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Hopkins HK, Traverse EM, Barr KL. Viral Parkinsonism: An underdiagnosed neurological complication of Dengue virus infection. PLoS Negl Trop Dis 2022; 16:e0010118. [PMID: 35139081 PMCID: PMC8827468 DOI: 10.1371/journal.pntd.0010118] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
Dengue virus (DENV) is a flavivirus that is a significant cause of human disease costing billions of dollars per year in medical and mosquito control costs. It is estimated that up to 20% of DENV infections affect the brain. Incidence of DENV infections is increasing, which suggests more people are at risk of developing neurological complications. The most common neurological manifestations of DENV are encephalitis and encephalopathy, and movement disorders such as parkinsonism have been observed. Parkinsonism describes syndromes similar to Parkinson’s Disease where tremors, stiffness, and slow movements are observed. Parkinsonism caused by viral infection is characterized by patients exhibiting at least two of the following symptoms: tremor, bradykinesia, rigidity, and postural instability. To investigate DENV-associated parkinsonism, case studies and reports of DENV-associated parkinsonism were obtained from peer-reviewed manuscripts and gray literature. Seven reports of clinically diagnosed DENV-associated parkinsonism and 15 cases of DENV encephalitis, where the patient met the case criteria for a diagnosis of viral parkinsonism were found. Clinically diagnosed DENV-associated parkinsonism patients were more likely to be male and exhibit expressionless face, speech problems, and lymphocytosis. Suspected patients were more likely to exhibit tremor, have thrombocytopenia and low hemoglobin. Viral parkinsonism can cause a permanent reduction in neurons with consequential cognitive and behavior changes, or it can leave a latent imprint in the brain that can cause neurological dysfunction decades after recovery. DENV-associated parkinsonism is underdiagnosed and better adherence to the case definition of viral parkinsonism is needed for proper management of potential sequalae especially if the patient has an ongoing or potential to develop a neurodegenerative disease. Dengue Virus (DENV) causes generalized fever in most patients and is transmitted via Aedes aegypti mosquitos. A small proportion of DENV infected patients have neurological complications associated with the critical phase of the illness. The usual neurological manifestations are encephalitis and encephalopathy, but there can also be movement disorders such as parkinsonism. DENV patients with parkinsonism present with tremor, bradykinesia, instability, and rigidity on top of the typical febrile manifestations of the disease. We searched the literature and uncovered 7 cases of clinically diagnosed DENV parkinsonism patients and 15 cases of suspected DENV parkinsonism. We found that the clinically diagnosed patients were more likely to be male, have expressionless face, speech issues and lymphocytosis. The suspected cases often had a diagnosis of encephalitis and were more likely to have tremors, thrombocytopenia, and low hemoglobin.
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Affiliation(s)
- Hannah K. Hopkins
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, Florida, United States of America
| | - Elizabeth M. Traverse
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, Florida, United States of America
| | - Kelli L. Barr
- Center for Global Health and Infectious Disease Research, University of South Florida, Tampa, Florida, United States of America
- * E-mail:
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Kumar SS, Baitha U, Vyas S. An unusual case of acute motor axonal neuropathy (AMAN) complicating dengue fever. Drug Discov Ther 2021; 15:214-217. [PMID: 34471003 DOI: 10.5582/ddt.2021.01063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neurological complications are increasingly being reported in dengue fever, and the dengue virus is now recognized as a neurotrophic virus. The damage caused by inflammatory cytokines in the febrile phase and molecular mimicry in the recovery phase is responsible for these neurological manifestations. We report such an unusual neurological complication occurring in a 27-year-old female in the recovery phase of dengue fever, who developed an acute onset of ascending symmetric weakness of all four limbs without any sensory, autonomic, cerebellar, or cranial nerve involvement. She was diagnosed as having an acute motor axonal neuropathy (AMAN) variant of Guillain-Barre syndrome (GBS) based on a nerve conduction study (NCS) showing axonal neuropathy and contrast-enhanced magnetic resonance imaging (CE-MRI) showing root enhancement at the region of the cauda equina. She was treated with intravenous immunoglobulin (IVIG) and showed full recovery from symptoms with treatment. Our case highlights the importance of being aware of such rare neurological complications in dengue fever. Early detection and rapid initiation of treatment can lead to the complete reversal of neurological deficits.
