Letters to the editor
Medwave 2016 Ene-Feb;16(1):e6869 doi: 10.5867/medwave.2017.01.6869
The Zika virus beyond microcephaly: will we face an increase in mental disorders?
Julio Torales, Iván Barrios
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Dear editor:

On January 15, 2016, the United States’ Centers for Disease Control and Prevention recommended pregnant women not to travel to areas where the Zika virus (ZIKV) was spreading. Only six months later, the ZIKV outbreak was already affecting more than 60 countries or territories [1],[2].

Serious birth defects, including microcephaly, are confirmed consequences of both symptomatic and asymptomatic ZIKV infection [1]. However, the consequences of ZIKV infection could go way beyond microcephaly [3]

Schizophrenia and other mental disorders have no single cause. The conditions are thought to arise from a combination of factors, including genetic predisposition and traumas later in life, such as sexual or physical abuse, abandonment or heavy drug use. Additionally, evidence has increased for years that mental disorders may be linked to exposure during pregnancy to viruses like rubella, herpes and influenza [4], and to parasites like Toxoplasma gondii. 

ZIKV bear a resemblance to some pathogens that have been linked to the development of schizophrenia, autism and bipolar disorder [3],[4],[5]. At this time, it is uncertain to define the final consequences of ZIKV infection in the central nervous system development and the possible emergence of mental disorders. Some authors have argued that neuronal migration, cellular organization, and myelination could be impaired by central nervous system infection, leading to different conditions, including major and minor brain malformations, and neuropsychiatric syndromes including intellectual impairment and autism [3]

In order to be prepare and address this possible increasing of mental disorders due to ZIKV infection, the thoughtful study of longitudinal cohorts of newborns from epidemic areas, involving methodical assessment of neurodevelopmental milestones [3], should be a priority in the coming years. In the meantime, general clinicians and psychiatrists should be trained on the neural consequences of ZIKV infection, in order to address the challenges ahead. 

Notes

From the editor
The authors originally submitted this article in Spanish and English. The Journal has not copyedited this English version. 

Conflicts of interest
Authors declare no conflicts of interest. 

Funding
The authors declare not having received any funding for this letter.

Licencia Creative Commons Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.

 

Author: Julio Torales[1], Iván Barrios[1]

Affiliation:
[1] Departamento de Neurociencias, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay

E-mail: jtorales@med.una.py

Author address:
[1] Avenida Mariscal López esquina Coronel Cazal
San Lorenzo
Paraguay

Citation: Torales J, Barrios I. The Zika virus beyond microcephaly: will we face an increase in mental disorders?. Medwave 2016 Ene-Feb;16(1):e6869 doi: 10.5867/medwave.2017.01.6869

Publication date: 24/2/2017

PubMed record

Comments (2)

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Nombre/name: beuy Dr
Fecha/date: 2017-03-10 07:04:59
Comentario/comment:
Zika virus and mental disorder
Beuy Joob1; Viroj Wiwanitkit2
1. Sanitation 1 Medical Academic Center, Bangkok Thailand
2. Visiting professor, Hainan Medical University, China
Correspondence
Beuy Joob
Sanitation 1 Medical Academic Center, Bangkok Thailand
Email: beuyjoob@hotmail.com

Dear Editor, the publication on “Zika virus infection” by Torales and Barrios is very interesting [1]. Torales and Barrios discussed on the possible mental disorder as a complication of Zika virus infection [1]. In fact, the neurological complication due to Zika virus infection is confirmed. In affected newborn with microcephaly, the mental problem can be expected. However, there is still no proof that the Zika virus infection can cause mental disorder in infected adult. We would like to share the experiences from tropical Southeast Asia. In our areas, the Zika virus infection is also endemic. Nevertheless, the neurological complications including to Guillain-Barré syndrome and is extremely rare and there has never any case of Zika virus infection complicated with mental disorder [2]. Most of the patients are asymptomatic [3]. As mentioned by Torales and Barrios, the rooted cause of mental disorder is multifactorial. Whether Zika virus infection can cause mental disorder or not is a very interesting research question. Referring to the similar tropical infection, dengue infection, there is no observation on mental disorder as dengue long term complication in a long term follow-up study [4].

Conflict of interest: None

References

1. Torales J, Barrios I. The Zika virus beyond microcephaly: will we face an increase in mental disorders? Medwave. 2017 Feb 24;17(1):e6869.
2. Wiwanitkit V. Guillain-Barré syndrome and Zika virus infection. Arq Neuropsiquiatr. 2016 Aug;74(8):692.
3. Wiwanitkit S, Wiwanitkit V. Afebrile, asymptomatic and non-thrombocytopenic Zika virus infection: Don < t miss it! Asian Pac J Trop Med. 2016 May;9(5):513.
4. García G1, González N, Pérez AB, Sierra B, Aguirre E, Rizo D, Izquierdo A, Sánchez L, Díaz D, Lezcay M, Pacheco B, Hirayama K, Guzmán MG. Long-term persistence of clinical symptoms in dengue-infected persons and its association with immunological disorders. Int J Infect Dis. 2011 Jan;15(1):e38-43.

