Zika Virus, Chikungunya Virus, and Dengue Virus in Cerebrospinal Fluid from Adults with Neurological Manifestations, Guayaquil, Ecuador.

Nathalie Acevedo,Benjamin Pinsky,Jesse Waggoner,Hector Zambrano,Lissette Rivera,José Landivar,Michelle Rodriguez

doi:10.3389/fmicb.2017.00042

Nathalie Acevedo, Benjamin Pinsky + Show 5 more

Open Access

https://doi.org/10.3389/fmicb.2017.00042

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Abstract

Zika virus (ZIKV), chikungunya virus (CHIKV), and dengue virus (DENV) have been associated with clinical presentations that involve acute neurological complaints. In the current study, we identified ZIKV, CHIKV, and DENV in cerebrospinal fluid (CSF) samples from patients admitted to the Hospital Luis Vernaza (Guayaquil, Ecuador) to the Emergency Room or the Intensive Care Unit, with neurological symptoms and/or concern for acute arboviral infections. Viral RNA from one or more virus was detected in 12/16 patients. Six patients were diagnosed with meningitis or encephalitis, three with Guillain–Barré Syndrome, and one with CNS vasculitis. Two additional patients had a systemic febrile illness including headache that prompted testing of CSF. Two patients, who were diagnosed with encephalitis and meningoencephalitis, died during their hospitalizations. These cases demonstrate the breadth and significance of neurological manifestations associated with ZIKV, CHIKV, and DENV infections.

Highlights

Zika virus (ZIKV) is an arthropod-borne virus of the genus Flavivirus that is transmitted by the same mosquito vectors as chikungunya virus (CHIKV) and dengue virus (DENV; Waggoner and Pinsky, 2016)
Testing for ZIKV diagnosis (Cao-Lormeau et al, 2016; Dos Santos et al, 2016). This may be due to difficulties in diagnosing acute ZIKV infections in adults, as detection of ZIKV in cerebrospinal fluid (CSF) has been infrequently reported (Parra et al, 2016; Rozé et al, 2016; Siu et al, 2016; Zambrano et al, 2016) and serologic testing may be difficult to interpret in DENV endemic regions (Waggoner and Pinsky, 2016)
While the neurological complications of ZIKV infection have been the cause of much concern during this outbreak, less attention has been paid to the neurological manifestations associated with acute or recent CHIKV and/or DENV infections (Solomon et al, 2000; Gerardin et al, 2016)

Summary

Introduction

Zika virus (ZIKV) is an arthropod-borne virus (arbovirus) of the genus Flavivirus (family Flaviviridae) that is transmitted by the same mosquito vectors as chikungunya virus (CHIKV) and dengue virus (DENV; Waggoner and Pinsky, 2016). Arbovirus Detection in CSF testing for ZIKV diagnosis (Cao-Lormeau et al, 2016; Dos Santos et al, 2016) This may be due to difficulties in diagnosing acute ZIKV infections in adults, as detection of ZIKV in CSF has been infrequently reported (Parra et al, 2016; Rozé et al, 2016; Siu et al, 2016; Zambrano et al, 2016) and serologic testing may be difficult to interpret in DENV endemic regions (Waggoner and Pinsky, 2016). Co-infections between these viruses may be common in certain settings (Villamil-Gomez et al, 2016; Waggoner et al, 2016b; Zambrano et al, 2016), and the detection of co-infections in cases of CNS disease has not been well described (Zambrano et al, 2016)

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