Produção Nacional
Revisado por pares
Central and peripheral nervous system involvement caused by Zika and chikungunya coinfection
2017; Public Library of Science; Volume: 11; Issue: 7 Linguagem: Inglês
10.1371/journal.pntd.0005583
ISSN1935-2735
AutoresCarlos Alexandre Antunes de Brito, Fernanda Azevedo, Marli Tenório Cordeiro, Ernesto T. A. Marques, Rafael Freitas de Oliveira França,
Tópico(s)Malaria Research and Control
ResumoBackgroundLarge outbreaks of dengue, Zika, and chikungunya are taking place in several countries in Asia and Latin America [1,2], and simultaneous circulation of these 3 arboviruses in the same region raises the possibility of coinfections of vertebrate and invertebrate hosts.Indeed, several cases of dengue and chikungunya coinfections have been reported [3].However, cocirculation of Zika and chikungunya is more recent.The 2013 outbreak in the French Polynesia [4] and the 2015 outbreak in Brazil [5] are the largest Zika virus outbreaks described to date.In Brazil, the Zika and chikungunya outbreaks partially overlapped, and few reports of coinfection are present in the literature [6,7].Here, we report a severe case of meningoencephalitis associated with peripheral polyneuropathy in a 74-year-old patient due to a coinfection with Zika and chikungunya. Case reportOn April 3, 2016, a 74-year-old male resident from Recife, northeast Brazil, with history of systemic arterial hypertension and controlled diabetes mellitus type II was admitted in a private hospital in the city of Recife, Pernambuco, in northeast Brazil.The patient appeared with acute symptoms of fever; arthralgia in his hands, knees, and ankles; and edema in the feet.The patient was admitted for hydration and prescription of symptomatic medications.On the third day from the onset of the symptoms, the patient began to vomit and worsen in overall health status.During hospitalization, disorientation and agitation were also added to the clinical presentation, followed by refractory arterial hypotension and shock, despite adequate volume reposition.The patient developed hypoxia, which required mechanical ventilation and use of vasoactive drugs.Complete blood count (CBC) showed normal leukocytes, 8 x 10 9 /L, with 88% of polymorphonuclear leukocytes and platelet count of 90 x 10 9 /L.Initial neurologic evaluation was performed at the intensive care unit with the patient sedated.However, the presence of stiff neck and muscular weaknesses associated with global areflexia were clear in the neurological examination.Altogether, these findings suggested the diagnosis of acute meningoencephalic syndrome.Laboratory analyses of cerebrospinal fluid (CSF) demonstrated the presence of a total 85 cells-60% lymphocytes, 20% monocytes, 20% neutrophils; protein 251 mg/dL; glucose 133 mg/dL; negative VDRL.Laboratory-performed ELISA IgM and PCR for
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