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Affiliation(s)
- Swasthi S Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Viral and Prion Infections Associated with Central Nervous System Syndromes in Brazil. Viruses 2021; 13:v13071370. [PMID: 34372576 PMCID: PMC8310075 DOI: 10.3390/v13071370] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022] Open
Abstract
Virus-induced infections of the central nervous system (CNS) are among the most serious problems in public health and can be associated with high rates of morbidity and mortality, mainly in low- and middle-income countries, where these manifestations have been neglected. Typically, herpes simplex virus 1 and 2, varicella-zoster, and enterovirus are responsible for a high number of cases in immunocompetent hosts, whereas other herpesviruses (for example, cytomegalovirus) are the most common in immunocompromised individuals. Arboviruses have also been associated with outbreaks with a high burden of neurological disorders, such as the Zika virus epidemic in Brazil. There is a current lack of understanding in Brazil about the most common viruses involved in CNS infections. In this review, we briefly summarize the most recent studies and findings associated with the CNS, in addition to epidemiological data that provide extensive information on the circulation and diversity of the most common neuro-invasive viruses in Brazil. We also highlight important aspects of the prion-associated diseases. This review provides readers with better knowledge of virus-associated CNS infections. A deeper understanding of these infections will support the improvement of the current surveillance strategies to allow the timely monitoring of the emergence/re-emergence of neurotropic viruses.
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Estofolete CF, Milhim BHGA, Zini N, Scamardi SN, Selvante JD, Vasilakis N, Nogueira ML. Flavivirus Infection Associated with Cerebrovascular Events. Viruses 2020; 12:v12060671. [PMID: 32580374 PMCID: PMC7354470 DOI: 10.3390/v12060671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022] Open
Abstract
Arthropod-borne viruses (arboviruses) of the genus Flavivirus are distributed globally and cause significant human disease and mortality annually. Flavivirus infections present a spectrum of clinical manifestations, ranging from asymptomatic to severe manifestations, including hemorrhage, encephalitis and death. Herein, we describe 3 case reports of cerebrovascular involvement in patients infected by dengue and Zika viruses in Sao Jose do Rio Preto, São Paulo State, Brazil, a hyperendemic area for arbovirus circulation, including dengue, yellow fever, chikungunya and Saint Louis encephalitis viruses. Our findings highlight the potential threat that unusual clinical manifestations may pose to arbovirus disease management and recovery.
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Affiliation(s)
- Cássia F Estofolete
- Department of Infectious, Dermatological and Parasitic Infections, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto 15090-000, Brazil
| | - Bruno H G A Milhim
- Department of Infectious, Dermatological and Parasitic Infections, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto 15090-000, Brazil
| | - Nathalia Zini
- Department of Infectious, Dermatological and Parasitic Infections, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto 15090-000, Brazil
| | - Samuel N Scamardi
- Department of Infectious, Dermatological and Parasitic Infections, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto 15090-000, Brazil
| | - Joana D'Arc Selvante
- Department of Infectious, Dermatological and Parasitic Infections, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto 15090-000, Brazil
| | - Nikos Vasilakis
- Department of Pathology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0609, USA
- Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0609, USA
- Center for Tropical Diseases, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0609, USA
- Institute for Human Infection and Immunity, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0610, USA
| | - Maurício L Nogueira
- Department of Infectious, Dermatological and Parasitic Infections, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto 15090-000, Brazil
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Herbuela VRDM, de Guzman FS, Sobrepeña GD, Claudio ABF, Tomas ACV, Arriola-Delos Reyes CM, Regalado RA, Teodoro MM, Watanabe K. Depressive and Anxiety Symptoms among Pediatric In-Patients with Dengue Fever: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010099. [PMID: 31877808 PMCID: PMC6981716 DOI: 10.3390/ijerph17010099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Psychiatric symptoms have been reported in adult patients with dengue fever (DF); however, information on pediatric patients remains inadequate. We sought to identify the prevalence and predictors of depressive and anxiety symptoms and identify other psychiatric symptoms among pediatric patients with DF. This case-control study involved pediatric in-patients (n = 225) who had clinical or serologic-confirmed DF and healthy school-based controls (n = 260). Participants completed the Revised Child Anxiety and Depression Scale (RCADS). RESULTS The prevalence of depressive (13.3%) and anxiety (34.2%) symptoms among pediatric patients with DF was significantly (p < 0.001) higher than that among controls (3.5% and 16.2%, respectively). Multiple linear regression analysis found that age, family history of DF, ≤2 days of hospitalization, myalgia, and arthralgia were predictors of increased depressive and anxiety symptoms among the patients. Further, 26.7% of pediatric patients reported irritability, agitation, visual hallucinations, and aggressiveness. CONCLUSION Pediatric patients present depressive and anxiety symptoms whose levels were associated with social and clinical factors. However, whether these symptoms are present only during the infection or may still persist after recovery or are brought by children's adverse reactions to hospitalization are unknown, and thus, further studies are needed.