Nombre/name: beuy Dr
Fecha/date: 2017-03-17 00:09:55
Comentario/comment:
Zika virus and mental disorder / Zika virus and mental disorder
Beuy Joob1; Viroj Wiwanitkit2
1. Sanitation 1 Medical Academic Center, Bangkok Thailand
2. Visiting professor, Hainan Medical University, China
Correspondence: Beuy Joob
Sanitation 1 Medical Academic Center, Bangkok Thailand
Email: beuyjoob@hotmail.com

Estimado Editor:
La publicación sobre "Infección por el virus Zika" de Torales y Barrios es muy interesante [1]. Torales y Barrios discutieron sobre el posible trastorno mental como una complicación de la infección por el virus Zika [1]. De hecho, se confirma la complicación neurológica debida a la infección por el virus Zika. En el recién nacido afectado con microcefalia, el problema mental puede esperarse. Sin embargo, todavía no hay pruebas de que la infección por el virus Zika puede causar trastorno mental en adultos infectados. Nos gustaría compartir las experiencias del sudeste asiático tropical. En nuestras áreas, la infección por el virus Zika también es endémica. Sin embargo, las complicaciones neurológicas, incluyendo el síndrome de Guillain-Barré y es extremadamente rara y nunca ha habido ningún caso de infección por el virus Zika complicada con trastorno mental [2]. La mayoría de los pacientes son asintomáticos [3]. Como lo han mencionado Torales y Barrios, la causa arraigada del trastorno mental es multifactorial. Si la infección por el virus Zika puede causar trastorno mental o no es una pregunta de investigación muy interesante. Refiriéndose a la infección tropical similar, la infección del dengue, no hay observación sobre el trastorno mental como complicación a largo plazo del dengue en un estudio de seguimiento a largo plazo [4].

Referencias
1. Torales J, Barrios I. The Zika virus beyond microcephaly: will we face an increase in mental disorders? Medwave. 2017 Feb 24;17(1):e6869.
2. Wiwanitkit V. Guillain-Barré syndrome and Zika virus infection. Arq Neuropsiquiatr. 2016 Aug;74(8):692.
3. Wiwanitkit S, Wiwanitkit V. Afebrile, asymptomatic and non-thrombocytopenic Zika virus infection: Don < t miss it! Asian Pac J Trop Med. 2016 May;9(5):513.
4. García G1, González N, Pérez AB, Sierra B, Aguirre E, Rizo D, Izquierdo A, Sánchez L, Díaz D, Lezcay M, Pacheco B, Hirayama K, Guzmán MG. Long-term persistence of clinical symptoms in dengue-infected persons and its association with immunological disorders. Int J Infect Dis. 2011 Jan;15(1):e38-43.


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  1. Frieden TR, Schuchat A, Petersen LR. Zika Virus 6 Months Later. JAMA. 2016 Oct 11;316(14):1443-1444. | CrossRef | PubMed |
  2. Adams L, Bello-Pagan M, Lozier M, Ryff KR, Espinet C, Torres J, et al. Update: Ongoing Zika Virus Transmission - Puerto Rico, November 1, 2015-July 7, 2016. MMWR Morb Mortal Wkly Rep. 2016 Aug 5;65(30):774-9. | CrossRef | PubMed |
  3. Simões E Silva AC, Moreira JM, Romanelli RM, Teixeira AL. Zika virus challenges for neuropsychiatry. Neuropsychiatr Dis Treat. 2016 Jul 14;12:1747-60. | CrossRef | PubMed |
  4. Boksa P. Maternal infection during pregnancy and schizophrenia. J Psychiatry Neurosci. 2008 May;33(3):183-5. | PubMed |
  5. Torales Benítez J, Rodríguez Marín H, López Olmedo P, Recalde Berni S. Esquizofrenia y otros Trastornos Psicóticos. En: El Libro Azul de la Psiquiatría. Asunción: EFACIM; 2012:107-128.
Frieden TR, Schuchat A, Petersen LR. Zika Virus 6 Months Later. JAMA. 2016 Oct 11;316(14):1443-1444. | CrossRef | PubMed |

Adams L, Bello-Pagan M, Lozier M, Ryff KR, Espinet C, Torres J, et al. Update: Ongoing Zika Virus Transmission - Puerto Rico, November 1, 2015-July 7, 2016. MMWR Morb Mortal Wkly Rep. 2016 Aug 5;65(30):774-9. | CrossRef | PubMed |

Simões E Silva AC, Moreira JM, Romanelli RM, Teixeira AL. Zika virus challenges for neuropsychiatry. Neuropsychiatr Dis Treat. 2016 Jul 14;12:1747-60. | CrossRef | PubMed |

Boksa P. Maternal infection during pregnancy and schizophrenia. J Psychiatry Neurosci. 2008 May;33(3):183-5. | PubMed |

Torales Benítez J, Rodríguez Marín H, López Olmedo P, Recalde Berni S. Esquizofrenia y otros Trastornos Psicóticos. En: El Libro Azul de la Psiquiatría. Asunción: EFACIM; 2012:107-128.