke or transient ischaemic attack, compared with five (6%) of 96 patients with Zika or chikungunya mono-infection (p=0·047).
Interpretation: There is a wide and overlapping spectrum of neurological manifestations caused by Zika or chikungunya mono-infection and by dual infections. The possible increased risk of acute cerebrovascular disease in patients with dual infection merits further investigation.
Funding: Fundação do Amparo a Ciência e Tecnologia de Pernambuco (FACEPE), EU's Horizon 2020 research and innovation programme, National Institute for Health Research.
Translations: For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.
(Copyright © 2020 Elsevier Ltd. All rights reserved.)
التعليقات: Comment in: Lancet Neurol. 2020 Oct;19(10):799-801. (PMID: 32949531)
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معلومات مُعتمدة: R01 NS110122 United States NS NINDS NIH HHS; MC_PC_15101 United Kingdom MRC_ Medical Research Council; IS-HPU-1112-10117 United Kingdom DH_ Department of Health; MC_PC_15096 United Kingdom MRC_ Medical Research Council; WT 202789/Z/16/Z United Kingdom WT_ Wellcome Trust; 205228/Z/16/Z United Kingdom WT_ Wellcome Trust; United Kingdom WT_ Wellcome Trust
تواريخ الأحداث: Date Created: 20200919 Date Completed: 20200930 Latest Revision: 20240207
رمز التحديث: 20240207
مُعرف محوري في PubMed: PMC7494308
DOI: 10.1016/S1474-4422(20)30232-5
PMID: 32949543
قاعدة البيانات: MEDLINE
الوصف
تدمد:1474-4465
DOI:10.1016/S1474-4422(20)30232-5