Neurologic Manifestation of Chikungunya Virus
- 622 Downloads
Purpose of Review
Chikungunya virus (CHIKV) is a RNA arbovirus that typically causes fevers and arthralgias, but reports of neurologic findings have become increasingly common. This article reviews our current understanding of CHIKV-associated neurologic manifestations.
In the last 5 years, CHIKV endemicity has spread to the Americas and the number of cases of CHIKV-related disease has dramatically increased. Evidence suggests increasing neurovirulence of the virus, particularly among the critically ill. The spectrum of neurologic manifestations of the disease includes encephalitis, myelitis, and Guillain-Barre syndrome, but isolated reports of cranial neuropathies and cognitive deficits associated with recent infection also are reported.
Though neurologic symptoms associated with CHIKV remain relatively uncommon, their frequency appears to be increasing. Clinicians treating patients with neurologic symptoms from CHIKV endemic areas should be aware of the growing association between CHIKV and neurologic sequelae to help guide diagnostics. Research into the optimal treatment of the disease is needed to inform treatment practices.
KeywordsChikungunya Neurology Mosquito-borne viruses Encephalitis Guillain-Barre syndrome
Compliance with Ethical Standards
Conflict of Interest
Dr. Brizzi declares no conflict of interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the author.
Papers of particular interest, published recently, have been highlighted as: • Of importance. •• Of major importance
- 2.•• Deeba F, Islam A, Kazim SN, Naqvi IH, Broor S, Ahmed A, Parveen S. Chikungunya virus: recent advances in epidemiology, host pathogen interaction and vaccine strategies. Pathog Dis. 2016;74(3). pii: ftv119. A recent review of the epidemiology of Chikungunya. Google Scholar
- 5.•• Petersen LR, Powers AM. Chikungunya: epidemiology. F1000Res. 2016;5. pii: F1000 Faculty Rev-82. A comprehensive review of the epidemiology of Chikungunya and the factors contributing to the spread of disease. Google Scholar
- 7.• Tsetsarkin KA, Vanlandingham DL, McGee CE, Higgs S. A single mutation in Chikungunya virus affects vector specificity and epidemic potential. PLoS Pathog. 2007;3(12):e201. This study demonstrated an envelope protein mutation in the virus that may explain changes in the global spread of Chikungunya virus.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.World Health Organization. Chikungunya [Internet]. Geneva: World Health Organization; 2016 Apr [cited 2016 Aug 28]. Available from: http://www.who.int/mediacentre/factsheets/fs327/en/.
- 11.Centers for Disease Control (US). Chikungunya Virus: 2015 final data for the United States [Internet]. Atlanta: Centers for Disease Control and Prevention; 2016 June [cited 2016 Aug 28]. Available from: https://www.cdc.gov/chikungunya/geo/united-states-2015.html.
- 12.•• Kendrick K, Stanek D, Blackmore C, Centers for Disease Control and Prevention (CDC). Notes from the field: transmission of Chikungunya virus in the continental United States—Florida, 2014. MMWR Morb Mortal Wkly Rep. 2014;63(48):1137. This paper is a quantification of Chikungunya cases in the United States.PubMedGoogle Scholar
- 15.•• Chiam CW, Chan YF, Ong KC, Wong KT, Sam IC. Neurovirulence comparison of Chikungunya virus isolates of the Asian and East/Central/South African genotypes from Malaysia. J Gen Virol. 2015;96(11):3243–54. A study illustrating the difference in neurovirulence of Chikungunya virus based on genotype.CrossRefPubMedGoogle Scholar
- 21.•• Rodriguez-Morales AJ, Gil-Restrepo AF, Ramírez-Jaramillo V, Montoya-Arias CP, Acevedo-Mendoza WF, Bedoya-Arias JE, et al. Post-Chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia. Version 2. F1000Res. 2016 Mar 16 [revised 2016 Apr 4];5:360. A retrospective review of the non-neurologic clinical effects of Chikungunya virus. Google Scholar
- 23.• Chandak NH, Kashyap RS, Kabra D, Karandikar P, Saha SS, Morey SH, et al. Neurological complications of Chikungunya virus infection. Neurol India. 2009;57(2):177–80. A prior review of the neurologic syndromes associated with Chikungunya infection seen in a cohort from India.CrossRefPubMedGoogle Scholar
- 26.• Gérardin P, Couderc T, Bintner M, Tournebize P, Renouil M, Lémant J, et al. Chikungunya virus-associated encephalitis: a cohort study on La Réunion Island, 2005-2009. Neurology. 2016;86(1):94–102. A comprehensive study examining neurologic syndromes in patients with Chikungunya virus on La Reunion Island.CrossRefPubMedGoogle Scholar
- 29.•• Maity P, Roy P, Basu A, Das B, Ghosh US. A case of ADEM following Chikungunya fever. J Assoc Physicians India. 2014;62(5):441–2. An illustrative case of demyelinating disease following Chikungunya infection.Google Scholar
- 35.•• Oehler E, Fournier E, Leparc-Goffart I, Larre P, Cubizolle S, Sookhareea C, et al. Increase in cases of Guillain-Barré syndrome during a Chikungunya outbreak, French Polynesia, 2014 to 2015. Euro Surveill. 2015;20(48):30079. A retrospective review of cases demonstrating correlation between increased GBS cases and the Chikungunya outbreak in French Polynesia.CrossRefPubMedGoogle Scholar
- 39.•• Mohite AA, Agius-Fernandez A. Chikungunya fever presenting with acute optic neuropathy. BMJ Case Rep. 2015 Jul 28;2015. pii: bcr2015210081. A case report of a patient with optic neuropathy following Chikungunya infection. Google Scholar
- 44.•• Leibovitch EC, Jacobson S. Vaccinations for neuroinfectious disease: a global health priority. Neurotherapeutics. 2016. [Epub ahead of print]. A discussion of the current state of vaccine development for Chikungunya infection. Google Scholar