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da Costa VG, Saivish MV, Sinhorini PF, Nogueira ML, Rahal P. A meta-analysis of Chikungunya virus in neurological disorders. Infect Dis Now 2024; 54:104938. [PMID: 38885813 DOI: 10.1016/j.idnow.2024.104938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/17/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024]
Abstract
Chikungunya disease typically presents with the fever-arthralgia-rash symptom triad. However, an increase in the number of atypical clinical manifestations, particularly neurological disorders, has occurred. The current evidence regarding the pooled prevalence of Chikungunya virus (CHIKV)-associated neurological cases (CANCs) suspected of having an arboviral aetiology is not well-understood. Therefore, this meta-analysis included 19 studies (n = 7319 patients) and aimed to determine the pooled rate of exposure to CANC. The pooled positivity rate of CANC was 12 % (95 % CI: 6-19), and Brazil was overrepresented (11/19). These estimations varied between 3 and 14 % based on the diagnostic method (real-time PCR vs. ELISA-IgM) and biological samples (cerebrospinal fluid or blood specimens) used for detection of CHIKV. Regarding the frequency of CHIKV in neurological clinical subgroups, the rates were higher among patients with myelitis (27 %), acute disseminated encephalomyelitis (27 %), Guillain-Barré syndrome (15 %), encephalitis (12 %), and meningoencephalitis (7 %). Our analysis highlights the significant burden of CANC. However, the data must be interpreted with caution due to the heterogeneity of the results, which may be related to the location of the studies covering endemic periods and/or outbreaks of CHIKV. Current surveillance resources should also focus on better characterizing the epidemiology of CHIKV infection in neurological disorders. Additionally, future studies should investigate the interactions between CHIKV and neurological diseases with the aim of gaining deeper insight into the mechanisms underlying the cause-and-effect relationship between these two phenomena.
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Affiliation(s)
- Vivaldo G da Costa
- Laboratório de Estudos Genômicos, Departamento de Biologia, Instituto de Biociências Letras e Ciências Exatas, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), São José do Rio Preto 15054-000, SP, Brazil.
| | - Marielena V Saivish
- Laboratório de Pesquisas em Virologia, Departamento de Doenças Dermatológicas, Infecciosas e Parasitárias, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto 15090‑000, SP, Brazil; Laboratório Nacional de Biociências, Centro Nacional de Pesquisa em Energia e Materiais (CNPEM), Campinas 13083‑100, SP, Brazil
| | - Paola F Sinhorini
- Laboratório de Estudos Genômicos, Departamento de Biologia, Instituto de Biociências Letras e Ciências Exatas, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), São José do Rio Preto 15054-000, SP, Brazil
| | - Maurício L Nogueira
- Laboratório de Pesquisas em Virologia, Departamento de Doenças Dermatológicas, Infecciosas e Parasitárias, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto 15090‑000, SP, Brazil; Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555-0609, USA
| | - Paula Rahal
- Laboratório de Estudos Genômicos, Departamento de Biologia, Instituto de Biociências Letras e Ciências Exatas, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), São José do Rio Preto 15054-000, SP, Brazil.
