Acute paralysis and neuro-inflammation in Jamaican children during Zika virus and dengue epidemics of 2016

Abstract

Dengue, Chikungunya virus (CHIKV) and Zika virus (ZIKV) are all transmitted by the Aedes aegypti mosquito and are currently circulating in Jamaica. Jamaica has been experiencing a ZIKV epidemic since February 2016. At the University Hospital of the West Indies (UHWI), Kingston, Jamaica, a cluster of five cases of paralysis attributed to neuro-inflammation was noted amongst adolescents admitted to the institution. Three were diagnosed with acute myelitis and one each with acute disseminated encephalomyelitis (ADEM) and Guillain Barre syndrome (GBS). In these patients, there were common presenting symptoms, characteristic findings of peripheral nerve involvement and a history of contact with persons with symptoms of possible ZIKV in the majority. In only one case was a viral association, Dengue infection, confirmed. This case series suggests a unique clinical pattern of neuro-inflammation in Jamaican adolescents occurring during the ZIKV epidemic and questions the role of the three circulating arboviruses in the pathogenesis.