The neurological complications of chikungunya virus: A systematic review

Abstract

We performed a systematic review on the neurological complications of chikungunya virus. Such complications are being reported increasingly, owing primarily to the scale of recent epidemics but also to a growing understanding of the virus' neurovirulence. We performed a thorough literature search using PubMed and Scopus databases, summating the data on all published reports of neurological disease associated with chikungunya virus. We appraised the data for each major condition in adults, children, and neonates, as well as evaluating the latest evidence on disease pathogenesis and management strategies. The review provides a comprehensive summary for clinicians, public health officials, and researchers tackling the challenges associated with this important emerging pathogen.

Keywords: Guillain-Barré syndrome; acute disseminated encephalomyelitis; chikungunya; complications; congenital infections; encephalitis; myelitis; neonatal infection; neurological; optic neuritis; retinitis; uveitis.

Figure 1

Search strategy to identify publications on neurological complications of chikungunya

Figure 2

Presentations of nervous system disease associated with chikungunya infection

Figure 3

Global distribution of chikungunya virus and countries/territories with reported associated neurology. Key: adult and child neurological disease associated with chikungunya infection; vertically acquired neurological disease in the neonate associated with chikungunya infection. *unclear date of case(s), year refers to year of publication. Data regarding global distribution of chikungunya virus acquired from the Centers for Disease Control and Prevention website95

Figure 4

Central nervous system imaging abnormalities in patients with chikungunya infection. A, Signal abnormality involving the periventricular white matter in an 85‐year‐old patient with encephalitis (axial fluid‐attenuated inversion recovery).44 B, Confluent areas of signal abnormality consistent with demyelination in an 8‐year‐old patient with acute disseminated encephalomyelitis (coronal T2).92 C, Signal abnormality (hyperintense) involving the corpus callosum and the frontal and parietal lobes in neonate A with vertically acquired encephalopathy (day 6, axial diffusion weighted imaging).105 D, Signal abnormality (hypointense) involving the frontal and parietal lobes in neonate B with vertically acquired encephalopathy (day 21, axial diffusion‐weighted imaging).105 E, Signal abnormality at T12 in a 47‐year‐old patient with myeloradiculopathy (sagittal T1)63