Guillain-Barré syndrome associated with the Zika virus outbreak in Brazil

Araujo, Lucas Masiêro; Ferreira, Maria Lúcia Brito; Nascimento, Osvaldo Jm

doi:10.1590/0004-282x20160035

Cited by 129 publications

(74 citation statements)

References 19 publications

(18 reference statements)

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“…Additional case control studies are emerging from other geographical areas, notably in Latin America, that are also reporting a very high incidence of Zika-associated GBS [76][77][78] . It therefore seems inevitable that this emergent form of GBS will continue to occur throughout Zika-affected regions in Asia and Africa.…”

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confidence: 99%

Guillain–Barré syndrome: a century of progress

2016

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In 1916, Guillain, Barré and Strohl reported on two cases of acute flaccid paralysis with high cerebrospinal fluid protein levels and normal cell counts -novel findings that identified the disease we now know as Guillain-Barré syndrome (GBS).100 years on, we have made great progress with the clinical and pathological characterization of GBS. Early clinicopathological and animal studies indicated that GBS was an immune-mediated demyelinating disorder with secondary axonal injury if severe; the current treatments of plasma exchange and intravenous immunoglobulin, which were developed in the 1980s, are based on this premise. Subsequent work has, however, shown that the underlying disease can be an axonal injury. The association of Campylobacter jejuni strains has led to confirmation that anti-ganglioside antibodies are pathogenic and that axonal GBS involves an antibody and complement-mediated disruption of nodes of Ranvier, neuromuscular junctions and other neuronal and glial membranes. Now, ongoing clinical trials of the complement inhibitor eculizumab are the first of targeted immunotherapy in GBS.Guillain-Barré syndrome (GBS) is the commonest cause of acute flaccid paralysis and manifests as rapidly evolving weakness and sensory disturbance in arms, legs and in some patients, facial, bulbar and respiratory muscles. Many patients will make a good recovery over many months but in severe cases patients can require months of intensive care support and be left with permanent severe weakness, sensory disturbance and pain. Furthermore, around 5% die from complications including respiratory failure, pneumonia and arrhythmias, making it a medical emergency with a high morbidity and significant mortality.Descriptions of clinical cases that closely resemble the condition we now know as GBS were made at least as early as 1859, when Jean Baptiste Octave Landry reported on "acute ascending paralysis". His report led to use of the term "Landry's ascending paralysis" to describe subacute ascending peripheral sensory and motor dysfunction. He observed that:

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Guillain–Barré syndrome: a century of progress

2016

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“…However, it is noteworthy that in adult patients suffering from retro-cochlear pathology, a variety of clinical findings has been discussed in the literature, where it is claimed that the audiological findings vary from normal hearing thresholds to profound hearing loss, which can be of the fluctuating type, and the acoustic reflexes can be either absent or increased (11,12) . As ZIKV is now recognized as a factor that can lead to neurological complications in adults following infection, such as Guillaine-Barré syndrome, facial paralysis, myelitis, and others that are still being analyzed, the importance of studying the damage caused by ZIKV action is further emphasized (13,14) . From this perspective, a study was performed investigating the risks of ZIKV for neuronal cells during the embryonic stage, as well as in childhood and adulthood.…”

Section: Discussionmentioning

confidence: 99%

Achados otológicos em pacientes pós-infecção pelo zika vírus: estudos de caso

Martins

Rodrigues²,

Santos

et al. 2017

Audiol., Commun. Res.

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The Zika virus is transmitted between humans by the Aedes aegypti mosquito and has become a public health emergency, as declared by the World Health Organization. Studies have reported the virus to be associated with hearing alterations in patients, following infection. This study was conceived in view of the importance of hearing for communication, associated with the limited number of reports on the impact of Zika virus on the hearing system of adults. The aim of the study was to characterize the otological findings in two adult patients, following infection with the Zika virus. The otological findings observed in two outpatients of an otorhinolaryngology service were described, both of whom reported hearing complaints immediately following the clinical symptoms of Zika virus infection. Both adult patients reported the following symptoms: discomfort, skin rash, joint pain, auricular fullness, and hearing loss. Serologic testing (IgG) for Zika virus was performed. The audiological findings were unilateral peripheral hearing loss in one of the patients, alterations in contralateral acoustic reflexes in both patients, and alteration in the brainstem auditory-evoked potential in one patient. The audiological findings demonstrate possible neuronal involvement in the manifested complaints, whether or not associated with the peripheral component, in patients infected with Zika virus. Keywords

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“…Zika virusa atfedilen mikrosefali, GBS ve ensefalomiyelit gibi ciddi enfeksiyon tablolarının virusun nörönal sisteme tropizm göstermesiyle ilişkili olduğu düşünülmektedir (21)(22)(23) . Zika virusun keşfinden birkaç yıl sonra (1952) yapılan bir çalışmada, virusun nörotropik karakteristiğine dair ilk veriler elde edilmiştir (1) .…”

Section: Patogenezunclassified

“…2013 yılı Kasım ayında laboratuvar olarak doğrulanmış Zika virus enfeksiyonu olan bir kadında GBS geliştiği detaylı olarak tanımlanmıştır (5) . Bunların dışında Şubat 2015'te DSÖ tarafından bir rapor yayımlanmış ve bu raporda GBS görülme olasılığının salgının aktif olduğu Brezilya'nın bazı bölgelerinde 5-6 kat arttığı bildirilmiştir (21) . DSÖ'nün Kasım 2016'da yayımlanan daha yeni bir raporuna göre ise en az 19 ülkeden konfirme edilmiş Zika virus enfeksiyonu ile birlikte olan GBS insidans artışı bildirilmiştir (33) .…”

Section: Klinikunclassified