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Abstract
Objective To characterize the full spectrum, relative frequency, and prognosis of the neurologic manifestations in Zika virus (ZIKV) postnatal infection.
Methods We conducted an observational study in consecutive ZIKV-infected patients presenting with neurologic manifestations during the French West Indies 2016 outbreak.
Results Eighty-seven patients, including 6 children, were enrolled. Ninety-five percent of all cases required hospitalization. Guillain-Barré syndrome was the most frequent manifestation (46.0%) followed by encephalitis or encephalomyelitis (20.7%), isolated single or multiple cranial nerve palsies (9.2%), other peripheral manifestations (6.9%), and stroke (1.1%). Fourteen patients (16.1%), including one child, developed a mixed disorder involving both the central and peripheral nervous system. Mechanical ventilation was required in 21 cases, all of whom had ZIKV RNA in at least one biological fluid. Two adult patients died due to neuroZika. Clinical follow-up (median 14 months; interquartile range, 13–17 months) was available for 76 patients. Residual disability (modified Rankin Scale score ≥2) was identified in 19 (25.0%) patients; in 6 cases (7.9%), disability was severe (modified Rankin Scale score ≥4). Among patients with ZIKV RNA detected in one biological fluid, the risk of residual disability or death was higher (odds ratio 9.19; confidence interval 1.12–75.22; p = 0.039).
Conclusions NeuroZika spectrum represents a heterogeneous group of clinical neurologic manifestations. During an outbreak, clinicians should consider neuroZika in patients presenting with cranial nerve palsies and a mixed neurologic disorder. Long-term sequelae are frequent in NeuroZika. ZIKV reverse-transcription PCR status at admission can inform prognosis and should therefore be taken into consideration in the management of hospitalized patients.
Glossary
- ADEM=
- acute disseminated encephalomyelitis;
- AIDP=
- acute inflammatory demyelinating polyradiculoneuropathy;
- CI=
- confidence interval;
- GBS=
- Guillain-Barré syndrome;
- GDS=
- Guillain-Barré Disability Scale;
- HR=
- hazard ratio;
- ICU=
- intensive care unit;
- IgG=
- immunoglobulin G;
- IgM=
- immunoglobulin M;
- IGOS=
- International GBS Outcome Study;
- IQR=
- interquartile range;
- IVIg=
- IV immunoglobulin;
- mRS=
- modified Rankin Scale;
- PAHO=
- Pan American Health Organization;
- PNS=
- peripheral nervous system;
- PRNT=
- plaque reduction neutralization test;
- RT-PCR=
- reverse transcription PCR;
- ZIKV=
- Zika virus
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* Drs. Lobjois and Fergé contributed equally to this article as co–second authors.
↵‡ Drs. Cabié, Lazarini, and Roze contributed equally to this article as co–last authors.
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- Received October 9, 2018.
- Accepted in final form January 22, 2019.
- © 2019 American Academy of Neurology
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