Chikungunya Encephalitis Research Articles

Chikungunya Encephalitis as the Hidden Face of a Known Foe

Chikungunya Encephalitis as the Hidden Face of a Known Foe

Chikungunya Encephalitis Presenting as Rhombencephalitis.

Chikungunya Encephalitis Presenting as Rhombencephalitis.

Magnetic Resonance Imaging Brain Findings in Chikungunya Virus (CHIKV) Infection with Neurological Complication during Epidemic Outbreak.

The Chikungunya virus is an alphavirus RNA of the family Togaviridae transmitted by the Aedes mosquito. We aim to report magnetic resonance imaging (MRI) brain findings for neurological complications at our institute during epidemic outbreak. A total of 43 seropositive cases of Chikungunya infection underwent MRI brain. Out of 43 patients, 27 (63%) had discrete and confluent supra-tentorial T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) hyper-intense white matter foci. A total of 14 patients (33%) showed multiple foci/areas of diffusion restriction, and four of these patients had infra-tentorial T2 & FLAIR hyper-intense foci with restricted diffusion. In three pediatric age group patients including two neonates, the pattern of involvement was diffuse white matter changes with restricted diffusion. In 30% cases, MRI was normal. Detection of focal or confluent white matter hyper-intense foci with restricted diffusion on MRI in patients presenting with fever and neurological symptoms has potential to conclude the diagnosis of Chikungunya encephalitis, especially in epidemic settings.

Prevalence of Neuroleptospirosis in Pediatric Acute Encephalitis Syndrome Cases: An Experience of Northern India Tertiary Care Centre

Background: Acute encephalitis syndrome (AES) is a serious public health problem in Northern India.Neuroleptospirosis presenting as AES is well documented, so this study was planned to know thecontribution of Neuroleptospirosis in AES, in children. Another gap in leptospirosis research is lack ofstudies on confirmed cases in children.Aims: The aim of this study was to look for contribution of Neuroleptospirosis in Pediatric AESpatients, in this part of the country.Method: All children with AES-like presentations were included. Detailed history, clinical examinationand appropriate lab investigations were done, to look for the cause of illness. For diagnosis ofLeptospirosis, IgM, polymerase chain reaction (PCR), and Microscopic Agglutination Test (MAT)Leptospira was done.Results: Among 100 AES children, 3 were diagnosed as neuroleptospirosis, the rest were 16 Scrubtyphus meningoencephalitis, 20 Japanese, 14 dengue, 2 herpes, and 1 case of chikungunya encephalitis.44 cases remain undifferentiated. Mean age at presentation for non-leptospirosis AES (NLAES)and Neuroleptospirosis was 75.4 & 96 months, 43% of NLAES were between 2-5 years while allneuroleptospirosis cases were older (> 8 years age). All neuroleptospirosis cases were, from a ruralbackground, presented in rainy / post rainy season and fulfilled Modified Faine’s criteria. BetterGlasgow coma scale score, absence of seizure & focal neurological deficit, hypertonia among clinicalfindings, and high serum bilirubin, liver enzymes, and creatinine were other important observations,though only high serum bilirubin was statistically significant.Conclusions: Neuroleptospirosis is uncommon but important treatable etiology for AES in childrenand should always be considered in differential while evaluating a child with AES.

Cerebral visual impairment secondary to chikungunya encephalitis – A case report

Cerebral visual impairment is a significant cause of visual impairment in children in developing countries. It has varied etiologies. In this report, we describe the evaluation and management of a 1-year-old child with visual impairment due to neonatal chikungunya encephalitis.

Chikungunya encephalitis, a case series from an endemic country

BackgroundThe Chikungunya Virus (CHIKV) was introduced into Honduras in 2015. Since then the WHO has reported more than 14,000 suspected cases in the country. Objective: To describe the clinical, laboratory, neuroimaging, and pathological features of CHIKV encephalitis. Patients and methodsWe evaluated all consecutive cases of CHIKV infection meeting encephalitis criteria at Hospital Escuela Universitario at Tegucigalpa, Honduras, during 2015. Who case definition was used: patient with neurological manifestations meeting clinical criteria (fever >38.5 °C, joint pain); resident/visitor in the last 15 days to an endemic area; laboratory confirmation with IgM/ELISA. Other etiologies were excluded by ancillary studies. ResultsOut of 95 cases with suspected CHIKV infection, 7 (7%) cases with CHIKV encephalitis were identified; mean age was 56 years and four were men. The mean latency from onset of symptoms to diagnosis was 5 five days. Clinical manifestations were: fever/arthralgia, headache/alteration of consciousness and status epilepticus. The EEG demonstrated slow background activity and generalized epileptiform discharges in three patients. Brain MRI showed bilateral white matter hyperintensities and one with focal encephalitis; CSF analysis demonstrated lymphocytic pleocytosis and hyperproteinorrachia. Two patients died. Postmortem brain examination of one patient revealed lymphocytic infiltrates with focal necrosis in hippocampus, frontal lobes and medulla oblongata. ConclusionsNeurological complications of CHIKV are infrequent, but may be severe. In this case series, the neurological manifestation was encephalitis. Predominant symptoms and signs were fever, behavioral abnormalities, headache and seizures. Because of the potential morbidity and mortality of CHIKV encephalitis, these patients should be admitted to hospital urgently.

Prevalence, Risk Factors, and Outcome of Chikungunya Encephalitis in Hospitalized Patients at a Tertiary Care Center in Gujarat, India, During the 2016 Outbreak

Background India has experienced 2 major chikungunya viral (CHIKV) fever outbreaks over the last decade, with reportedly higher mortality during the 2006 outbreak. Methods This was a retrospective observational study conducted at a tertiary care center over a period of 4 months involving 110 hospitalized patients confirmed with CHIKV fever during the 2016 outbreak. Data on the proportion of patients with CHIK viral encephalitis (CHIK VE) and possible attributable risk factors were obtained from a retrospective chart review and data analysis using SPSS. Results Of 110 patients with confirmed CHIKV fever, 16 (14.6%) developed CHIK VE; 62.5% of the hospitalized patients with CHIK VE were older than 60 years. Patients with CHIK VE presented late to the hospital (4.9 ± 2.7 vs 2.9 ± 1.5, respectively, P = 0.00031) as opposed to those without encephalitis; 87.5% patients in the CHIK VE group required intensive care unit admission and had a prolonged hospital stay (9.2 ± 6.7 days vs 5.1 ± 4.2 days; odds ratio, 0.034; P = 0.001) compared with those in the nonencephalitis group. Patients in the extreme age groups were more vulnerable to CHIK VE compared with adults aged between 30 and 60 years, without a statistically significant difference. There was no statistically significant difference in the mean absolute lymphocyte count, globulin levels, total leukocyte counts, and underlying comorbidities between the 2 groups. Overall mortality with CHIK VE was 18.75%. Conclusions Large-scale studies are needed to validate the association of CHIK VE patients with probable risk factors, as it is associated with high mortality, based on the findings of the present study.

Clinical outcome of Chikungunya encephalitis in children from South India

Introduction: Acute encephalitis syndrome (AES) is defined by WHO as a person of any age, at any time of year with acute onset of fever and a change in mental status and/or new onset of seizures. The etiology varies with age, geographic area and vaccination coverage. Viruses have been implicated as the commonest cause in children and with the outbreak of viral hemorrhagic fevers, Dengue and Chikungunya encephalitis have emerged as important causes of encephalitis all over the world.