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2
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Oliver GF, Ashander LM, Dawson AC, Ma Y, Carr JM, Williams KA, Smith JR. Dengue Virus Infection of Human Retinal Müller Glial Cells. Viruses 2023; 15:1410. [PMID: 37515098 PMCID: PMC10385653 DOI: 10.3390/v15071410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/17/2023] [Accepted: 06/18/2023] [Indexed: 07/30/2023] Open
Abstract
Retinopathy is a recently recognized complication of dengue, affecting up to 10% of hospitalized patients. Research on the pathogenesis has focused largely on effects of dengue virus (DENV) at the blood-retinal barrier. Involvement of retinal Müller glial cells has received little attention, although this cell population contributes to the pathology of other intraocular infections. The goal of our work was to establish the susceptibility of Müller cells to infection with DENV and to identify characteristics of the cellular antiviral, inflammatory, and immunomodulatory responses to DENV infection in vitro. Primary human Müller cell isolates and the MIO-M1 human Müller cell line were infected with the laboratory-adapted Mon601 strain and DENV serotype 1 and 2 field isolates, and cell-DENV interactions were investigated by immunolabelling and quantitative real-time polymerase chain reaction. Müller cells were susceptible to DENV infection, but experiments involving primary cell isolates indicated inter-individual variation. Viral infection induced an inflammatory response (including tumour necrosis factor-α, interleukin [IL]-1β, and IL-6) and an immunomodulatory response (including programmed death-ligand [PD-L]1 and PD-L2). The type I interferon response was muted in the Müller cell line compared to primary cell isolates. The highest infectivity and cell responses were observed in the laboratory-adapted strain, and overall, infectivity and cell responses were stronger in DENV2 strains. This work demonstrates that Müller cells mount an antiviral and immune response to DENV infection, and that this response varies across cell isolates and DENV strain. The research provides a direction for future efforts to understand the role of human retinal Müller glial cells in dengue retinopathy.
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Affiliation(s)
- Genevieve F Oliver
- Flinders Health and Medical Research Institute, and College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Liam M Ashander
- Flinders Health and Medical Research Institute, and College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Abby C Dawson
- Flinders Health and Medical Research Institute, and College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Yuefang Ma
- Flinders Health and Medical Research Institute, and College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Jillian M Carr
- Flinders Health and Medical Research Institute, and College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Keryn A Williams
- Flinders Health and Medical Research Institute, and College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Justine R Smith
- Flinders Health and Medical Research Institute, and College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
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3
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Absalan Y, Gholizadeh M, Choi HJ. Magnetized solvents: Characteristics and various applications. J Mol Liq 2021. [DOI: 10.1016/j.molliq.2021.116167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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4
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Chiang JO, Azevedo RS, Justino MCA, Matos HJ, Cabeça HLS, Silva SP, Henriques DF, Silva EVP, Andrade GSS, Vasconcelos PF, Martins LC, Azevedo RSS. Neurological disease caused by Oropouche virus in northern Brazil: should it be included in the scope of clinical neurological diseases? J Neurovirol 2021; 27:626-630. [PMID: 34115330 PMCID: PMC8458178 DOI: 10.1007/s13365-021-00987-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022]
Abstract
We describe two neurological cases of Oropouche virus infection in northern Brazil, where the virus is endemic but neglected as a pathogen. This study reiterates the necessity of developing protocols for diagnosing infections and training medical personnel to recognize the pathogenicity of Oropouche virus in neurological infections.
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Affiliation(s)
- Jannifer O Chiang
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ananindeua, Pará, Brazil.
| | - Rafael S Azevedo
- Institutional Program for Scientific Initiation Scholarships (PIBIC), Evandro Chagas Institute. Ananindeua, Pará, Brazil
| | - Maria C A Justino
- Department of Virology, Evandro Chagas Institute. Ananindeua, Pará, Brazil
| | - Haroldo J Matos
- Epidemiology Service, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | | | - Sandro P Silva
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Daniele F Henriques
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Eliana V P Silva
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | | | - Pedro Fc Vasconcelos
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Lívia C Martins
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Raimunda S S Azevedo
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ananindeua, Pará, Brazil
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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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Araújo LJTD, Gonzalez LL, Buss LF, Guerra JM, Gomez DS, Ferreira CSDS, Cirqueira CS, Ghillardi F, Witkin SS, Sabino EC. Surveillance of hemorrhagic fever and/or neuroinvasive disease: challenges of diagnosis. Rev Saude Publica 2021; 55:41. [PMID: 34190890 PMCID: PMC8225321 DOI: 10.11606/s1518-8787.2021055003068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/09/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the performance of post mortem laboratory analysis in identifying the causes of hemorrhagic fever and/or neuroinvasive disease in deaths by arbovirus infection. METHODS Retrospective cross-sectional study based on the differential analysis and final outcome obtained in patients whose samples underwent laboratory testing for arboviruses at the Pathology Center of the Adolfo Lutz Institute, in São Paulo, Brazil. RESULTS Of the 1355 adults clinically diagnosed with hemorrhagic fever and/or neuroinvasive disease, the most commonly attributed cause of death and the most common final outcome was dengue fever. Almost half of the samples tested negative on all laboratory tests conducted. CONCLUSION The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology. Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent. While part of our findings may be due to technical issues related to sample fixation, better information availability when making the initial diagnosis is crucial. Including molecular approaches might lead to a significant advancement in diagnostic accuracy.
