ABSTRACT
TITLE: Hemicerebelitis por chikungunya asociado a estado epiléptico refractario en edad pediátrica.
Subject(s)
Cerebellar Diseases/etiology , Chikungunya Fever/complications , Status Epilepticus/etiology , Acute Disease , Antibodies, Viral/blood , Antibodies, Viral/cerebrospinal fluid , Anticonvulsants/therapeutic use , Attention Deficit Disorder with Hyperactivity/etiology , Attention Deficit and Disruptive Behavior Disorders/etiology , Brain Damage, Chronic/etiology , Cerebellar Diseases/diagnostic imaging , Chikungunya Fever/blood , Chikungunya Fever/cerebrospinal fluid , Chikungunya virus/immunology , Child, Preschool , Drug Resistance , Dysarthria/etiology , Humans , Immunoglobulin M/blood , Immunoglobulin M/cerebrospinal fluid , Magnetic Resonance Imaging , Male , Neuroimaging , Paresis/etiology , Phenobarbital/therapeutic use , Status Epilepticus/drug therapyABSTRACT
We report here a probable case of vertical transmission of chikungunya infection with confirmed maternal viremia close to labor that led to severe infection in the newborn. The newborn progressed with cutaneous lesions and irritability 2 months after vertical transmission, when chikungunya virus was detected in the infant's CSF by a molecular diagnostic test (real-time polymerase chain reaction).
Subject(s)
Central Nervous System/virology , Chikungunya Fever/cerebrospinal fluid , Chikungunya Fever/diagnosis , Chikungunya virus/isolation & purification , Infectious Disease Transmission, Vertical , Chikungunya Fever/transmission , Chikungunya Fever/virology , Female , Humans , Infant , Pregnancy , Pregnancy Complications, Infectious/virology , ViremiaABSTRACT
We instituted active surveillance among febrile patients presenting to the largest Houston-area pediatric emergency department to identify acute infections of dengue virus (DENV), West Nile virus (WNV), and chikungunya virus (CHIKV). In 2014, 1,063 children were enrolled, and 1,015 (95%) had blood and/or cerebrospinal fluid specimens available for DENV, WNV, and CHIKV testing. Almost half (49%) reported recent mosquito bites, and 6% (N = 60) reported either recent international travel or contact with an international traveler. None were positive for acute WNV; three had false-positive CHIKV results; and two had evidence of DENV. One DENV-positive case was an acute infection associated with international travel, whereas the other was identified as a potential secondary acute infection, also likely travel-associated. Neither of the DENV-positive cases were clinically recognized, highlighting the need for education and awareness. Health-care professionals should consider the possibility of arboviral disease among children who have traveled to or from endemic areas.
Subject(s)
Antibodies, Viral/blood , Arbovirus Infections/epidemiology , Epidemiological Monitoring , Fever/epidemiology , Fever/virology , Acute Disease/epidemiology , Adolescent , Arbovirus Infections/blood , Arbovirus Infections/cerebrospinal fluid , Bites and Stings/epidemiology , Chikungunya Fever/blood , Chikungunya Fever/cerebrospinal fluid , Chikungunya Fever/epidemiology , Child , Child, Preschool , Coinfection/epidemiology , Coinfection/virology , Communicable Diseases, Imported/epidemiology , Communicable Diseases, Imported/virology , Dengue/blood , Dengue/cerebrospinal fluid , Dengue/epidemiology , Female , Humans , Infant , Infant, Newborn , Male , Texas/epidemiology , Travel , West Nile Fever/blood , West Nile Fever/cerebrospinal fluid , West Nile Fever/epidemiology , Young AdultABSTRACT
Chikungunya virus causes fever and severe polyarthritis or arthralgia and is associated with neurologic manifestations that are sometimes challenging to diagnose. We demonstrate intrathecal synthesis of chikungunya antibodies in a patient with a history of acute infection complicated by encephalitis. The specificity of the intracerebral immune response supports early chikungunya-associated encephalitis diagnosis.
Subject(s)
Chikungunya Fever/cerebrospinal fluid , Chikungunya Fever/diagnosis , Immunoglobulins/cerebrospinal fluid , Aged , Anti-Inflammatory Agents/therapeutic use , Biomarkers/cerebrospinal fluid , Chikungunya Fever/drug therapy , Cyclooxygenase Inhibitors/therapeutic use , Encephalitis, Viral , Female , Humans , Prednisolone/therapeutic use , Sulfonamides/therapeutic useABSTRACT
The first case of Chikungunya virus in Honduras was identified in 2014. The virus has spread widely across Honduras via the Aedes aegypti mosquito, leading to an outbreak of Chikungunya virus (CHIKV) in 2015 that significantly impacted children. A retrospective chart review of 235 children diagnosed with CHIKV and admitted to the National Autonomous University of Honduras Hospital Escuela (Hospital Escuela) in Tegucigalpa, Honduras, was accomplished with patients who were assessed for clinical features and neurologic complications. Of 235 children admitted to Hospital Escuela with CHIKV, the majority had symptoms of fever, generalized erythematous rash, and irritability. Fourteen percent had clinical arthritis. Ten percent of patients had seizures. Six percent had meningoencephalitis. There were 2 childhood deaths during the course of this study, one from meningoencephalitis and another from myocarditis. Chikungunya virus can cause severe complications in children, the majority of which impact the central nervous system.
