Bahadar Srichawla1, Muhammed Manan3, Vincent Kipkorir4, Arkadeep Dhali5, Sebastian Diebel6, Tirtha Sawant7, Subtain Zia2, Diego Carrion-Alvarez8, Richard Suteja9, Khulud Nurani10, Mihnea-Alexandru Găman11
1Neurology, University of Massachusetts Chan Medical School, 2University of Massachusetts Chan Medical School, 32Services Institute of Medical Sciences, 4University of Nairobi, College of Health Sciences, 5Internal Medicine, Nottingham University Hospitals NHS Trust, 6Northern Ontario School of Medicine University, 7Spartan Health Sciences University, 8ISSSTE Regional de Monterrey, 9Udayana University, 10University of Nairobi, 11“Carol Davila” University of Medicine and Pharmacy
Objective:
Our objective is to identify and map all aspects of arbovirus neuroinvasive disease, clarify key concepts, and identify gaps within our knowledge with appropriate future directions related to the improvement of global health.
Background:
Arboviruses are RNA viruses and some have the potential to cause neuroinvasive disease and are a growing threat to global health.
Design/Methods:
A scoping review of the literature was conducted using PubMed, Scopus, ScienceDirect, and Hinari. Original data including epidemiology, risk factors, neurological manifestations, neuro-diagnostics, management, and preventive measures related to neuroinvasive arbovirus infections was obtained. Sources of evidence not reporting on original data, non-English, and not in peer-reviewed journals were removed. An initial pilot sample of 30 abstracts were reviewed by all authors and a Cohen’s kappa of κ =0.81 (near-perfect agreement) was obtained. Records were manually reviewed by two authors using the Rayyan QCRI software.
Results:
A total of 171 records were included. A wide array of neurological manifestations can occur most frequently, including parkinsonism, encephalitis/encephalopathy, meningitis, flaccid myelitis, and Guillain-Barré syndrome (GBS). Magnetic resonance imaging (MRI) of the brain often reveals subcortical lesions, sometimes with diffusion restriction consistent with acute ischemia. Vertical transmission of arbovirus is most often secondary to the Zika virus. Neurological manifestations of congenital Zika syndrome, include microcephaly, failure to thrive, intellectual disability, and seizures. Cerebrospinal fluid analysis often shows lymphocytic pleocytosis, elevated albumin, and protein consistent with blood-brain barrier dysfunction.
Conclusions:
Arbovirus infection with neurological manifestations leads to increased morbidity and mortality. Risk factors for infection include living and traveling in an arbovirus endemic zone, age, pregnancy, and immunosuppressed status. The management of neuroinvasive arbovirus disease is largely supportive and focuses on specific neurological complications. There is a need for therapeutics and currently, management is based on disease prevention and limiting zoonosis.