Clinical Features of Guillain-Barré Syndrome With vs Without Zika Virus Infection, Puerto Rico, 2016

Abstract

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.

Integrated analyses of single-cell atlases reveal age, gender, and smoking status associations with cell type-specific expression of mediators of SARS-CoV-2 viral entry and highlights inflammatory programs in putative target cells

“…Taken together, the expression of myelin proteins across multiple ACE2 + TMPRSS2 + cells may hypothetically contribute to antigen presentation and autoimmune response in the context of viral infection. A small number of COVID-19 patients were reported to have Guillain-Barre Syndrome 144 , with a demyelinating process in some; this is consistent with observations of Guillain-Barre Syndrome following other viral infections such as Zika, influenza, and Epstein-Barr virus 139,145,146 . Whether anti myelin specific immunity can be induced by virus infected cells expressing myelin proteins remains an area for future study.…”

Incidence of Guillain-Barré Syndrome (GBS) in Latin America and the Caribbean Before and During the 2015-2016 Zika Virus Epidemic: A Systematic Review and Meta-Analysis

“…We reviewed 135 full-text articles, of which 31 were eligible for inclusion ( Fig 1). Of the 31 studies, 28 reported countryspecific GBS rates from 13 LAC countries (Tables 1 & 2), 3 regional rates, [18,35,36] 15 background rates [18,[35][36][37][38][39][40][41][42][43][44][45][46][47][48], 11 rates during an arboviral outbreak [49][50][51][52][53][54][55][56][57][58][59], and 5 compared rates before and during an outbreak [27,[60][61][62][63]. Many studies presented data from Brazil (29%) and Colombia (16%), and the majority (68%) were published in 2015 or later.…”

“…The IR in the French West Indies during the 2014 CHIKV epidemic was 3.45 per 100,000 persons [27], representing a two-fold increase from 1.77 per 100,000 during 2011-2013 (p = 0.006) [27]. [48,63]. In South America, there was substantial heterogeneity in the GBS IRs during the 2015 −2016 ZIKV epidemic for the population as a whole, ranging from 7.63 per 100,000 in Barranquilla, Colombia [58], to 0.71 per 100,000 in the Brazilian state of Piauí [54].…”

Dysregulation of RNA editing may help explain pathogenicity mechanisms of congenital Zika syndrome and Guillain-Barre syndrome

“…Below we highlight a broad variety of clinical symptoms and outcomes associated with ZIKV infection, with the explicit purpose of identifying connectedness of ZIKV sequelae across different life stages. For in-depth comprehensive surveys focused on fetal or adult outcomes, we refer the reader to the following studies [9,19,20] .…”