Eurosurveillance: Zika Virus Detected In CSF From Two Patients With Encephalopathy - Martinique 2016

Credit CDC

# 11,297


While the primary concern with the Zika virus remains the teratogenic effect on the  fetus during maternal infection, increasingly we are seeing evidence of other, albeit rare, neurological impacts on infected individuals.

The Zika Virus arrived in Martinique (pop. 386K) in December of 2015 and the most recent ECDC report indicates that infections are still increasing, and `As of 14 April 2016, 17 990 suspected cases have been reported, an increase of 1 340 since last week'

Previously we looked at a Eurosurveillance report on  Zika Virus Detection In 2 Patients With Guillain Barre Syndrome - Martinique, and another where WHO Detailed A Microcephaly Case In Martinique.

Today the Journal Eurosurveillance is back with a report on two cases of Encephalopathy - one a `young adult' and the other `in their late 70s' - whose cerebrospinal fluid (CSF), urine and plasma tested positive for Zika virus RNA. 

I've only include a few excerpts, so follow the link to read the entire report:

Rapid communication

Zika virus detection in cerebrospinal fluid from two patients with encephalopathy, Martinique, February 2016

B Rozé ¹ , F Najioullah ^{2 3} , A Signate ⁴ , K Apetse ⁵ , Y Brouste ⁶ , S Gourgoudou ⁶ , L Fagour ² , S Abel ^{1 3} , P Hochedez ^{1 3} , R Cesaire ^{2 3} , A Cabié ^{1 3 7} , on behalf of the Neuro-Zika Working Group of Martinique ⁸

Received:04 April 2016; Accepted:21 April 2016

We report two cases of encephalopathy (one with seizures, one with electroencephalogram changes) in patients with Zika virus infection. The cases occurred on Martinique in February 2016, during the Zika virus outbreak. Awareness of the various neurological complications of Zika virus infection is needed for patients living in areas affected by Zika virus infections or for travellers to these areas.

We describe two cases of encephalopathy in patients with Zika virus infection detected on Martinique in February 2016. In both patients, Zika virus RNA was detected in their cerebrospinal fluid (CSF), plasma, and urine.

(SNIP)

Dscussion

(Excerpt)

Over the past five years, there have been between one and three patients with encephalitis hospitalised monthly in the University Hospital of Martinique.

In this report, we present two cases of encephalopathy fulfilling the diagnostic criteria of the Consensus Statement of the International Encephalitis Consortium [3]. Based on the laboratory findings, we consider these cases as Zika virus-associated. In keeping with neurological findings in other arbovirus infections, the presentations were of non-specific nature; the spectrum of arboviral neurological disease may even lead to ischemic stroke [4]. Moreover, in arbovirus-related neurological disorders, imaging findings may be normal and different EEG abnormalities can be seen [5]. Zika virus is known as a neurotropic microorganism [6], however, both structural imaging and EEG can be normal in acute infection [5].

The mechanism of flavivirus infection of the central nervous system (CNS) is not clearly understood and pathology depends on the virus. Neurological involvement can be caused by direct damage of the nerve by the virus but also be immune mediated. For example, dengue virus can infect human astrocytes and brain microvascular endothelial cells, whereas West Nile virus infection could lead to a blood-brain barrier dysfunction [7].

Awareness of the wide spectrum of neurological symptoms of Zika virus infection is needed for patients living in, or travelling to areas affected by Zika virus infections. Knowledge of the pathophysiology of Zika virus infection and the reasons behind its predilection for the CNS is needed to design treatment strategies to mitigate significant morbidity.