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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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Sampaio MPDS, do Rosário MS, Martins LC, Trindade LVL, Francisco MVLDO, Costa BGG, Vasconcelos GA, Lima IAB, Macêdo YSF, Carvalho FML, de Santana MBR, Khouri R, Fritsch H, Xavier J, Fonseca V, Giovanetti M, de Mello ALES, Pereira FM, Campos GS, de Jesus PAP, Farias DS, de Souza MS, Galvão AJP, Costa FO, Bessa MC, Chagas JRLP, Silvany C, Teles JMM, de Lima MM, Farias TLA, Gräf T, de Siqueira IC. Detection of encephalitis-causing viruses reveals predominance of chikungunya virus in the state of Bahia, Brazil. Int J Infect Dis 2024; 145:107090. [PMID: 38762045 PMCID: PMC11183300 DOI: 10.1016/j.ijid.2024.107090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/11/2024] [Accepted: 05/05/2024] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVES Encephalitis is a severe neurological syndrome for which herpesvirus and enteroviruses are the most common etiological agents. Arboviruses, a wildly diverse group of pathogens, are also critical epidemiological agents associated with encephalitis. In Brazil, little is known about the causative agents of encephalitis. METHODS We conducted a hospital surveillance for encephalitis between 2020 and 2022. Molecular (RT-PCR and qPCR) and serological (virus-specific IgM and viral antigens) techniques were performed in cerebrospinal fluid and serum samples obtained from study participants. RESULTS In the 43 participants evaluated, the etiologic agent or the presence of IgM was detected in 16 (37.2%). Nine (20.9%) cases were positive for chikungunya virus (CHIKV), three (7.0%) for dengue virus, two (4.7%) for human adenovirus, one (2.3%) for varicella-zoster virus, and one (2.3%) for enterovirus. Whole-genome sequencing revealed that the CHIKV identified belongs to the East/Central/South African lineage. CONCLUSION Herein, CHIKV is a common pathogen identified in encephalitis cases. Our results reinforce previous evidence that chikungunya represents a significant cause of encephalitis during CHIKV outbreaks and epidemics and add to existing information on the epidemiology of encephalitis in Brazil.
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Affiliation(s)
- Maria Paula de Souza Sampaio
- Laboratório de Investigação em Saúde Global e Doenças Negligenciadas, Instituto Gonçalo Moniz, Fiocruz-Bahia, Salvador, Brazil
| | - Mateus Santana do Rosário
- Laboratório de Investigação em Saúde Global e Doenças Negligenciadas, Instituto Gonçalo Moniz, Fiocruz-Bahia, Salvador, Brazil; Hospital Santa Izabel, Salvador, Brazil; Hospital Santo Antonio-Obras Sociais Irmã Dulce, Salvador, Brazil
| | - Lorena Cunha Martins
- Laboratório de Investigação em Saúde Global e Doenças Negligenciadas, Instituto Gonçalo Moniz, Fiocruz-Bahia, Salvador, Brazil
| | - Luiza Vieira Luedy Trindade
- Laboratório de Investigação em Saúde Global e Doenças Negligenciadas, Instituto Gonçalo Moniz, Fiocruz-Bahia, Salvador, Brazil
| | | | - Bernardo Gratival Gouvea Costa
- Laboratório de Investigação em Saúde Global e Doenças Negligenciadas, Instituto Gonçalo Moniz, Fiocruz-Bahia, Salvador, Brazil
| | - Gessica Almeida Vasconcelos
- Laboratório de Investigação em Saúde Global e Doenças Negligenciadas, Instituto Gonçalo Moniz, Fiocruz-Bahia, Salvador, Brazil
| | - Italo Andrade Barbosa Lima
- Laboratório de Investigação em Saúde Global e Doenças Negligenciadas, Instituto Gonçalo Moniz, Fiocruz-Bahia, Salvador, Brazil
| | - Yasmin Santos Freitas Macêdo
- Laboratório de Investigação em Saúde Global e Doenças Negligenciadas, Instituto Gonçalo Moniz, Fiocruz-Bahia, Salvador, Brazil
| | - Fernanda Maria Lessa Carvalho
- Laboratório de Enfermidades Infecciosas Transmitidas por Vetores, Instituto Gonçalo Moniz, Fiocruz-Bahia, Salvador, Brazil
