Neurological Manifestations in Oropouche Virus Infection: A Systematic Review and Meta-Analysis

Oropouche virus (OROV), an emerging arbovirus, poses a significant public health concern in tropical and subtropical regions of Latin America, as well as in other parts of the world, with imported cases reported in North America and Europe. While OROV is primarily associated with acute febrile illness, especially emerging evidence suggests it may cause neurological complications, though these remain understudied. This systematic review and meta-analysis aim to estimate the prevalence of neurological manifestations in OROV infections. Following the PRISMA 2020 guidelines, a systematic literature search was conducted across PubMed, Web of Science, and Embase up to January 25, 2025, and registered in PROSPERO (Registration ID: CRD42025634617). Nested Knowledge software was employed for the screening and data extraction processes. Data extraction and quality assessment were performed using a modified version of the Newcastle-Ottawa Scale. A meta-analysis was conducted using R software to estimate the pooled prevalence rates of neurological manifestations, with heterogeneity assessed using the I² statistic. Sensitivity analyses and publication bias assessments were also performed. Ten studies from Brazil, Peru, and Colombia were included, encompassing a total of 2872 patients. The pooled prevalence of neurological symptoms was high, with headache (89.16%), myalgia (70.71%), and eye pain (52.87%) being the most common. Other symptoms included arthralgia (56.5%), back pain (46.1%), and nausea (43.3%). Significant heterogeneity was observed across studies, likely due to variations in geography and diagnostic methods. Sensitivity analyses confirmed the robustness of the findings. Neurological manifestations are prevalent in OROV infections, with headache, myalgia, and eye pain being the most frequent. The clinical overlap with other arboviruses complicates diagnosis, underscoring the need for improved diagnostic tools and surveillance of neurological syndromes associated with arboviruses in endemic regions and newly emerging areas with recent circulation of the virus. To improve generalizability, future research should broaden geographic analyses and concentrate on longitudinal and standardized studies to better understand the temporal dynamics of symptoms.