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Affiliation(s)
- Von Ralph Dane M Herbuela
- Graduate School of Science and Engineering, Ehime University, Bunkyo-cho 3, Matsuyama 790-8577, Japan
| | - Ferdinand S de Guzman
- Department of Family and Community Medicine, Infectious Diseases and Tropical Medicine, San Lazaro Hospital, Manila 1003, Philippines
| | - Girly D Sobrepeña
- Pediatrics Department, Quezon City General Hospital, Quezon City 1106, Philippines
| | | | - Angelica Cecilia V Tomas
- Department of Pediatrics, College of Medicine, University of the Philippines, Manila 1000, Philippines
| | | | - Rachele A Regalado
- Guidance Department, University of Santo Tomas-Angelicum College, Quezon City 1114, Philippines
| | - Mariama M Teodoro
- Counseling and Educational Psychology Department, De La Salle University, Manila 1004, Philippines
| | - Kozo Watanabe
- Graduate School of Science and Engineering, Ehime University, Bunkyo-cho 3, Matsuyama 790-8577, Japan
- Biological Control Research Unit, Center for Natural Science and Environmental Research, De La Salle University, Manila 1004, Philippines
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Borrelli S, Sinzobahamvya E, Smetcoren C, Van Den Broucke S, Gille M. Post-dengue sacral radiculitis presenting as a cauda equina syndrome: a case report. Acta Neurol Belg 2019; 119:127-128. [PMID: 28444632 DOI: 10.1007/s13760-017-0784-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Serena Borrelli
- Department of Neurology, Europa Hospitals, 206 Avenue de Fré, 1180, Brussels, Belgium
| | | | - Charlotte Smetcoren
- Department of Neurology, Europa Hospitals, 206 Avenue de Fré, 1180, Brussels, Belgium
| | | | - Michel Gille
- Department of Neurology, Europa Hospitals, 206 Avenue de Fré, 1180, Brussels, Belgium.
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Li GH, Ning ZJ, Liu YM, Li XH. Neurological Manifestations of Dengue Infection. Front Cell Infect Microbiol 2017; 7:449. [PMID: 29119088 PMCID: PMC5660970 DOI: 10.3389/fcimb.2017.00449] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/04/2017] [Indexed: 12/20/2022] Open
Abstract
Dengue counts among the most commonly encountered arboviral diseases, representing the fastest spreading tropical illness in the world. It is prevalent in 128 countries, and each year >2.5 billion people are at risk of dengue virus infection worldwide. Neurological signs of dengue infection are increasingly reported. In this review, the main neurological complications of dengue virus infection, such as central nervous system (CNS), peripheral nervous system, and ophthalmic complications were discussed according to clinical features, treatment and possible pathogenesis. In addition, neurological complications in children were assessed due to their atypical clinical features. Finally, dengue infection and Japanese encephalitis were compared for pathogenesis and main clinical manifestations.