| | | | - Ricardo Khouri
- Laboratório de Enfermidades Infecciosas Transmitidas por Vetores, Instituto Gonçalo Moniz, Fiocruz-Bahia, Salvador, Brazil
| | - Hegger Fritsch
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Joilson Xavier
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vagner Fonseca
- Department of Exact and Earth Sciences, University of the State of Bahia, Salvador, Brazil; Coordenação de Vigilância, Preparação e Resposta à Emergências e Desastres (PHE), Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS), Brasilia, Brazil
| | - Marta Giovanetti
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil; Sciences and Technologies for Sustainable Development and One Health, Università Campus Bio-Medico di Roma, Roma, Italy
| | | | | | - Gubio Soares Campos
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Pedro Antonio Pereira de Jesus
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil; Hospital Geral Roberto Santos, Salvador, Brazil
| | | | | | | | | | | | | | - Celia Silvany
- Hospital da Criança, Obras Sociais Irmã Dulce, Salvador, Brazil
| | | | | | | | - Tiago Gräf
- Laboratório de Virologia Molecular, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, Brazil
| | - Isadora Cristina de Siqueira
- Laboratório de Investigação em Saúde Global e Doenças Negligenciadas, Instituto Gonçalo Moniz, Fiocruz-Bahia, Salvador, Brazil.
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Gómez G, Hufstedler H, Montenegro Morales C, Roell Y, Lozano-Parra A, Tami A, Magalhaes T, Marques ETA, Balmaseda A, Calvet G, Harris E, Brasil P, Herrera V, Villar L, Maxwell L, Jaenisch T. Pooled Cohort Profile: ReCoDID Consortium's Harmonized Acute Febrile Illness Arbovirus Meta-Cohort. JMIR Public Health Surveill 2024; 10:e54281. [PMID: 39042429 PMCID: PMC11288473 DOI: 10.2196/54281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/09/2024] [Accepted: 05/17/2024] [Indexed: 07/24/2024] Open
Abstract
Infectious disease (ID) cohorts are key to advancing public health surveillance, public policies, and pandemic responses. Unfortunately, ID cohorts often lack funding to store and share clinical-epidemiological (CE) data and high-dimensional laboratory (HDL) data long term, which is evident when the link between these data elements is not kept up to date. This becomes particularly apparent when smaller cohorts fail to successfully address the initial scientific objectives due to limited case numbers, which also limits the potential to pool these studies to monitor long-term cross-disease interactions within and across populations. CE data from 9 arbovirus (arthropod-borne viruses) cohorts in Latin America were retrospectively harmonized using the Maelstrom Research methodology and standardized to Clinical Data Interchange Standards Consortium (CDISC). We created a harmonized and standardized meta-cohort that contains CE and HDL data from 9 arbovirus studies from Latin America. To facilitate advancements in cross-population inference and reuse of cohort data, the Reconciliation of Cohort Data for Infectious Diseases (ReCoDID) Consortium harmonized and standardized CE and HDL from 9 arbovirus cohorts into 1 meta-cohort. Interested parties will be able to access data dictionaries that include information on variables across the data sets via Bio Studies. After consultation with each cohort, linked harmonized and curated human cohort data (CE and HDL) will be made accessible through the European Genome-phenome Archive platform to data users after their requests are evaluated by the ReCoDID Data Access Committee. This meta-cohort can facilitate various joint research projects (eg, on immunological interactions between sequential flavivirus infections and for the evaluation of potential biomarkers for severe arboviral disease).