Subject(s)
Chikungunya Fever/complications , Chikungunya Fever/epidemiology , Chikungunya virus/pathogenicity , Child, Hospitalized/statistics & numerical data , Nervous System Diseases/etiology , Adolescent , Age Distribution , Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/therapeutic use , Chikungunya Fever/cerebrospinal fluid , Chikungunya Fever/drug therapy , Chikungunya virus/genetics , Child , Child, Preschool , Female , Genes, Viral/genetics , Honduras/epidemiology , Humans , Infant , Infant, Newborn , Male , Nervous System Diseases/diagnosis , Nervous System Diseases/virology , Neurologic Examination , Retrospective StudiesABSTRACT
Zika virus (ZIKV) and chikungunya virus (CHIKV) cocirculate throughout much of the tropical Western Hemisphere; however, few cases of coinfection with these two pathogens have been reported. Herein, we describe three cases of ZIKV-CHIKV coinfection detected at a single center in Ecuador: a patient who developed symptoms on postoperative day 5 from an orthopedic procedure, a woman who had traveled to Ecuador for fertility treatment, and a woman who was admitted for Guillain-Barré syndrome and had ZIKV and CHIKV detected in serum and cerebrospinal fluid. All cases were diagnosed using a multiplex real-time reverse transcription polymerase chain reaction, and ZIKV viremia was detected as late as 16 days after symptom onset. These cases demonstrate the varied clinical presentation of ZIKV-CHIKV coinfections as well as the importance of multiplexed arboviral testing for these pathogens.
Subject(s)
Chikungunya Fever/complications , Coinfection/virology , Medical Tourism , Orthopedic Procedures , Reproductive Techniques, Assisted , Viremia/complications , Zika Virus Infection/complications , Adult , Chikungunya Fever/blood , Chikungunya Fever/cerebrospinal fluid , Chikungunya virus/genetics , Ecuador , Female , Femoral Fractures/surgery , Fractures, Malunited/surgery , Guillain-Barre Syndrome/cerebrospinal fluid , Guillain-Barre Syndrome/virology , Humans , Male , Middle Aged , Postoperative Complications/virology , RNA, Viral/blood , Real-Time Polymerase Chain Reaction , Reverse Transcriptase Polymerase Chain Reaction , Viremia/blood , Zika Virus/genetics , Zika Virus Infection/blood , Zika Virus Infection/cerebrospinal fluidABSTRACT
BACKGROUND: Chikungunya infection caused by Chikungunya virus (CHIKV) is an inflammatory disease affecting the joints and may also lead to neurological complications. We investigated a panel of human Toll-like receptor (TLR)-induced cytokines in Chikungunya patients with and without neurological complications. METHODS: In a case-control study, a panel of 12 cytokines and chemokines, TNF-α, IFN-α, IL-1ß, IL-6, IL-12, IL-17A, IL-8, monocyte chemotactic protein (MCP)-1, RANTES, interferon (IFN)-γ-induced protein (IP)-10, monokine induced by IFN-γ (MIG) and thymus and activation-regulated chemokine (TARC), was analysed using a conventional ELISA protocol in the serum samples of Chikungunya patients without neurological complications and in the cerebrospinal fluid (CSF) and paired serum samples of Chikungunya patients with neurological complications. RESULTS: The levels of 3 cytokines, IL-1ß, IL-17A and IL-8, and 4 chemokines, MCP-1, RANTES, IP-10 and TARC, were raised in serum samples of Chikungunya patients without neurological complications, whereas, 4 cytokines, TNF-α, IFN-α, IL-6 and IL-8, and 4 chemokines, MCP-1, RANTES, MIG and TARC, were elevated in CSF samples of Chikungunya patients with neurological complications. Moreover, the levels of IL-6 and IL-8 cytokines were significantly elevated in the CSF compared to paired serum samples in Chikungunya patients with neurological complications. CONCLUSIONS: In CHIKV infection, multiple cytokines are elevated in serum and CSF. The elevation in IL-6 and IL-8 cytokines in CSF correlates with neurological involvement.