Neurological Compromise in Chikungunya: A Meta-Analysis of its Prevalence
DOI:
https://doi.org/10.17533/udea.hm.323253Keywords:
chikungunya, seizures, emerging, Latin America, meta-analysis, clinical epidemiology, neuroinfectionAbstract
Objective: To determine the percentage of patients that would develop neurological manifestations and/or complications of chikungunya infection (NeuroCHIK).
Methods: We conducted a systemic review of the literature in three databases (PubMed, SCI, Scopus and SciELO) in order to identify studies assessing the proportion of patients that present NeuroCHIK. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% CI. Measures of heterogeneity, including Cochran’s Q statistic, the I2 index, and the tau-squared test, were estimated and reported. Subgroup analyses were conducted by type of study, country, studies with ≥200 patients, studies evaluating attention difficulties, encephalitis and seizures. Publication bias was assessed using a funnel-plot.
Results: Up to June 15, 2015, our literature search yielded 143 citations. The pooled prevalence of NeuroCHIK at nine selected studies among 2,161 patients was 34.53% [95%CI, (20.78–48.27%), τ2 = 0.0734]. Prospective cohorts shown a prevalence of NeuroCHIK of 36.87% [95%CI, (5.17%-68.57%), τ2 = 0.0818]. Occurrence of attention difficulties prevalence was 16.46% [95%CI, (5.65%-27.27%), τ2 = 0.0149]. In the case of encephalitis its prevalence was 9.90% [95%CI, (8.25%-11.54%), τ2 <0.0001]. Finally, analyzing the prevalence of seizures this was 3.43% [95%CI, (0.55%-6.31%), τ2 = 0.0006].
Conclusions: According with our results, in the most conservative scenario, about 33% of CHIK cases would develop NeuroCHIK (36% if we just consider prospective studies), 10% encephalitis, and 3% seizures.
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References
Alfaro-Toloza P, Clouet-Huerta DE, Rodri-guez-Morales AJ. Chikungunya, the emerging mi-gratory rheumatism. The Lancet Infectious diseases. 2015;15:510-2.
Rodriguez-Morales AJ. La amenaza de Chikun-gunya y otros virus emergentes en las Américas. R His-panoamericana de Ciencias de la Salud. 2015;1:9-12.
Cardona-Ospina JA, Rodriguez-Morales AJ, Villamil-Gómez W. Burden of chikungunya in one coastal department of Colombia (Sucre): estimates of disability adjusted life years (DALY) lost in 2014 epide-mic. J Infect Public Health. 2015.
Herrera-Martinez AD, Rodriguez-Morales AJ.Potential influence of climate variability on dengue incidence registered in a western pediatric Hospital of Venezuela. Tropical biomedicine. 2010;27:280-6.
Mattar S, Morales V, Cassab A, Rodriguez-Mo-rales AJ. Effect of climate variables on dengue inci-dence in a tropical Caribbean municipality of Colom-bia, Cerete, 2003-2008. Int. j. of infectious diseases : IJID : official publication of the International Society for Inf. Diseases. 2013;17:358-9
Quintero-Herrera LL, Ramirez-Jaramillo V, Bernal-Gutierrez S, Cardenas-Giraldo EV, Guerrero-Matituy EA, Molina-Delgado AH, et al. Potential impact of climatic variability on the epide-miology of dengue in Risaralda, Colombia, 2010-2011. J. of inf. and public health. 2015;8:291-7.
Zambrano LI, Sevilla C, Reyes-Garcia SZ, Sie-rra M, Kafati R, Rodriguez-Morales AJ, et al. Potential impacts of climate variability on dengue he-morrhagic fever in Honduras, 2010. Tropical biomedici-ne. 2012;29:499-507.
Bandyopadhyay B, Bandyopadhyay D, Bhattacharya R, De R, Saha B, Mukherjee H, et al. Death due to chikungunya. Trop Doct. 2009;39:187-8.
Sam IC, Kamarulzaman A, Ong GS, Veriah RS, Ponnampalavanar S, Chan YF, et al. Chikungun-ya virus-associated death in Malaysia. Trop Biomed. 2010;27:343-7.
de la Hoz JM, Bayona B, Viloria S, Accini JLJuan-Vergara HS, Viasus D. Fatal cases of Chikun-gunya virus infection in Colombia: diagnostic and treatment challenges. Journal of Clinical Virology. 2015;69:27-9.