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Affiliation(s)
- Guo-Hong Li
- Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Zhi-Jie Ning
- Jinan Infectious Diseases Hospital, Jinan, China
| | - Yi-Ming Liu
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiao-Hong Li
- Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
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Watrin L, Ghawché F, Larre P, Neau JP, Mathis S, Fournier E. Guillain-Barré Syndrome (42 Cases) Occurring During a Zika Virus Outbreak in French Polynesia. Medicine (Baltimore) 2016; 95:e3257. [PMID: 27057874 PMCID: PMC4998790 DOI: 10.1097/md.0000000000003257] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 12/14/2022] Open
Abstract
Zika virus (transmitted by mosquitoes) reached French Polynesia for the first time in 2013, leading to an epidemic affecting 10% of the total population. So far, it has not been known to induce any neurological complications, but, a few weeks after the outbreak, an unexpectedly high number of 42 patients presented with Guillain-Barré syndrome.We report the clinical and electrophysiological characteristics of this series. Males predominated with a sex ratio of 2.82 (mean age: 46). All patients (except 2) were native Polynesian. At admission, 55% were able to walk unaided against 38% at nadir, 24% had swallowing troubles (nadir: 45%), 74% had motor weakness of the limbs (nadir: 86%) and deep tendon reflexes were diminished or not found in the vast majority of patients. Mean duration of the progressive phase and of the plateau phase was respectively 7 and 9 days. Thirty-eight percent of the patients were admitted in intensive care unit and 10 patients underwent tracheotomy. Nerve electrophysiological studies at admission showed marked distal motor conduction alterations, which had almost completely disappeared at the 4th month; this pattern was more suggestive of acute motor axonal neuropathy (AMAN) than of acute inflammatory demyelinating polyneuropathy (AIDP). Lumbar puncture showed elevated proteins in 90% of the cases, with cell count always inferior to 50/μL.This epidemic raises several questions, such as the potential existence of interactions between Zika virus and Polynesian HLA system and/or the consequences of several recombination events of this virus. This situation should call for increased vigilance, especially in countries where Aedes mosquitoes are present.
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Affiliation(s)
- Louise Watrin
- From the Department of Neurology (LW, J-PN, SM), Poitiers University Hospital Center, Poitiers, France; Department of Neurology (FG, PL), French Polynesia Hospital Center, Papeete, Tahiti, French Polynesia; and Department of Clinical Neurophysiology (EF), La Pitié-Salpêtrière University Hospital Center, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Bd de l'Hôpital, Paris cedex, France
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Simon O, Billot S, Guyon D, Daures M, Descloux E, Gourinat AC, Molko N, Dupont-Rouzeyrol M. Early Guillain-Barré Syndrome associated with acute dengue fever. J Clin Virol 2016; 77:29-31. [PMID: 26895226 DOI: 10.1016/j.jcv.2016.01.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/16/2015] [Accepted: 01/29/2016] [Indexed: 12/25/2022]
Abstract
Various forms of neurological manifestations are reported in dengue fever. We describe here three cases of concomitant Guillain-Barré syndrome and dengue virus (DENV) infection during the largest DENV-1 outbreak in New Caledonia. Research of viral RNA was positive in both blood and CSF samples. All patients were treated with intravenous polyvalent immunoglobulins and recovered without sequelae within one week.
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Affiliation(s)
- O Simon
- Department of Neurology, Territorial Hospital, Noumea, New Caledonia.
| | - S Billot
- Department of Neurology, Territorial Hospital, Noumea, New Caledonia
| | - D Guyon
- Department of Neurology, Territorial Hospital, Noumea, New Caledonia
| | - M Daures
- New Caledonia Health Department, Noumea, New Caledonia
| | - E Descloux
- Department of Internal Medicine and Infectious Diseases, Territorial Hospital, Noumea, New Caledonia
| | - A C Gourinat
- Immuno-Serology and Molecular Biology Lab, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Noumea, New Caledonia
| | - N Molko
- Department of Neurology, Territorial Hospital, Noumea, New Caledonia
| | - M Dupont-Rouzeyrol
- Dengue and Arboviruses Expertise and Research Unit, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Noumea, New Caledonia
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