Neuroaxis involvement in Chikungunya virus infection: a retrospective case series

Chikungunya virus (CHIKV) is an arthropod-borne virus belonging to the genus Alphavirus; it has been increasingly linked to neurological complications. This study aimed to highlight the neurological manifestations of chikungunya virus infection.

This retrospective case series was conducted at the Aga Khan University Hospital, Karachi, Pakistan. Adult patients (aged 18 years and above) with typical arboviral prodrome (fever, arthralgias, myalgias) who tested positive for chikungunya IgM antibodies in serum and demonstrated new-onset neurological symptoms were included in the study. The sample size consisted of 18 patients. Descriptive statistics were used to demonstrate demographics and the clinical, radiological, and electrodiagnostic details of participants. Patients with neuro-chikungunya were trichotomized based on the extent of neuroaxis involvement into those with central nervous system (CNS) involvement, those with CNS and peripheral nervous system (PNS) involvement, and those with isolated PNS involvement.

This study found heterogenous nervous system involvement in chikungunya virus infection, including the brain, spinal cord, nerve roots, and peripheral nerves in variable combinations. The majority of patients in this cohort had CNS involvement (55%). Patients with widespread neuroaxis involvement tended to have a complicated hospital course leading to intensive care unit admission and even mortality.

The widespread neurological involvement seen in this study potentially points towards the possibility that chikungunya virus may affect the entire neuroaxis. Studies focusing on long-term sequelae are needed to ascertain the prognosis of neuro-chikungunya.