Torres JR, Leopoldo Códova G, Castro JS, Ro-dríguez L, Saravia V, Arvelaez J, et al. Chikun-gunya fever: Atypical and lethal cases in the Western hemisphere: A Venezuelan experience. IDCases. 2015;2:6-10
Rodriguez-Morales AJ, Orrego-Acevedo CA, Zambrano-Munoz Y, Garcia-Folleco FJ, Herre-ra-Giraldo AC, Lozada-Riascos CO. Mapping ma-laria in municipalities of the Coffee Triangle region of Colombia using Geographic Information Systems (GIS). J. of inf. and public health. 2015
Rodriguez-Morales AJ, Paniz-Mondolfi AE. Venezuela’s failure in malaria control. Lancet. 2014;384(9944):663-4
Vera-Polania F, Munoz-Urbano M, Banol-Giraldo AM, Jimenez-Rincon M, Granados-Alvarez S, Rodriguez-Morales AJ. Bibliometric assessment of scientific production of literature on chikungunya. J. of inf. and public health. 2015;8:386-8
Cardona-Ospina JA, Vera-Polania F, Rodri-guez-Morales AJ. Chikungunya or not, differential diagnosis and the importance of laboratory confirma-tion for clinical and epidemiological research: com-ment on the article by Rosario et al. Clinical rheuma-tology. 2015.
Clouet-Huerta D, Alfaro-Toloza P, Rodriguez-Morales AJ. [Chikungunya in the Americas: prepa-redness, surveillance and alert in Chile]. R. chilena de infectologia : organo oficial de la Sociedad Chilena de Infectologia. 2014;31:761-2
Rodriguez-Morales A, Cardona-Ospina J, Vi-llamil-Gómez W, Paniz-Mondolfi A. How many patients with post-chikungunya chronic inflammatory rheumatism can we expect in the new endemic areas of Latin America? Rheumatology international. 2015.
Rodriguez-Morales AJ, Cardenas-Giraldo EV, Montoya-Arias CP, Guerrero-Matituy EA, Be-doya-Arias JE, Ramirez-Jaramillo V, et al. Map-ping chikungunya fever in municipalities of one coastal department of Colombia (Sucre) using geographic in-formation system (GIS) during 2014 outbreak: Implica-tions for travel advice. Travel medicine and infectious disease. 2015;13:256-8.
Jimenez-Canizales CE, Medina-Gaitan DA, Mondragon-Cardona AE, Rodriguez-Morales AJ. From imported to an endemic disease: impact of chikungunya virus disease in the hospital epidemio-logy, tolima, Colombia, 2014-2015. Recent patents on anti-infective drug discovery. 2015;10:64-6
Dupuis-Maguiraga L, Noret M, Brun S, Le Grand R, Gras G, Roques P.Chikungunya disea-se: infection-associated markers from the acute to the chronic phase of arbovirus-induced arthralgia. PLoS neglected tropical diseases. 2012;6:e1446.
Petitdemange C, Wauquier N, Vieillard V. Con-trol of immunopathology during chikungunya virus in-fection. The Journal of allergy and clinical immunology. 2015;135:846-55
Bedoya-Arias JE, Murillo-Garcia DR, Bolanos-Munoz E, Hurtado-Hurtado N, Ramirez-Ja-ramillo V, Granados-Alvarez S,et al. Healthcare students and workers’ knowledge about epidemiology and symptoms of chikungunya fever in two cities of Colombia. Journal of infection in developing countries. 2015;9:330-2
Suryawanshi SD, Dube AH, Khadse RK, Jal-gaonkar SV, Sathe PS, Zawar SD, et al. Clinical profile of chikungunya fever in patients in a tertiary care centre in Maharashtra, India. The Indian journal of medi-cal research. 2009;129:438-41
Rajapakse S, Rodrigo C, Rajapakse A. Atypical manifestations of chikungunya infection. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2010;104:89-96
Chusri S, Siripaitoon P, Hirunpat S, Silpa-pojakul K. Case reports of neuro-Chikungunya in southern Thailand. The American journal of tropical medicine and hygiene. 2011;85:386-9
Ganesan K, Diwan A, Shankar SK, Desai SB, Sainani GS,Katrak SM. Chikungunya encepha-lomyeloradiculitis: report of 2 cases with neuroimaging and 1 case with autopsy findings. AJNR Am J Neurora-diol. 2008;29:1636-7
Maity P, Roy P, Basu A, Das B, Ghosh US.A case of ADEM following Chikungunya fever. The J. of the As-sociation of Physicians of India. 2014;62(5):441-2.
Economopoulou A, Dominguez M, Helynck B, Sissoko D, Wichmann O, Quenel P, et al. Atypical Chikungunya virus infections: clinical mani-festations, mortality and risk factors for severe disease during the 2005-2006 outbreak on Reunion. Epidemiol Infect. 2009;137:534-41
Alla SAO, Combe B.Arthritis after infection with Chikungunya virus. Best Practice & Research Clinical Rheumatology. 2011;25:337-46.
Arroyo-Ávila M, Vilá LM. Rheumatic Manifesta-tions in Patients with Chikungunya Infection. Puerto Rico Health Sciences J. 2015;34:71-7.
Teng TS, Kam YW, Lee B, Hapuarachchi HC, Wimal A, Ng LC, et al. A Systematic Meta-analysis of Immune Signatures in Patients With Acute Chikungun-ya Virus Infection. The Journal of infectious diseases. 2015;211:1925-35.
