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Zika Virus Meningoencephalitis

      To the Editor:
      In the March 2017 issue of Mayo Clinic Proceedings, Schwartzmann et al
      • Schwartzmann P.V.
      • Ramalho L.N.
      • Neder L.
      • et al.
      Zika virus meningoencephalitis in an immunocompromised patient.
      reported on a single case of Zika virus meningoencephalitis and concluded that, “In this case, central nervous system involvement and ZIKV propagation to other organs in a disseminated pattern is quite similar to that observed in other fatal Flaviviridae viral infections.” The patient reported by Schwartzmann et al
      • Schwartzmann P.V.
      • Ramalho L.N.
      • Neder L.
      • et al.
      Zika virus meningoencephalitis in an immunocompromised patient.
      was immunocompromised at the time of Zika virus infection; however, meningoencephalitis accompanying Zika virus infection has also been reported in apparently immunocompetent patients.
      • Duca L.M.
      • Beckham J.D.
      • Tyler K.L.
      • Pastula D.M.
      Zika virus disease and associated neurologic complications.
      An interesting question is whether the immune status has any relationship to the occurrence of meningoencephalitis. In the similar arbovirus infection, dengue infection, meningoencephalitis can also be seen regardless of immune status.
      • Araújo F.M.
      • Araújo M.S.
      • Nogueira R.M.
      • et al.
      Central nervous system involvement in dengue: a study in fatal cases from a dengue endemic area.
      In our setting in Southeast Asia, dengue is highly prevalent and Zika virus infection is also endemic. Nevertheless, Zika virus infection is usually asymptomatic and neurological manifestations are extremely rare. Furthermore, despite an extremely high prevalence of dengue in our area (30-224 cases per 100,000
      • Limkittikul K.
      • Brett J.
      • L'Azou M.
      Epidemiological trends of dengue disease in Thailand (2000–2011): a systematic literature review.
      ), there has never been a report on meningoencephalitis in dengue patients regardless of immune status.

      References

        • Schwartzmann P.V.
        • Ramalho L.N.
        • Neder L.
        • et al.
        Zika virus meningoencephalitis in an immunocompromised patient.
        Mayo Clin Proc. 2017; 92: 460-466
        • Duca L.M.
        • Beckham J.D.
        • Tyler K.L.
        • Pastula D.M.
        Zika virus disease and associated neurologic complications.
        Curr Infect Dis Rep. 2017; 19: 4
        • Araújo F.M.
        • Araújo M.S.
        • Nogueira R.M.
        • et al.
        Central nervous system involvement in dengue: a study in fatal cases from a dengue endemic area.
        Neurology. 2012; 78: 736-742
        • Limkittikul K.
        • Brett J.
        • L'Azou M.
        Epidemiological trends of dengue disease in Thailand (2000–2011): a systematic literature review.
        PLoS Negl Trop Dis. 2014; 8: e3241

      Linked Article

      • Zika Virus Meningoencephalitis in an Immunocompromised Patient
        Mayo Clinic ProceedingsVol. 92Issue 3
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          The World Health Organization considers the Zika virus (ZIKV) outbreak in the Americas a global public health emergency. The neurologic complications due to ZIKV infection comprise microcephaly, meningoencephalitis, and Guillain-Barré syndrome. We describe a fatal case of an adult patient receiving an immunosuppressive regimen following heart transplant. The patient was admitted with acute neurologic impairment and experienced progressive hemodynamic instability and mental deterioration that finally culminated in death.
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      • In Reply—Zika Virus Meningoencelphalitis
        Mayo Clinic ProceedingsVol. 92Issue 8
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          We read with interest the letter from Joob and Wiwanitkit1 which reinforced our interpretation that immunosuppression predisposes the central nervous system (CNS) to infection by Zika virus.
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