Neurological evaluation in patients infected with Chikungunya virus: analysis of a cohort of Rio de Janeiro/Brazil

Abstract

Background: In addition to fever and typical joint pain caused by Chikungunya virus (CHIKV), demonstrations as meningoencephalitis, mielorradiculopathy, mieloneuropathy and myelitis, Guillain-Barre syndrome have been described. However, most of the neurological changes have been reported in the acute phase, there are few records in the chronic phase of the disease. Given this, the objectives is to describe in this study the main changes to the neurological examination in patients infected by CHIKV in the chronic phase of the disease. Methods & Materials: Neurological assessment of patients with diagnosis of CHIKV served in a reference center in Rio de Janeiro/Brazil between February and July 2017. Results: Twelve patients were evaluated, 10 women, 2 men. All patients evaluated were chronic phase of the disease, with no signs of acute infection. Changes found in the clinical examination: hipopalestesia by at least two members in 5 (41.6%) patients, and hypoesthesia (tactile, thermal and painful) in 5 (41.6%). 3 patients (25%) presented concomitance of the two amendments. 2 (16.6%) did not show any changes to the neurological examination. Only 1 patient developed neurological symptoms during the acute phase of the disease (paresthesia in the lower limbs). No patient presented any neurological symptoms during the evaluation. 3 (25%) were in use of metrotexate (10 mg/day) due to the severity of the joint pain, but did not provide different neurological changes. Rheumatologic tests (FAN, rheumatoid factor) were negative in all. One patient has diabetes and other Sjogren's syndrome-neurological deficits remained with the same sensitivity pattern in these two cases. All patients had diagnostic confirmation for CHIKV (serological evaluation); no other infectious disease was identified. The pain described by all patients was of origin nociceptive, not neuropathic (according to the application questionnaire for neuropathic pain DN4). Conclusion: Patients in acute and chronic phase of infection by CHIKV may have neurological changes, even without a specific manifestation. The commitment of superficial sensitivity was the dominant one in this sample evaluation; no central symptom was observed. The severity of the joint pain, the most important thing in these cases, has not been directly linked to neurological changes.