RESUMO
TITLE: Hemicerebelitis por chikungunya asociado a estado epiléptico refractario en edad pediátrica.
Assuntos
Doenças Cerebelares/etiologia , Febre de Chikungunya/complicações , Estado Epiléptico/etiologia , Doença Aguda , Anticorpos Antivirais/sangue , Anticorpos Antivirais/líquido cefalorraquidiano , Anticonvulsivantes/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/etiologia , Dano Encefálico Crônico/etiologia , Doenças Cerebelares/diagnóstico por imagem , Febre de Chikungunya/sangue , Febre de Chikungunya/líquido cefalorraquidiano , Vírus Chikungunya/imunologia , Pré-Escolar , Resistência a Medicamentos , Disartria/etiologia , Humanos , Imunoglobulina M/sangue , Imunoglobulina M/líquido cefalorraquidiano , Imageamento por Ressonância Magnética , Masculino , Neuroimagem , Paresia/etiologia , Fenobarbital/uso terapêutico , Estado Epiléptico/tratamento farmacológicoRESUMO
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).
Assuntos
Sistema Nervoso Central/virologia , Febre de Chikungunya/líquido cefalorraquidiano , Febre de Chikungunya/diagnóstico , Vírus Chikungunya/isolamento & purificação , Transmissão Vertical de Doenças Infecciosas , Febre de Chikungunya/transmissão , Febre de Chikungunya/virologia , Feminino , Humanos , Lactente , Gravidez , Complicações Infecciosas na Gravidez/virologia , ViremiaRESUMO
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.
Assuntos
Anticorpos Antivirais/sangue , Infecções por Arbovirus/epidemiologia , Monitoramento Epidemiológico , Febre/epidemiologia , Febre/virologia , Doença Aguda/epidemiologia , Adolescente , Infecções por Arbovirus/sangue , Infecções por Arbovirus/líquido cefalorraquidiano , Mordeduras e Picadas/epidemiologia , Febre de Chikungunya/sangue , Febre de Chikungunya/líquido cefalorraquidiano , Febre de Chikungunya/epidemiologia , Criança , Pré-Escolar , Coinfecção/epidemiologia , Coinfecção/virologia , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/virologia , Dengue/sangue , Dengue/líquido cefalorraquidiano , Dengue/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Texas/epidemiologia , Viagem , Febre do Nilo Ocidental/sangue , Febre do Nilo Ocidental/líquido cefalorraquidiano , Febre do Nilo Ocidental/epidemiologia , Adulto JovemRESUMO
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.
Assuntos
Febre de Chikungunya/líquido cefalorraquidiano , Febre de Chikungunya/diagnóstico , Imunoglobulinas/líquido cefalorraquidiano , Idoso , Anti-Inflamatórios/uso terapêutico , Biomarcadores/líquido cefalorraquidiano , Febre de Chikungunya/tratamento farmacológico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Encefalite Viral , Feminino , Humanos , Prednisolona/uso terapêutico , Sulfonamidas/uso terapêuticoRESUMO
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.
Assuntos
Febre de Chikungunya/complicações , Febre de Chikungunya/epidemiologia , Vírus Chikungunya/patogenicidade , Criança Hospitalizada/estatística & dados numéricos , Doenças do Sistema Nervoso/etiologia , Adolescente , Distribuição por Idade , Anti-Inflamatórios/uso terapêutico , Antivirais/uso terapêutico , Febre de Chikungunya/líquido cefalorraquidiano , Febre de Chikungunya/tratamento farmacológico , Vírus Chikungunya/genética , Criança , Pré-Escolar , Feminino , Genes Virais/genética , Honduras/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/virologia , Exame Neurológico , Estudos RetrospectivosRESUMO
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.
Assuntos
Febre de Chikungunya/complicações , Coinfecção/virologia , Turismo Médico , Procedimentos Ortopédicos , Técnicas de Reprodução Assistida , Viremia/complicações , Infecção por Zika virus/complicações , Adulto , Febre de Chikungunya/sangue , Febre de Chikungunya/líquido cefalorraquidiano , Vírus Chikungunya/genética , Equador , Feminino , Fraturas do Fêmur/cirurgia , Fraturas Mal-Unidas/cirurgia , Síndrome de Guillain-Barré/líquido cefalorraquidiano , Síndrome de Guillain-Barré/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/virologia , RNA Viral/sangue , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Viremia/sangue , Zika virus/genética , Infecção por Zika virus/sangue , Infecção por Zika virus/líquido cefalorraquidianoRESUMO
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.