Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Jun 25, 2023; 12(3): 172-192
Published online Jun 25, 2023. doi: 10.5501/wjv.v12.i3.172
Viruses and autism: A Bi-mutual cause and effect
Mohammed Al-Beltagi, Nermin Kamal Saeed, Reem Elbeltagi, Adel Salah Bediwy, Syed A Saboor Aftab, Rawan Alhawamdeh
Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta ‎31511‎, Alghrabia, Egypt
Mohammed Al-Beltagi, Department of Pediatrics, University Medical Center, King Abdulla Medical City, Dr. Sulaiman Al Habib ‎Medical Group, Manama ‎26671‎, Bahrain
Nermin Kamal Saeed, Medical Microbiology Section, Pathology Department, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Bahrain
Nermin Kamal Saeed, Microbiology Section, Pathology Department, Irish Royal College of Surgeon, Busaiteen ‎15503‎, Muharraq, Bahrain
Reem Elbeltagi, Department of Medicine, The Royal College of Surgeons in Ireland - Bahrain‎, Busiateen ‎15503‎, Muharraq, Bahrain
Adel Salah Bediwy, Department of Pulmonolgy, Faculty of Medicine, Tanta University, Tanta ‎31527‎, Alghrabia, Egypt
Adel Salah Bediwy, Department of Chest Disease, University Medical Center, King Abdulla Medical City, ‎Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama ‎26671‎, Bahrain
Syed A Saboor Aftab, Endocrinology and DM, William Harvey Hospital (Paula Carr Centre), Ashford TN24 0LZ, Kent, United Kingdom
Rawan Alhawamdeh, Pediatrics Research and Development, Genomics Creativity and Play Center, Manama 0000, Bahrain
Author contributions: Al-Biltagi M, Saeed NK, Elbeltagi R, Bediwy AS, Aftab S, and Alhawamdeh R contributed equally to this work; all the authors worked together to; collect the data and write and revise the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Beltagi, MBChB, MD, MSc, PhD, Academic Editor, Chairman, Consultant Physician-Scientist, Professor, Researcher, Department of Pediatrics, Faculty of Medicine, Tanta University, Al bahr Street, Tanta ‎31511‎, Alghrabia, Egypt. mbelrem@hotmail.com
Received: February 15, 2023
Peer-review started: February 15, 2023
First decision: March 15, 2023
Revised: March 16, 2023
Accepted: April 18, 2023
Article in press: April 18, 2023
Published online: June 25, 2023
Processing time: 125 Days and 22.7 Hours
Abstract

Autism spectrum disorder (ASD) is a group of heterogeneous, multi-factorial, neurodevelopmental disorders resulting from genetic and environmental factors interplay. Infection is a significant trigger of autism, especially during the critical developmental period. There is a strong interplay between the viral infection as a trigger and a result of ASD. We aim to highlight the mutual relationship between autism and viruses. We performed a thorough literature review and included 158 research in this review. Most of the literature agreed on the possible effects of the viral infection during the critical period of development on the risk of developing autism, especially for specific viral infections such as Rubella, Cytomegalovirus, Herpes Simplex virus, Varicella Zoster Virus, Influenza virus, Zika virus, and severe acute respiratory syndrome coronavirus 2. Viral infection directly infects the brain, triggers immune activation, induces epigenetic changes, and raises the risks of having a child with autism. At the same time, there is some evidence of increased risk of infection, including viral infections in children with autism, due to lots of factors. There is an increased risk of developing autism with a specific viral infection during the early developmental period and an increased risk of viral infections in children with autism. In addition, children with autism are at increased risk of infection, including viruses. Every effort should be made to prevent maternal and early-life infections and reduce the risk of autism. Immune modulation of children with autism should be considered to reduce the risk of infection.

Keywords: Autism, Children, Rubella, Cytomegalovirus, Herpes simplex virus, Influenza virus, ‎Zika virus, SARS-CoV-2, COVID-19, Viral infection

Core Tip: There is a mutual relationship between viral infections and autism. There is an increased risk of developing autism when contracting a viral infection during pregnancy or early postnatal life during the critical period of brain development. At the same time, children with autism have many co-morbidities that expose them to more risk of contracting infections, including viruses. Therefore, every effort should be made to prevent infections, especially during this critical period of neurodevelopment. Parents should also be educated about the importance of vaccination and immune modulation in children with autism to avoid further infections.