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Abstract
Objective: To estimate the cumulative incidence rate (CIR) of Chikungunya virus (CHIKV)–associated CNS disease during the La Réunion outbreak, and assess the disease burden and patient outcome after 3 years.
Methods: CHIKV-associated CNS disease was characterized retrospectively in a cohort of patients with positive CHIKV reverse transcriptase PCR or anti-CHIKV immunoglobulin M antibodies in the CSF and fulfilling International Encephalitis Consortium criteria for encephalitis or encephalopathy. Neurologic sequelae were assessed after 3 years.
Results: Between September 2005 and June 2006, 57 patients were diagnosed with CHIKV-associated CNS disease, including 24 with CHIKV-associated encephalitis, the latter corresponding to a CIR of 8.6 per 100,000 persons. Patients with encephalitis were observed at both extremes of age categories. CIR per 100,000 persons were 187 and 37 in patients below 1 year and over 65 years, respectively, both far superior to those of cumulated causes of encephalitis in the United States in these age categories. The case-fatality rate of CHIKV-associated encephalitis was 16.6% and the proportion of children discharged with persistent disabilities estimated between 30% and 45%. Beyond the neonatal period, the clinical presentation and outcomes were less severe in infants than in adults.
Conclusions: In the context of a large outbreak, CHIKV is a significant cause of CNS disease. As with other etiologies, CHIKV-associated encephalitis case distribution by age follows a U-shaped parabolic curve.
GLOSSARY
- ADEM=
- acute disseminated encephalomyelitis;
- CHIKV=
- Chikungunya virus;
- CFR=
- case-fatality rate;
- CIR=
- cumulative incidence rate;
- DQ=
- development quotient;
- DWI=
- diffusion-weighted imaging;
- ECSA=
- East Central South African;
- IEC=
- International Encephalitis Consortium;
- IgM=
- immunoglobulin M;
- LP=
- lumbar puncture;
- NECACD=
- nonencephalitic Chikungunya virus–associated CNS disease;
- WNV=
- West Nile virus
Footnotes
↵† Deceased.
Coinvestigators of the Encephalchik Study Group are listed on the Neurology® Web site at Neurology.org.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received February 18, 2015.
- Accepted in final form August 31, 2015.
- © 2015 American Academy of Neurology
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