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Affiliation(s)
| | | | - Lewis Fletcher Buss
- Universidade de São Paulo. Instituto de Medicina Tropical. São Paulo, SP, Brasil
| | - Juliana Mariotti Guerra
- Instituto Adolfo Lutz. Centro de Patologia. Núcleo de Patologia Quantitativa. São Paulo, SP, Brasil
| | | | | | - Cinthya Santos Cirqueira
- Instituto Adolfo Lutz. Centro de Patologia. Núcleo de Patologia Quantitativa. São Paulo, SP, Brasil
| | - Fábio Ghillardi
- Universidade de São Paulo. Instituto de Medicina Tropical. São Paulo, SP, Brasil
| | - Steven S Witkin
- Universidade de São Paulo. Instituto de Medicina Tropical. São Paulo, SP, Brasil.,Weill Cornell Medicine. Department of Obstetrics and Gynecology. New York, NY, USA
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de Almeida Oliveira Evangelista G, Carvalho RH, Menezes GS, Abreu YCD, Sardi SI, Campos GS. Meningoencephalitis associated with Zika virus and Chikungunya virus infection. Jpn J Infect Dis 2021; 74:584-586. [PMID: 33952765 DOI: 10.7883/yoken.jjid.2020.1000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Etiology of viral meningoencephalitis is frequently unidentified. Chikungunya virus (CHIKV) and Zika virus (ZIKV) have been known to affect the central nervous system, and should, therefore, be considered for diagnosis of meningoencephalitis since its outcome may be influenced by the etiologic agent, age and immunological condition of the patient. In this study we aimed to determine if CHIKV and ZIKV were the etiological agent of viral encephalitis in meningoencephalitis patients admitted to the main hospital of infectious disease in the city of Salvador, Brazil. From 1049 patients with neurological symptoms who were admitted to the hospital during the time of this study, 149 were enrolled and 20 (13.34%) tested positive for ZIKV (12%) or CHIKV (1.34%). No specific clinical manifestations were observed to be associated to the ZIKV or CHIKV infection. Determination of the etiology of meningitis' and encephalitis' causing agent is important for patient management and correct treatment.
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Affiliation(s)
| | - Rejane Hughes Carvalho
- Laboratory of Virology, Health Sciences Institute, Universidade Federal da Bahia, Brazil
| | | | - Yara Carvalho de Abreu
- Laboratory of Virology, Health Sciences Institute, Universidade Federal da Bahia, Brazil
| | - Silvia Ines Sardi
- Laboratory of Virology, Health Sciences Institute, Universidade Federal da Bahia, Brazil
| | - Gubio Soares Campos
- Laboratory of Virology, Health Sciences Institute, Universidade Federal da Bahia, Brazil
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Imbeloni AA, de Alcantara BN, Coutinho LN, de Azevedo Scalercio SRR, Carneiro LA, Oliveira KG, Filho AJM, de Brito Simith Durans D, da Silva WB, Nunes BTD, Casseb LMN, Chiang JO, de Carvalho CAM, Machado MB, Quaresma JAS, de Almeida Medeiros DB, da Costa Vasconcelos PF. Prenatal disorders and congenital Zika syndrome in squirrel monkeys. Sci Rep 2021; 11:2698. [PMID: 33514824 PMCID: PMC7846595 DOI: 10.1038/s41598-021-82028-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/06/2021] [Indexed: 12/31/2022] Open
Abstract
During the Zika virus (ZIKV) outbreak in Brazil (2015–2016), the clinical manifestations associated with its infection were complex and included miscarriage and congenital malformations, not previously described. In this study, we evaluated the prenatal conditions of pregnant female squirrel monkeys (Saimiri collinsi) infected during different gestational thirds (GTs) and assessed all clinical aspects, diagnostic imaging, viremia and the immune response. In our study, 75% of the infected animals in the 1st GT group had significant clinical manifestations, such as miscarriage and prolonged viremia associated with a late immune response. Consequently, their neonates showed fetal neuropathology, such as cerebral hemorrhage, lissencephaly or malformations of the brain grooves, ventriculomegaly, and craniofacial malformations. Thus, our study demonstrated the relevance of pregnant squirrel monkeys as a model for the study of ZIKV infection in neonates due to the broad clinical manifestations presented, including the typical congenital Zika syndrome manifestations described in humans.
