- To establish the impact of Zika, Chikungunya and Dengue viral infections in the epidemiology of neurological problems in the Americas.
- To establish an international registry of neurological problems associated with arboviruses in the Americas.
- To Determine the role of Zika, Chikungunya and Dengue viruses in the pathogenesis of neuroinflammatory diseases in the Americas.
How we do it?
Any health care provider in the Americas, who as part of their practice encounters patients with new onset of neurological disease and suspected infection by mosquito-borne viruses such as Dengue (DENV), Chikungunya (CHIKV) and Zika (ZIKV) viruses can register their case on this website
The clinical information, physical exam, laboratories, lumbar puncture and Magnetic Resonance Imaging (if is available), will be collected through a virtual questionnaire on this website. The provided information will be stored in the NEAS central server.
If a center expects to encounter several cases and wants to have access to the submitted information, to modify it or even administer their uploaded cases, they can contact us to become a NEAS Center. A username and a password will be assigned to the center leader in order to handle higher amount of patients.
Arbovirus-related neurological complications in the Americas – Study design
NEAS corresponds to a multicentric case-control study focus on the arbovirus-related neuroinflammatory complications. Dengue, Chikungunya and Dengue viruses are the arboviruses of our interest.
A NEAS center has the capability to register eligible participants, whatever cases or controls. We will analyze the collected information and biological samples (e.g. blood, urine and cerebrospinal fluid) in order to answer:
- Is there any causal association between arbovirus infections and some neuroinflammatory diseases?
- Which are the clinical and laboratory profiles of the neuroinflammatory diseases possibly arbovirus-related?
- How is the host immune response against the reemerging arboviruses infection in the Americas? Which are the viral genetic features of the reemerging arboviruses in the Americas?
Who can participate?
Who is a case?
- Guillain-Barre syndrome.
- Miller-Fisher syndrome.
- Unilateral/Bilateral optic neuritis reported on physical examination.
- III, IV and/or VI cranial nerves palsy reported on physical examination.
- Unilateral/Bilateral facial palsy.
- Lower/bulbar cranial nerves palsy causing hoarse/muffled voice, dysphagia or swallowing disturbances. Those findings would be reported on physical examination.
Who is a control?
NEAS collect multiple controls for each case:
- Hospital control.
- Home control.
- Neighborhood control.
- Control with a confirmed arbovirus infection, but with no neurological symptoms.
Diagnostic criteria of eligible cases
Features required for diagnosis:
- Progressive weakness in both arms and legs (might start with weakness only in the legs) Areflexia (or decreased tendon reflexes)
- Features that strongly support diagnosis:
- Progression of symptoms over days to 4 weeks.
- Relative symmetry of symptoms
- Mild sensory symptoms or signs Cranial nerve involvement, especially bilateral weakness of facial muscles
- Autonomic dysfunction
- Pain (often present)
- High concentration of protein in CSF
- Typical electrodiagnostic features
Features that should raise doubt about the diagnosis:
- Severe pulmonary dysfunction with limited limb weakness at onset
- Severe sensory signs with limited weakness at onset
- Bladder or bowel dysfunction at onset Fever at onset
- Sharp sensory level (think about myelitis)
- Slow progression with limited weakness without respiratory involvement (consider subacute inflammatory demyelinating polyneuropathy or CIDP)
- Marked persistent asymmetry of weakness
- Persistent bladder or bowel dysfunction (think about myelitis)
- Increased number of mononuclear cells in CSF (>50 cells/mm3)
- Polymorphonuclear cells in CSF
Source: Adapted from Asbury A. K., Cornblath D. R. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol (1990); 27(2):1-4.
|Level 1 of Diagnostic Certainty||Level 2 of Diagnostic Certainty||Level 3 of Diagnostic Certainty|
Source: J.J. Sejvar et al. Guillain–Barré syndrome and Fisher syndrome: Case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 29 (2011) 599–612
Features required for diagnosis
- Bilateral ophthalmoparesis or ophthalmoplegia
- Areflexia (or decreased tendon reflexes)
Features that support diagnosis
- Progression of symptoms over days to 4 weeks
- Relative symmetry of symptoms
- Mild limb weakness (in case of prominent limb weakness, consider GBS-MFS overlap syndrome)
- Mild sensory symptoms or signs (in case of prominent sensory symptoms or signs, consider GBS-MFS overlap syndrome)
- Facial palsy and/or bulbar palsy
- Presence of serum IgG antibodies against ganglioside GQ1b
- Nerve conduction studies: no changes in extremities
- High concentration of protein in CSF, cytoalbuminologic dissociation
Features that should raise doubt about the diagnosis
- Alterations in consciousness
- Corticospinal tract signs
- Fever at onset
- Marked persistent asymmetry of weakness
Adapted from Sejvar JJ, Kohl KS. Guillain-Barré syndrome and Fisher syndrome: Case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2011;29: 599-612 and van der Meché FGA, van Doorn PA. Diagnostic and Classification Criteria for the GuillainBarréSyndrome. Eur Neurol 2001;45:133-139.
- Sensory, motor or autonomic dysfunction attributable to the spinal cord.
- Inflammation of the spinal cord demonstrated by CSF pleocytosis, an elevated IgG index or lesion enhancement in MRI.
- Exclusion of a compressive etiology by neuroimaging
Findings that support diagnosis but are not required: clear sensory level, bilateral signs and symptoms but not necessarily symmetric.
Source: Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of actute transverse myelitis. Neurology (2002); 59(4):499-505.
Infarction of the brain attributable to ischemia or hemorrhage based on
- Pathological, imaging, or other objective evidence of cerebral, spinal cord, or retinal focal ischemic injury in a defined vascular distribution; or
- Clinical evidence of cerebral ischemic injury based on symptoms persisting ≥24 hours or until death, and other etiologies excluded.
Source: Sacco R. L. et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke (2013); 44(7):2064-89.
- Major Criterion (required): Patients presenting to medical attention with altered mental status (defined as decreased or altered level of consciousness, lethargy or personality change) lasting at least or > 24 h with no alternative cause identified.
- Minor criteria (2 required for possible encephalitis; at least 3 or more for probable or confirmed encephalitis)
- Documented fever >38ºC within 72 h before or after presentation.
- Generalized or partial seizure not fully attributable to a preexisting seizure disorder.
- New onset of focal neurologic findings.
- CSF WBC count at least or > 5 cells/mm3
- Abnormality of brain parenchyma on neuroimaging suggestive of encephalitis that is either new from prior studies or appears acute in onset.
- Abnormality on electroencephalography not attributable to another cause.
Source: A. Venkatesan et al. Case Definitions, Diagnostic Algorithms, and Priorities in Encephalitis: Consensus Statement of the International Encephalitis Consortium. CID (2013); 57:1114-1128
¿What is ZikaPLAN?
NEAS became part of the ZikaPLAN (Preparedness Latin America Network), an initiative supported by the European Union which joins the strengths of 25 research partners in Latin America, North America, Africa, Asia and Europe to study the maternal and neurological complication associated with the emergence of Zika virus. The two main purposes of the ZikaPLAN are to address the current knowledge gaps on Zika virus and to prepare a sustained Latin America network able to respond to the emerging infectious diseases outbreaks in the future.
This website is curated by the Neuroimmunopathology Laboratory at the Division of Neuroimmunology and Neuroinfectious Disorders, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287. This project is funded in part by Johns Hopkins Project Restore & The Bart McLean Fund for Neuroimmunology Research.