Stroup DF, Berlin JA, Morton SC, Olkin I, Wi-lliamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epi-demiology (MOOSE) group. JAMA. 2000;283:2008-12
Dekkers OM, Egger M, Altman DG, Vanden-broucke JP. Distinguishing case series from cohort studies. Ann Intern Med. 2012;156:37-40.
Weaver SC, Lecuit M. Chikungunya virus and the global spread of a mosquito-borne disease. The New England J. of medicine. 2015;372:1231-9
Margulis AV, Pladevall M, Riera-Guardia N, Varas-Lorenzo C, Hazell L, Berkman ND, et al. Quality assessment of observational studies in a drug-safety systematic review, comparison of two tools: the Newcastle-Ottawa Scale and the RTI item bank. Clinical epidemiology. 2014;6:359-68.
Neyeloff JL, Fuchs SC, Moreira LB. Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analy-sis. BMC research notes. 2012;5:52
Carod-Artal FJ, Wichmann O, Farrar J, Gascon J. Neurological complications of dengue virus infec-tion. The Lancet Neurology. 2013;12:906-19
Delbue S, Ferrante P, Mariotto S, Zanusso G, Pavone A, Chinaglia M, et al. Review of West Nile virus epidemiology in Italy and report of a case of West Nile virus encephalitis. Journal of neurovirology. 2014;20:437-41.
Ramos C, Sanchez G, Pando RH, Baquera J, Hernandez D, Mota J, et al. Dengue virus in the brain of a fatal case of hemorrhagic dengue fever. Jour-nal of neurovirology. 1998;4:465-8.
Velandia-Romero ML, Acosta-Losada O, Cas-tellanos JE.In vivo infection by a neuroinvasive neurovirulent dengue virus. Journal of neurovirology. 2012;18:374-87
Rampal, Sharda M, Meena H. Neurological com-plications in Chikungunya fever. The Journal of the As-sociation of Physicians of India. 2007;55:765-9
Singh RK, Tiwari S, Mishra VK, Tiwari R, Dho-le TN. Molecular epidemiology of Chikungunya virus: mutation in E1 gene region. J Virol Methods. 2012;185:213-20.
Staikowsky F, Talarmin F, Grivard P, Souab A, Schuffenecker I, Le Roux K, et al. Prospective stu-dy of Chikungunya virus acute infection in the Island of La Reunion during the 2005-2006 outbreak. PloS one. 2009;4(10):e7603
Lewthwaite P, Vasanthapuram R, Osborne JC, Begum A, Plank JL, Shankar MV, et al.Chikungunya virus and central nervous system infec-tions in children, India. Emerging infectious diseases. 2009;15:329-31
Gerardin P, Fianu A, Malvy D, Mussard C, Boussaid K, Rollot O, et al. Perceived morbidity and community burden after a Chikungunya outbreak: the TELECHIK survey, a population-based cohort study. BMC medicine. 2011;9:5.
Kashyap RS, Morey SH, Chandak NH, Purohit HJ, Taori GM, Daginawala HF. Detection of viral antigen, IgM and IgG antibodies in cerebrospinal fluid of Chikungunya patients with neurological complica-tions. Cerebrospinal fluid research. 2010;7:12.
Chandak NH, Kashyap RS, Kabra D, Karan-dikar P, Saha SS, Morey SH, et al. Neurological complications of Chikungunya virus infection. Neuro-logy India. 2009;57(2):177-80
Rodríguez-Morales AJ, Cardona-Ospina JA, Urbano-Garzón SF, Hurtado-Zapata JS. Pre-valence of post-Chikungunya Chronic Inflammatory Rheumatism: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2016 Epub Ahead Mar 25; available online at: http://onlinelibrary.wiley.com/doi/10.1002/acr.22900/abstract
Rodriguez-Morales AJ, Gil-Restrepo AF, Ra-mírez-Jaramillo V, Montoya-Arias CP, Ace-vedo-Mendoza WF, Bedoya-Arias JE, et al.Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia. [version 2; referees: 3 approved] F1000Research 2016, 5:360.
Sarmiento-Ospina A, Vásquez-Serna H, Jime-nez-Canizales CE, Villamil-Gómez WE, Rodri-guez-Morales AJ. Zika associated deaths in Colom-bia. Lancet Infect Dis 2016; 16:523-524.
Arzuza-Ortega L, Polo A, Pérez-Tatis G, López-García H, Parra E, Pardo-Herrera LC, et al. Fatal Sickle Cell Disease and Zika Virus Infection in Girl from Colombia. Emerg Infect Dis 2016; 22:925-927
Rodriguez-Morales AJ, Villamil-Gómez W. El Reto de Zika en Colombia y América Latina: Una emer-gencia sanitaria internacional. Infectio 2016; 20:59-61
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