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Affiliation(s)
- Aline Amaral Imbeloni
- National Primate Center, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil.,Post-Graduate Program in Virology, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil
| | | | | | | | - Liliane Almeida Carneiro
- National Primate Center, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil
| | - Karol Guimarães Oliveira
- National Primate Center, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil
| | - Arnaldo Jorge Martins Filho
- Department of Pathology, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil
| | - Darlene de Brito Simith Durans
- Department of Arbovirology and Hemorrhagic Fever, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil
| | | | - Bruno Tardelli Diniz Nunes
- Department of Arbovirology and Hemorrhagic Fever, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil
| | - Livia Medeiros Neves Casseb
- Department of Arbovirology and Hemorrhagic Fever, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil
| | - Jannifer Oliveira Chiang
- Department of Arbovirology and Hemorrhagic Fever, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil
| | | | - Mariana Borges Machado
- University Center of Para, Governador Jose Malcher Avenue, 485, Belem, Para, 66035-065, Brazil
| | - Juarez Antônio Simões Quaresma
- Department of Pathology, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil.,University of Pará State, Tv. Perebebuí-Marco, 2623, Belém, Para State, 66087-662, Brazil
| | - Daniele Barbosa de Almeida Medeiros
- Post-Graduate Program in Virology, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil. .,Department of Arbovirology and Hemorrhagic Fever, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil.
| | - Pedro Fernando da Costa Vasconcelos
- Post-Graduate Program in Virology, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil. .,Department of Arbovirology and Hemorrhagic Fever, Evandro Chagas Institute, Rodovia BR-316, km-07, Ananindeua, Para, 67030-000, Brazil. .,University of Pará State, Tv. Perebebuí-Marco, 2623, Belém, Para State, 66087-662, Brazil.
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Lima ECBD, Montarroyos UR, Magalhães JJFD, Dimech GS, Lacerda HR. Survival analysis in non-congenital neurological disorders related to dengue, chikungunya and Zika virus infections in Northeast Brazil. Rev Inst Med Trop Sao Paulo 2020; 62:e69. [PMID: 33027393 PMCID: PMC7534407 DOI: 10.1590/s1678-9946202062069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022] Open
Abstract
The Northeast of Brazil has experienced a triple epidemic, with the simultaneous circulation of dengue virus (DENV), chikungunya virus (CHIKV) and Zika virus (ZIKV), which may have contributed to the observed increase across this region of atypical forms of disease and deaths. In view of this fact, non-congenital neurological disorders related to arboviruses were compared with other etiologies, mortality and survival rates of patients admitted to referral neurology hospitals in Pernambuco State, Northeast Brazil, from 2015 to 2018. Blood and cerebrospinal fluid samples were collected and tested using molecular and serological assays. The arbovirus-exposed groups were compared with respect to epidemiological, clinical and neurologic characteristics by using the Pearson’s chi-square test. For the survival analysis, the Kaplan-Meier and Hazard Ratio (HR) tests were used, with a 95% confidence interval (CI). Encephalitis and encephalomyelitis were more frequent in arboviruses, while myelitis predominated in the neurological disorders of other etiologies. Guillain-Barré Syndrome (GBS) was similarly distributed amongst the groups. Exposure to one of the arboviruses caused a six-fold increase in the risk of death (HR: 6.37; CI: 2.91 - 13.9). Amongst the arbovirus-exposed groups, infection (DENV/CHIKV) increased nine times the risk of death (HR: 9.07; CI: 3.67 - 22.4). The survival curve indicates that have been exposed to some arbovirus decreased the likelihood of survival compared to those with other etiologies (Log-Rank: p<0.001). Within this scenario, neurologic manifestations of DENV, CHIKV and ZIKV have the potential to increase mortality and decrease survival, and concomitant infection (DENV/CHIKV) is an aggravating factor in reducing the likelihood of survival when compared to monoinfections.
