Ortiz-Quezada Jorge, Rodriguez Edith E, Hesse Heike, Molina Lázaro, Duran Cesar, Lorenzana Ivette, England John D
Honduras Neurology Training Program, Faculty of Medical Sciences, National Autonomous University of Honduras, Honduras.
Epidemiology Program, Secretaria de Salud, Tegucigalpa, Honduras.
J Neurol Sci. 2021 Jan 15;420:117279. doi: 10.1016/j.jns.2020.117279. Epub 2020 Dec 26.
The Chikungunya Virus (CHIKV) was introduced into Honduras in 2015. Since then the WHO has reported more than 14,000 suspected cases in the country.
To describe the clinical, laboratory, neuroimaging, and pathological features of CHIKV encephalitis.
We evaluated all consecutive cases of CHIKV infection meeting encephalitis criteria at Hospital Escuela Universitario at Tegucigalpa, Honduras, during 2015. Who case definition was used: patient with neurological manifestations meeting clinical criteria (fever >38.5 °C, joint pain); resident/visitor in the last 15 days to an endemic area; laboratory confirmation with IgM/ELISA. Other etiologies were excluded by ancillary studies.
Out of 95 cases with suspected CHIKV infection, 7 (7%) cases with CHIKV encephalitis were identified; mean age was 56 years and four were men. The mean latency from onset of symptoms to diagnosis was 5 five days. Clinical manifestations were: fever/arthralgia, headache/alteration of consciousness and status epilepticus. The EEG demonstrated slow background activity and generalized epileptiform discharges in three patients. Brain MRI showed bilateral white matter hyperintensities and one with focal encephalitis; CSF analysis demonstrated lymphocytic pleocytosis and hyperproteinorrachia. Two patients died. Postmortem brain examination of one patient revealed lymphocytic infiltrates with focal necrosis in hippocampus, frontal lobes and medulla oblongata.
Neurological complications of CHIKV are infrequent, but may be severe. In this case series, the neurological manifestation was encephalitis. Predominant symptoms and signs were fever, behavioral abnormalities, headache and seizures. Because of the potential morbidity and mortality of CHIKV encephalitis, these patients should be admitted to hospital urgently.
基孔肯雅病毒（CHIKV）于2015年传入洪都拉斯。自那时起，世界卫生组织报告该国疑似病例超过14000例。
描述基孔肯雅病毒脑炎的临床、实验室、神经影像学和病理特征。
我们评估了2015年期间在洪都拉斯特古西加尔巴的大学医院符合脑炎标准的所有连续性基孔肯雅病毒感染病例。采用的病例定义为：有符合临床标准的神经学表现（发热>38.5°C、关节疼痛）的患者；过去15天内居住/到访过流行地区；IgM/酶联免疫吸附测定法实验室确诊。通过辅助检查排除其他病因。
在95例疑似基孔肯雅病毒感染病例中，确诊7例（7%）基孔肯雅病毒脑炎；平均年龄56岁，4例为男性。从症状出现到诊断的平均潜伏期为5天。临床表现为：发热/关节痛、头痛/意识改变和癫痫持续状态。脑电图显示3例患者背景活动减慢和广泛性癫痫样放电。脑部磁共振成像显示双侧白质高信号，1例有局灶性脑炎；脑脊液分析显示淋巴细胞增多和蛋白含量增高。2例患者死亡。1例患者的尸检脑部检查显示海马体、额叶和延髓有淋巴细胞浸润伴局灶性坏死。
基孔肯雅病毒的神经并发症不常见，但可能很严重。在本病例系列中，神经学表现为脑炎。主要症状和体征为发热、行为异常、头痛和癫痫发作。鉴于基孔肯雅病毒脑炎的潜在发病率和死亡率，这些患者应紧急入院治疗。
