Abstract：
Chikungunya disease typically presents with the fever-arthralgia-rash symptom triad. However, an increase in the number of atypical clinical manifestations, particularly neurological disorders, has occurred. The current evidence regarding the pooled prevalence of Chikungunya virus (CHIKV)-associated neurological cases (CANCs) suspected of having an arboviral aetiology is not well-understood. Therefore, this meta-analysis included 19 studies (n = 7319 patients) and aimed to determine the pooled rate of exposure to CANC. The pooled positivity rate of CANC was 12 % (95 % CI: 6-19), and Brazil was overrepresented (11/19). These estimations varied between 3 and 14 % based on the diagnostic method (real-time PCR vs. ELISA-IgM) and biological samples (cerebrospinal fluid or blood specimens) used for detection of CHIKV. Regarding the frequency of CHIKV in neurological clinical subgroups, the rates were higher among patients with myelitis (27 %), acute disseminated encephalomyelitis (27 %), Guillain-Barré syndrome (15 %), encephalitis (12 %), and meningoencephalitis (7 %). Our analysis highlights the significant burden of CANC. However, the data must be interpreted with caution due to the heterogeneity of the results, which may be related to the location of the studies covering endemic periods and/or outbreaks of CHIKV. Current surveillance resources should also focus on better characterizing the epidemiology of CHIKV infection in neurological disorders. Additionally, future studies should investigate the interactions between CHIKV and neurological diseases with the aim of gaining deeper insight into the mechanisms underlying the cause-and-effect relationship between these two phenomena.
摘要：
基孔肯雅病通常表现为发烧-关节痛-皮疹症状三联症。然而,非典型临床表现的数量增加，特别是神经系统疾病，已经发生了。目前关于基孔肯雅病毒（CHIKV）相关的神经系统病例（CANC）的合并流行率的证据尚不清楚。因此,这项荟萃分析纳入了19项研究(n=7319例患者),旨在确定合并的CANC暴露率.CANC的合并阳性率为12%(95%CI:6-19)，巴西任职人数偏高（11/19）。根据诊断方法，这些估计值在3%到14%之间变化(实时PCR与ELISA-IgM）和用于检测CHIKV的生物样品（脑脊液或血液标本）。关于CHIKV在神经系统临床亚组中的频率，脊髓炎患者的发病率更高(27%)，急性播散性脑脊髓炎（27%），格林-巴利综合征（15%）脑炎（12%），和脑膜脑炎（7%）。我们的分析强调了CANC的重大负担。然而,由于结果的异质性，必须谨慎解释数据，这可能与涵盖CHIKV流行期和/或暴发的研究地点有关。当前的监测资源还应侧重于更好地表征神经系统疾病中CHIKV感染的流行病学。此外,未来的研究应该探讨CHIKV与神经系统疾病之间的相互作用,以期更深入地了解这两种现象之间因果关系的潜在机制.
