Central and peripheral nervous system involvement caused by Zika and chikungunya coinfection

In spite of chikungunya and Zika outbreaks, dengue virus is still the most important arboviral disease in the world. [...]considering the circulation of all 4 serotypes of dengue virus in Brazil, large dengue outbreaks were common over the last decades. Interestingly, no neurological complications were reported in this patient [6]. [...]Waggoner et al. reported the identification of 16 cases (4.6%) of Zika and chikungunya coinfections in a group of 263 patients presenting arbovirus symptoms. According to the authors, clinically, the patients with coinfections and monoinfections presented a very similar pattern; the only difference was a slightly higher hospitalization rate in patients with coinfections (83.3%) versus monoinfections (64.0%) [19]. To our knowledge, among neurological complications following chikungunya infection, encephalitis is the most common reported clinical characteristic [15]. [...]although chikungunya and dengue coinfection cases have been described, most of the studies comparing the clinical significance of coinfections have not demonstrated any type of disease exacerbation or any differential clinical outcome (relative to single infections) [20-22].