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Affiliation(s)
| | | | | | - George Santiago Dimech
- Secretaria de Saúde do Estado de Pernambuco, Departamento de Vigilância Epidemiológica, Recife, Pernambuco, Brazil
| | - Heloísa Ramos Lacerda
- Universidade Federal de Pernambuco, Departamento de Medicina Clínica, Recife, Pernambuco, Brazil
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Abstract
Alphaviruses, members of the enveloped, positive-sense, single-stranded RNA Togaviridae family, represent a reemerging public health threat as mosquito vectors expand into new geographic territories. The Old World alphaviruses, which include chikungunya virus, Ross River virus, and Sindbis virus, tend to cause a clinical syndrome characterized by fever, rash, and arthritis, whereas the New World alphaviruses, which consist of Venezuelan equine encephalitis virus, eastern equine encephalitis virus, and western equine encephalitis virus, induce encephalomyelitis. Following recovery from the acute phase of infection, many patients are left with debilitating persistent joint and neurological complications that can last for years. Clues from human cases and studies using animal models strongly suggest that much of the disease and pathology induced by alphavirus infection, particularly atypical and chronic manifestations, is mediated by the immune system rather than directly by the virus. This review discusses the current understanding of the immunopathogenesis of the arthritogenic and neurotropic alphaviruses accumulated through both natural infection of humans and experimental infection of animals, particularly mice. As treatment following alphavirus infection is currently limited to supportive care, understanding the contribution of the immune system to the disease process is critical to developing safe and effective therapies.
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Affiliation(s)
- Victoria K Baxter
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mark T Heise
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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11
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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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12
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Hameed S, Memon M, Imtiaz H, Kanwar D. Longitudinally extensive transverse myelitis with seropositive chikungunya. BMJ Case Rep 2019; 12:12/10/e231745. [PMID: 31604723 DOI: 10.1136/bcr-2019-231745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chikungunya viral (CHIKV) fever is often a self-limiting febrile illness associated with severe debilitating arthralgia. Neurological complications associated with CHIKV, although rare, have been reported in literature; however, longitudinally extensive transverse myelitis (LTEM) is rarely associated with it. We present a case of a middle-aged man with a 1-week history of low-grade fever and arthralgia followed by urinary retention and quadriplegia. A sensory level was noted at T2. On subsequent investigations, he was diagnosed with LETM. Although LETM is commonly seen in patients with neuromyelitis optica, the other possible etiologies are inflammatory and parainfectious. To date, only two cases of LETM are reported worldwide in association with CHIKV fever and this is the first case from Pakistan. With frequent chikungunya outbreaks, neurological complications are increasingly seen in clinical practice. The knowledge of these associations will result in their early diagnosis and treatment.
