Guillain–Barré Syndrome, Acute Disseminated Encephalomyelitis and Encephalitis Associated with Zika Virus Infection in Brazil: Detection of Viral RNA and Isolation of Virus during Late Infection

Ferreira, Maria Lúcia Brito; Brito, Carlos; Moreira, Álvaro José Porto; Machado, Maria Íris de Morais; Henriques-Souza, Adélia Maria de Miranda; Cordeiro, Marli Tenório; Marques, Ernesto T. A.; Pena, Lindomar

doi:10.4269/ajtmh.17-0106

Cited by 62 publications

(56 citation statements)

References 21 publications

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“…Compared with urine specimens, a higher proportion of serum specimens had positive ZIKV rRT-PCR results, with the added benefit of also being able to detect anti-ZIKV antibodies. Results are consistent with those reported from Brazil 32 and further suggest that ZIKV RNA persistence was similar among patients with ZIKV disease and those who developed GBS after ZIKV infection. For patients with GBS, adding the median times from antecedent illness to neurologic illness onset (7 days) and from neurologic illness onset to specimen collection (9 days), the time from antecedent illness to specimen collection was roughly 16 days.…”

Section: Discussionsupporting

confidence: 90%

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

et al. 2018

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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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Section: Discussionsupporting

confidence: 90%

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

et al. 2018

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“…Similar to observations of other viral infections, ZIKV infection may also be related to ADEM. 32,33 The imaging findings described are like those observed in other related causes of ADEM, such as multifocal and asymmetric lesions, affecting the brain and the spinal cord. The clinical course of ADEM-ZIKV cases was very similar to that of the most typical ADEM cases, characterized as a self-limited and monophasic course, appearing weeks after the viral infection.…”

Section: Neurologic Disorders Associated With Zika Virus Infection Insupporting

confidence: 68%

Neuroimaging Findings of Zika Virus–Associated Neurologic Complications in Adults

Cruz

Nascimento

Lopes

et al. 2018

AJNR Am J Neuroradiol

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When the first suspected cases of neurologic disorders associated with the Zika virus were noticed in Brazil in late 2015, several studies had been conducted to understand the pathophysiology of the disease and its associated complications. In addition to its well-established association with microcephaly in neonates, the Zika virus infection has also been suggested to trigger other severe neurologic complications in adults, such as Guillain-Barré syndrome, radiculomyelitis, and meningoencephalitis. Hence, the Zika virus should be deemed a global threat that can cause devastating neurologic complications among individuals in all age ranges. The aim of this review was to further describe neuroimaging findings of Zika virus infection and associated neurologic complications found in adults.

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“…A recent study showed ZIKV cases with neurological alterations similar to those found in our study, defined as GBS. In these cases, the viremia appeared to persist for longer than normal (Brito Ferreira et al, 2017 ). While the relationship between Zika fever and GBS still relies solely on epidemiological data, the description of the viral influence toward congenital malformations has become less enigmatic.…”

Section: Discussionmentioning

confidence: 99%

Placental Inflammation and Fetal Injury in a Rare Zika Case Associated With Guillain-Barré Syndrome and Abortion

et al. 2018

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Zika virus (ZIKV) is an emerging virus involved in recent outbreaks in Brazil. The association between the virus and Guillain-Barré syndrome (GBS) or congenital disorders has raised a worldwide concern. In this work, we investigated a rare Zika case, which was associated with GBS and spontaneous retained abortion. Using specific anti-ZIKV staining, the virus was identified in placenta (mainly in Hofbauer cells) and in several fetal tissues, such as brain, lungs, kidneys, skin and liver. Histological analyses of the placenta and fetal organs revealed different types of tissue abnormalities, which included inflammation, hemorrhage, edema and necrosis in placenta, as well as tissue disorganization in the fetus. Increased cellularity (Hofbauer cells and TCD8+ lymphocytes), expression of local pro-inflammatory cytokines such as IFN-γ and TNF-α, and other markers, such as RANTES/CCL5 and VEGFR2, supported placental inflammation and dysfunction. The commitment of the maternal-fetal link in association with fetal damage gave rise to a discussion regarding the influence of the maternal immunity toward the fetal development. Findings presented in this work may help understanding the ZIKV immunopathogenesis under the rare contexts of spontaneous abortions in association with GBS.

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Guillain–Barré Syndrome, Acute Disseminated Encephalomyelitis and Encephalitis Associated with Zika Virus Infection in Brazil: Detection of Viral RNA and Isolation of Virus during Late Infection

Cited by 62 publications

References 21 publications

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

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

Neuroimaging Findings of Zika Virus–Associated Neurologic Complications in Adults

Placental Inflammation and Fetal Injury in a Rare Zika Case Associated With Guillain-Barré Syndrome and Abortion

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