Autoimmune Neurological Complications of Chikungunya Virus - Does it really trigger

Dr. Bharat Bhushan; Dr. C.P. Meena; Dr Gopikishan Sharma; Dr. Sushil Kumar; Dr. Hemant Kumar Richhariya

Volume : VIII, Issue : V, May - 2019

Autoimmune Neurological Complications of Chikungunya Virus - Does it really trigger

Dr. Bharat Bhushan, Dr. C. P. Meena, Dr Gopikishan Sharma, Dr. Sushil Kumar, Dr. Hemant Kumar Richhariya

Abstract :

Introduction: Our aim was to study Chikungunya related autoimmune neurological complications (ANC) during the recent epidemic. Material and Methods: This was a cross–sectional observational study of 164 Laboratory confirmed cases out of 1840 cases, which were screened for chikungunya virus infection from October 2017 to October 2018 and followed–up for 3 months. Laboratory, clinicoradiological data, predictors of neuraxial involvement, correlations, and outcome by immunomodulation were also analyzed. Results: Out of the 164 confirmed Chikungunya cases, 48.13% developed overall neurological complications and only 23.8% cases had ANC. In ANC, majority had onset in the subacute (7–30 days) latency period without any mortality. We found Miller Fisher Syndrome (MFS) and peripheral ganglionic cyst formation as a new finding in ANC spectrum. Chikungunya patients were more prone to develop achial plexus neuritis, polyneuritis cranialis and Guillain–Barre Syndrome (GBS). Significant (P<0.001) predictors of central nervous system involvement were anemia and elevated uric acid levels, whereas patients with higher mean body temperature and ANA positive status were more prone for peripheral nervous system involvement. Platelets counts and hemoglobin levels had a negative correlation whereas mean body temperature and alanine aminotransferase levels had a moderately significant positive correlation for development of ANC. Immunomodulatory therapy (IMT), if initiated after fever abatement, leads to significant clinical favorable outcome at 3 months, especially in patients with GBS, polyneuritis cranialis, and achial plexus neuritis. Conclusion: The spectrum of ANC in chikungunya infection may include MFS and peripheral ganglionic cyst formation. Early initiation of IMT, in the presence of significant predictors, may reduce ANC related morbidity