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Affiliation(s)
- Sajid Hameed
- Neurology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Mubashar Memon
- Neurology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Hina Imtiaz
- Neurology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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Counotte MJ, Meili KW, Taghavi K, Calvet G, Sejvar J, Low N. Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: A living systematic review. F1000Res 2019; 8:1433. [PMID: 31754425 PMCID: PMC6852328 DOI: 10.12688/f1000research.19918.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 01/10/2023] Open
Abstract
Background: The Zika virus (ZIKV) caused a large outbreak in the Americas leading to the declaration of a Public Health Emergency of International Concern in February 2016. A causal relation between infection and adverse congenital outcomes such as microcephaly was declared by the World Health Organization (WHO) informed by a systematic review structured according to a framework of ten dimensions of causality, based on the work of Bradford Hill. Subsequently, the evidence has continued to accumulate, which we incorporate in regular updates of the original work, rendering it a living systematic review. Methods: We present an update of our living systematic review on the causal relation between ZIKV infection and adverse congenital outcomes and between ZIKV and GBS for four dimensions of causality: strength of association, dose-response, specificity, and consistency. We assess the evidence published between January 18, 2017 and July 1, 2019. Results: We found that the strength of association between ZIKV infection and adverse outcomes from case-control studies differs according to whether exposure to ZIKV is assessed in the mother (OR 3.8, 95% CI: 1.7-8.7, I
2=19.8%) or the foetus/infant (OR 37.4, 95% CI: 11.0-127.1, I
2=0%). In cohort studies, the risk of congenital abnormalities was 3.5 times higher after ZIKV infection (95% CI: 0.9-13.5, I
2=0%). The strength of association between ZIKV infection and GBS was higher in studies that enrolled controls from hospital (OR: 55.8, 95% CI: 17.2-181.7, I
2=0%) than in studies that enrolled controls at random from the same community or household (OR: 2.0, 95% CI: 0.8-5.4, I
2=74.6%). In case-control studies, selection of controls from hospitals could have biased results. Conclusions: The conclusions that ZIKV infection causes adverse congenital outcomes and GBS are reinforced with the evidence published between January 18, 2017 and July 1, 2019.
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Affiliation(s)
| | - Kaspar Walter Meili
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
| | - Katayoun Taghavi
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
| | - Guilherme Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - James Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicola Low
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
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Mustafá YM, Meuren LM, Coelho SVA, de Arruda LB. Pathways Exploited by Flaviviruses to Counteract the Blood-Brain Barrier and Invade the Central Nervous System. Front Microbiol 2019; 10:525. [PMID: 30984122 PMCID: PMC6447710 DOI: 10.3389/fmicb.2019.00525] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/28/2019] [Indexed: 12/27/2022] Open
Abstract
Human infection by different flaviviruses may cause severe neurologic syndromes, through pathogenic mechanisms that are still largely unknown. Japanese encephalitis virus (JEV), West Nile virus (WNV), Zika virus (ZIKV), yellow fever virus (YFV), dengue virus (DENV), and tick-borne encephalitis virus (TBEV) are believed to reach the central nervous system by a hematogenous route, upon crossing the blood-brain barrier. Although the disruption of BBB during flavivirus infection has been largely evidenced in experimental models, the relevance of BBB breakdown for virus entering the brain was not completely elucidated. In vitro models of BBB had demonstrated that these viruses replicated in brain microvascular endothelial cells (BMECs), which induced downregulation of tight junction proteins and increased the permeability of the barrier. Other reports demonstrated that infection of BMECs allowed the basolateral release of infectious particles, without a remarkable cytopathic effect, what might be sufficient for virus invasion. Virus replication and activation of other cells associated to the BBB, mostly astrocytes and microglia, were also reported to affect the endothelial barrier permeability. This event might occur simultaneously or after BMECs infection, being a secondary effect leading to BBB disruption. Importantly, activation of BMECs, astrocytes, and microglia by flaviviruses was associated to the expression and secretion of inflammatory mediators, which are believed to recruit leukocytes to the CNS. The leukocyte infiltrate could further mediate viral invasion through a Trojan horse mechanism and might contribute to BBB breakdown and to neurological alterations. This review discussed the previous studies regarding in vitro and in vivo models of JEV, WNV, ZIKV, YFV, DENV, and TBEV infection and addressed the pathways for BBB overcome and invasion of the CNS described for each virus infection, aiming to increment the knowledge and stimulate further discussion about the role of BBB in the neuropathogenesis of flavivirus infection.
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Affiliation(s)
- Yasmin Mucunã Mustafá
- Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Lana Monteiro Meuren
- Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Sharton Vinícius Antunes Coelho
- Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Luciana Barros de Arruda
- Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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