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Neurological Disease Associated with Chikungunya in Indonesia

Khin S. A. MyintEijkman Institute for Molecular Biology, Jakarta, Indonesia;

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Arthur H. P. MawuntuFaculty of Medicine, Universitas Sam Ratulangi, R.D. Kandou Hospital, Manado, Indonesia;

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Sotianingsih HaryantoRaden Mattaher Hospital, Jambi, Indonesia;
Faculty of Medicine and Health Sciences, Universitas Jambi, Jambi, Indonesia;

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Darma ImranFaculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia;

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Sofiati DianFaculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia;

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Yora P. DewiEijkman Institute for Molecular Biology, Jakarta, Indonesia;

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Ahmad R. GaniemFaculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia;

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Riane AnggreaniFaculty of Medicine, Universitas Sam Ratulangi, R.D. Kandou Hospital, Manado, Indonesia;

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Mirna M. IskandarRaden Mattaher Hospital, Jambi, Indonesia;
Faculty of Medicine and Health Sciences, Universitas Jambi, Jambi, Indonesia;

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Janno B. B. BernadusFaculty of Medicine, Universitas Sam Ratulangi, R.D. Kandou Hospital, Manado, Indonesia;

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Kartika MaharaniFaculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia;

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David SusantoFaculty of Medicine, Universitas Sam Ratulangi, R.D. Kandou Hospital, Manado, Indonesia;

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Riwanti EstiasariFaculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia;

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Hasna DewiFaculty of Medicine and Health Sciences, Universitas Jambi, Jambi, Indonesia;

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Amanda KristianiKS Prima Laboratory, Jambi, Indonesia;

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Lidia GaghiwuFaculty of Medicine, Universitas Sam Ratulangi, R.D. Kandou Hospital, Manado, Indonesia;

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Edison JoharEijkman Institute for Molecular Biology, Jakarta, Indonesia;

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Frilasita A. YudhaputriEijkman Institute for Molecular Biology, Jakarta, Indonesia;

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Ungke AntonjayaEijkman Institute for Molecular Biology, Jakarta, Indonesia;
Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia;

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Jeremy P. LedermannCenters for Disease Control and Prevention, Fort Collins, Colorado;

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Reinout van CrevelDepartment of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands;

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Raph L. HamersEijkman-Oxford Clinical Research Unit, Jakarta, Indonesia;
Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom

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Ann M. PowersCenters for Disease Control and Prevention, Fort Collins, Colorado;

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ABSTRACT.

Chikungunya virus (CHIKV) is recognized but rarely considered as a cause of central nervous system infection in endemic areas. A total of 244 patients with acute meningoencephalitis in Indonesia were retrospectively tested to identify whether any CHIKV infection was associated with neurological manifestations, especially in provinces known for CHIKV endemicity. Cerebrospinal fluid (CSF) and blood specimens were tested using CHIKV-specific real-time reverse transcription polymerase chain reaction and IgM ELISA, alongside a panel of neurotropic viruses. We report four cases of suspected or confirmed CHIKV-associated neurological disease, including CHIKV RNA detection in CSF of one patient and in acute serum of another, and CHIKV IgM in CSF of three patients and in serum of a fourth. In conclusion, CHIKV should be considered as a cause of neurologic disease in endemic areas and especially during outbreaks, in addition to the more common arboviral diseases such as dengue and Japanese encephalitis viruses.

Author Notes

Address correspondence to Khin S. A. Myint, Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jalan Pangeran Diponegoro No. 69, DKI Jakarta, Indonesia. E-mail: khinsawying@hotmail.com

Financial support: This work was supported by the Ministry of Research and Technology, Republic of Indonesia; Sam Ratulangi University Medical Faculty; Faculty of Medicine and Health Sciences, Universitas Jambi; and the U.S. Centers for Disease Control and Prevention. The Indonesia Brain Infection Study received support from the U.S. National Institutes of Health through the ULTIMATE project (Grant no. R01AI145781). RLH is supported by the Wellcome Trust.

Disclaimers: The funding institutions did not participate in study design, data collection or analysis, decision to publish, or preparation of the manuscript. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Authors’ addresses: Khin S. A. Myint, Yora P. Dewi, Edison Johar, and Frilasita A. Yudhaputri, Eijkman Institute for Molecular Biology, Jakarta, Indonesia, E-mails: khinsawying@hotmail.com, yoradewi@eijkman.go.id, edisonjohar@eijkman.go.id, and sisi@eijkman.go.id. Arthur H. P. Mawuntu, Riane Anggreani, Janno B. B. Bernadus, David Susanto, and Lidia Gaghiwu, Faculty of Medicine, Universitas Sam Ratulangi, R. D. Kandou Hospital, Manado, Indonesia, E-mails: arthur_mawuntu@yahoo.com, ririanggreani636@gmail.com, jannobernadusmd@gmail.com, david_susanto@outlook.com, and gaghiwulidia@gmail.com. Sotianingsih Haryanto and Mirna M. Iskandar, Raden Mattaher Hospital, Jambi, Indonesia, and Faculty of Medicine and Health Sciences, Universitas Jambi, Jambi, Indonesia, E-mails: sotianingsih@yahoo.com and mirnamiskandar@gmail.com. Darma Imran, Kartika Maharani, and Riwanti Estiasari, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia, E-mails: darma_imran@yahoo.com, tikamaharanimd@gmail.com, and estiasari@gmail.com. Sofiati Dian and Ahmad R. Ganiem, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, E-mails: sofiatidian@gmail.com and rizalbdg@gmail.com. Hasna Dewi, Faculty of Medicine and Health Sciences, Universitas Jambi, Jambi, Indonesia, E-mail: hasnadewidr@gmail.com. Amanda Kristiani, KS Prima Laboratory, Jambi, Indonesia, E-mail: amandakristianii@gmail.com. Ungke Antonjaya, Eijkman Institute for Molecular Biology, Jakarta, Indonesia, and Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia, E-mail: ungkeajy@gmail.com. Jeremy P. Ledermann and Ann M. Powers, Centers for Disease Control and Prevention, Fort Collins, CO, E-mails: jledermann@cdc.gov and apowers@cdc.gov. Reinout van Crevel, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands, E-mail: reinout.vancrevel@radboudumc.nl. Raph L. Hamers, Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia, and Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom, E-mail: rhamers@eocru.org.

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