Oropouche Fever Associated with Combined Central and Peripheral Demyelination (CCPD): A Case Report from Ceará, Brazil, 2024

  1. Carlos Garcia Filho
  2. Antonio Silva Lima Neto
  3. Ana Maria Cabral Maia
  4. Fernanda Martins Maia Carvalho
  5. Matheus Andrighetti Rossi
  6. Milena Sales Pitombeira
  7. Paula Camila Alves de Assis Pereira Mato
  8. Tania Mara Silva Coelho
  9. Lauro Vieira Perdigão Neto
  10. Lívia Mendes de Almeida
  11. Felipe Gomes Naveca
  12. Kleber Giovanni Luz
  13. Andre Ricardo Ribas Freitas
  14. Luciano Pamplona de Góes Cavalcanti

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Abstract

Background: Oropouche fever, caused by the Oropouche orthobunyavirus (OROV), is an arboviral illness transmitted by midges and mosquitoes. Although commonly regarded as a mild illness, severe neurological manifestations are increasingly being reported. Case Summary: We report a 48-year-old female patient  without comorbidities, from Capistrano, Ceará, Brazil, who developed Combined Central and Peripheral Demyelination (CCPD) following confirmed OROV infection. Her clinical presentation included ascending flaccid tetraparesis, bilateral facial paresis, and progressive visual loss. Neurological investigation confirmed demyelinating polyneuropathy and retrobulbar optic neuritis. Despite initial corticosteroid therapy, gradual and partial clinical improvement was observed after plasmapheresis; however, visual and motor deficits persisted even after 90 days. Conclusion: A reported case of combined central and peripheral demyelination (CCPD) associated with OROV represents an unprecedented complication, emphasizing the potential for severe outcomes linked to OROV infection. This highlights the need for increased clinical awareness and greater attention to the epidemiology of this disease. OROV infection has demonstrated the capacity to cause severe neuroinvasive complications, underscoring its critical and emerging epidemiological significance amidst the ongoing epidemic in the Americas. Driven by a novel reassortant lineage of OROV, this outbreak has been associated with previously unreported severe manifestations, including adult and fetal deaths. Enhanced surveillance systems and targeted training for the early recognition of neurological complications are essential to mitigate long-term impacts and guide public health strategies to address the growing burden of this arboviral infection.

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  1. PREreview

    This Zenodo record is a permanently preserved version of a Structured PREreview. You can view the complete PREreview at https://prereview.org/reviews/14951887.

    Does the introduction explain the objective of the research presented in the preprint? Yes The introduction of the Preprint clearly explains the objectives of the paper making it an appropriate section. It provided the background to the study and also reason for this case report
    Are the methods well-suited for this research? Highly appropriate The case report methodological approach was clearly stated. However, the author did not provide justification for choosing plasma apheresis over other immunomodulators
    Are the conclusions supported by the data? Highly supported
    Are the data presentations, including visualizations, well-suited to represent the data? I don't know
    How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research? Somewhat clearly The discussion of their findings seems to be somewhat clear because the paper didn't justify the reason why the laboratory findings is not aligning with their diagnosis as this condition seems to be an autoimmune disorder. Also, their cell count and differential seems to be inappropriate because how can it be justified to have the percentage reported in Lymphocytes and neutrophils when the cell count is just 2cells/ul.
    Is the preprint likely to advance academic knowledge? Highly likely The Preprint clearly calls for public awareness of the neurological defect with OROV infection and also calls for public health action as this is a major concern to the outbreak. This Preprint also reveals the need to strengthen surveillance towards the detection of the infection to prevent morbidity and mortality from the outbreak
    Would it benefit from language editing? No
    Would you recommend this preprint to others? Yes, it's of high quality Provided the suggestion raised are addressed
    Is it ready for attention from an editor, publisher or broader audience? Yes, after minor changes

    Competing interests

    The authors declare that they have no competing interests.

  2. Version published to 10.1590/scielopreprints.10912 on SciELO Preprints