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Affiliation(s)
- Gustavo Gómez
- Grupo de Epidemiología Clínica, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Heather Hufstedler
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Yannik Roell
- Center for Global Health, Colorado School of Public Health, Aurora, CO, United States
| | - Anyela Lozano-Parra
- Grupo de Epidemiología Clínica, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Adriana Tami
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Departamento de Estudios Clínicos, Facultad de Ciencias de la Salud, Universidad de Carabobo, Valencia, Venezuela
| | - Tereza Magalhaes
- Department of Entomology, Texas A&M University, College Station, TX, United States
- Department of Preventive and Social Medicine, School of Medicine, Universidade Federal da Bahia, Salvador, Brazil
| | - Ernesto T A Marques
- Department of Virology and Experimental Therapeutics, Aggeu Magalhães Institute, Oswaldo Cruz Foundation (Fiocruz), Recife, Brazil
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Guilherme Calvet
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Eva Harris
- Division of Infectious Diseases, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Patricia Brasil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Victor Herrera
- Grupo de Epidemiología Clínica, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Luis Villar
- Grupo de Epidemiología Clínica, Universidad Industrial de Santander, Bucaramanga, Colombia
- Centro de Atención y Diagnóstico de Enfermedades Infecciosas, Bucaramanga, Colombia
| | - Lauren Maxwell
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Jaenisch
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Center for Global Health, Colorado School of Public Health, Aurora, CO, United States
- Section Clinical Tropical Medicine, Department for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
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Puccioni-Sohler M, Nascimento Soares C, Christo PP, Almeida SMD. Review of dengue, zika and chikungunya infections in nervous system in endemic areas. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:1112-1124. [PMID: 38157877 PMCID: PMC10756841 DOI: 10.1055/s-0043-1777104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/15/2023] [Indexed: 01/03/2024]
Abstract
Dengue, zika, and chikungunya are arboviruses of great epidemiological relevance worldwide. The emergence and re-emergence of viral infections transmitted by mosquitoes constitute a serious human public health problem. The neurological manifestations caused by these viruses have a high potential for death or sequelae. The complications that occur in the nervous system associated with arboviruses can be a challenge for diagnosis and treatment. In endemic areas, suspected cases should include acute encephalitis, myelitis, encephalomyelitis, polyradiculoneuritis, and/or other syndromes of the central or peripheral nervous system, in the absence of a known explanation. The confirmation diagnosis is based on viral (isolation or RT-PCR) or antigens detection in tissues, blood, cerebrospinal fluid, or other body fluids, increase in IgG antibody titers between paired serum samples, specific IgM antibody in cerebrospinal fluid and serological conversion to IgM between paired serum samples (non-reactive in the acute phase and reactive in the convalescent). The cerebrospinal fluid examination can demonstrate: 1. etiological agent; 2. inflammatory reaction or protein-cytological dissociation depending on the neurological condition; 3. specific IgM, 4. intrathecal synthesis of specific IgG (dengue and chikungunya); 5. exclusion of other infectious agents. The treatment of neurological complications aims to improve the symptoms, while the vaccine represents the great hope for the control and prevention of neuroinvasive arboviruses. This narrative review summarizes the updated epidemiology, general features, neuropathogenesis, and neurological manifestations associated with dengue, zika, and chikungunya infection.
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Affiliation(s)
- Marzia Puccioni-Sohler
- Universidade Federal do Estado do Rio de Janeiro, Escola de Medicina e Cirurgia, Departamento de Medicina Geral, Rio de Janeiro RJ, Brazil.
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Rio de Janeiro RJ, Brazil.
| | | | - Paulo Pereira Christo
- Santa Casa BH, Faculdade de Saúde, Programa de Pós-Graduação Stricto Sensu em Medicina-Biomedicina, Belo Horizonte MG, Brazil.
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Neurologia, Belo Horizonte MG, Brazil.
| | - Sérgio Monteiro de Almeida
- Universidade Federal do Paraná, Faculdade de Medicina, Departamento de Patologia Médica, Curitiba PR, Brazil.
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