Long-term outcome in neuroZika

Annie Lannuzel (1) , Jean-Louis Fergé (2) , Quentin Lobjois (1) , Aissatou Signate (3) , Benoit Roze (3) , Benoit Tressieres (4) , Yoann Madec (5) , Pascale Poullain (1) , Cécile Herrmann (1) , Fatiha Najioullah (3) , Eavan M Mcgovern (6) , Anne-Charlotte Savidan (2) , Ruddy Valentino (2) , Sebastien Breurec (7, 8) , Raymond Cesaire (3) , Etienne Hirsch (2) , Pierre-Marie Lledo (9) , Guillaume Thiery (1) , André Cabié (4) , Françoise Lazarini (9) , Emmanuel Roze (6, 2)

1 CHU Pointe-à-Pitre/Abymes [Guadeloupe]
2 ICM - Institut du Cerveau = Paris Brain Institute
3 CHU de la Martinique [Fort de France]
4 CIC - Antilles Guyane - Centre d'investigation clinique Antilles-Guyane
5 Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology
6 CHU Pitié-Salpêtrière [AP-HP]
7 Institut Pasteur de la Guadeloupe
8 UA - Université des Antilles
9 Perception et Mémoire / Perception and Memory

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.

Domains: Emerging diseases; Infectious diseases; Cognitive Sciences; Neuroscience

Annie Lannuzel, Jean-Louis Fergé, Quentin Lobjois, Aissatou Signate, Benoit Roze, et al.. Long-term outcome in neuroZika. Neurology, 2019, 92 (21), pp.e2406-e2420. ⟨10.1212/WNL.0000000000007536⟩. ⟨pasteur-02113729⟩