Fatal encephalitis associated with Zika virus infection in an adult.
Zika virus (ZIKV) was first identified in the Americas in 2015, when an outbreak of an exanthematous illness occurred in Brazil. Subsequentely, there was an increase of microcephaly cases, suggesting an association between ZIKV and this neurological complication. Currently, ZIKV has been recognised as causing a wide range of neurological complications including Guillain Barré syndrome, and myelitis.



In this report, we describe the first fatal case of encephalitis in a 47 years old non pregnant woman, infected during the Brazilian zika epidemic of 2016.



The diagnosis of encephalitis was determined by the presence of a disturbed level of consciousness and focal neurological signs during an exanthemous viral infection.



CSF analysis supported the diagnosis of viral encephalitis, revealing lymphocytic pleocytosis, a high protein concentration, and the presence of IgM zika antibodies. RT-PCR analysis for ZIKV was positive in the urine. A brain computed tomography showed massive brain swelling. Our case differs from previous reports, because her neurological picture developed rapidly and in a very aggressive manner leading to brain death after eleven days of admission.



In endemic areas, ZIKV should be considered as an aetiological agent in cases of encephalitis, and clinicians should be aware of its potential severity.
Hospital Federal dos Servidores do Estado, Neurology Service, Rua Sacadura Cabral 176, Rio de Janeiro, RJ, Brazil. Electronic address: crist_nsoares@yahoo.com.br.
Cristiane N
CN
Soares
Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Patrícia
P
Brasil
Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK.
Raquel Medialdea
RM
Carrera
Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.
Patricia
P
Sequeira
Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.
Ana Bispo
AB
de Filippis
Hospital Badim, Rio de Janeiro, Brazil.
Vitor A
VA
Borges
Hospital Badim, Rio de Janeiro, Brazil.
Fernando
F
Theophilo
Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK; Walton Centre NHS Foundation Trust, Liverpool, UK.
Mark A
MA
Ellul
Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK; Walton Centre NHS Foundation Trust, Liverpool, UK.
Tom
T
Solomon
D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D018792:Encephalitis, Viral; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D000071244:Zika Virus; D000071243:Zika Virus Infection
Encephalitis; Neurological manifestations; Zika virus