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Zika virus and Guillain-Barre syndrome in Bangladesh.

ABSTRACT: Previous studies have associated Guillain-Barré syndrome (GBS) with Zika virus (ZIKV) outbreaks in South America and Oceania. In Asia, ZIKV is known to circulate widely, but the association with Guillain-Barré syndrome is unclear. We investigated whether endemic ZIKV infection is associated with the development of GBS.A prospective study was conducted from 2011 to 2015 in Bangladesh. A total of 418 patients and 418 healthy family controls were included in the study. Patients were diagnosed with GBS prior to inclusion according to established criteria. Detailed information on the epidemiology, clinical presentation, electrophysiology, diagnosis, disease severity, and clinical course were obtained during a follow-up of 1 year using a predefined protocol.ZIKV-neutralizing antibodies were detected in our study from 2013 onwards. The prevalence of ZIKV-neutralizing antibodies was not significantly higher in patients with GBS compared to healthy controls (OR 2.23, P = 0.14, 95% CI 0.77-6.53). Serological evidence for prior ZIKV infection in patients with GBS was associated with more frequent cranial, sensory, and autonomic nerve involvement compared to GBS patients with Campylobacter jejuni, the predominant preceding infection in GBS worldwide. Nerve-conduction studies revealed that ZIKV antibodies were associated with a demyelinating subtype of GBS, while C. jejuni infections were related to an axonal subtype.No significant association was found between ZIKV infection and GBS in Bangladesh, but GBS following ZIKV infection was characterized by a distinct clinical and electrophysiological subtype compared to C. jejuni infection. These findings indicate that ZIKV may precede a specific GBS subtype but the risk is low.

SUBMITTER: GeurtsvanKessel CH

PROVIDER: S-EPMC5945960 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Zika virus and Guillain-Barré syndrome in Bangladesh.

GeurtsvanKessel Corine H CH Islam Zhahirul Z Islam Md Badrul MB Kamga Sandra S Papri Nowshin N van de Vijver David A M C DAMC Reusken Chantal C Mogling Ramona R Heikema Astrid P AP Jahan Israt I Pradel Florence K FK Pavlicek Rebecca L RL Mohammad Quazi D QD Koopmans Marion P G MPG Jacobs Bart C BC Endtz Hubert P HP

Annals of clinical and translational neurology 20180406 5

<h4>Objective</h4>Previous studies have associated Guillain-Barré syndrome (GBS) with Zika virus (ZIKV) outbreaks in South America and Oceania. In Asia, ZIKV is known to circulate widely, but the association with Guillain-Barré syndrome is unclear. We investigated whether endemic ZIKV infection is associated with the development of GBS.<h4>Methods</h4>A prospective study was conducted from 2011 to 2015 in Bangladesh. A total of 418 patients and 418 healthy family controls were included in the st ...[more]

PMID: 29761123

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Project description:Importance:The pathophysiologic mechanisms of Guillain-Barré syndrome (GBS) associated with Zika virus (ZIKV) infection may be indicated by differences in clinical features. Objective:To identify specific clinical features of GBS associated with ZIKV infection. Design, Setting, and Participants:During the ZIKV epidemic in Puerto Rico, prospective and retrospective strategies were used to identify patients with GBS who had neurologic illness onset in 2016 and were hospitalized at all 57 nonspecialized hospitals and 2 rehabilitation centers in Puerto Rico. Guillain-Barré syndrome diagnosis was confirmed via medical record review using the Brighton Collaboration criteria. Specimens (serum, urine, cerebrospinal fluid, and saliva) from patients with GBS were tested for evidence of ZIKV infection by real-time reverse transcriptase-polymerase chain reaction; serum and cerebrospinal fluid were also tested by IgM enzyme-linked immunosorbent assay. In this analysis of public health surveillance data, a total of 123 confirmed GBS cases were identified, of which 107 had specimens submitted for testing; there were 71 patients with and 36 patients without evidence of ZIKV infection. Follow-up telephone interviews with patients were conducted 6 months after neurologic illness onset; 60 patients with and 27 patients without evidence of ZIKV infection participated. Main Outcomes and Measures:Acute and long-term clinical characteristics of GBS associated with ZIKV infection. Results:Of 123 patients with confirmed GBS, the median age was 54 years (age range, 4-88 years), and 68 patients (55.3%) were male. The following clinical features were more frequent among patients with GBS and evidence of ZIKV infection compared with patients with GBS without evidence of ZIKV infection: facial weakness (44 [62.0%] vs 10 [27.8%]; P?<?.001), dysphagia (38 [53.5%] vs 9 [25.0%]; P?=?.005), shortness of breath (33 [46.5%] vs 9 [25.0%]; P?=?.03), facial paresthesia (13 [18.3%] vs 1 [2.8%]; P?=?.03), elevated levels of protein in cerebrospinal fluid (49 [94.2%] vs 23 [71.9%]; P?=?.008), admission to the intensive care unit (47 [66.2%] vs 16 [44.4%]; P?=?.03), and required mechanical ventilation (22 [31.0%] vs 4 [11.1%]; P?=?.02). Six months after neurologic illness onset, patients with GBS and evidence of ZIKV infection more frequently reported having excessive or inadequate tearing (30 [53.6%] vs 6 [26.1%]; P?=?.03), difficulty drinking from a cup (10 [17.9%] vs 0; P?=?.03), and self-reported substantial pain (15 [27.3%] vs 1 [4.3%]; P?=?.03). Conclusions and Relevance:In this study, GBS associated with ZIKV infection was found to have higher morbidity during the acute phase and more frequent cranial neuropathy during acute neuropathy and 6 months afterward. Results indicate GBS pathophysiologic mechanisms that may be more common after ZIKV infection.

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Zika virus and Guillain-Barre syndrome in Bangladesh.

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Zika virus and Guillain-Barré syndrome in Bangladesh.

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