Guillain–Barré Syndrome Associated With Zika Virus Infection: A Prospective Case Series From Mexico

Abstract

Background: On May 2016, anticipating the rainy season from June to October in Mexico, we expected an increase in cases of Zika virus (ZIKV) infections. With the goal of identifying cases of GBS associated with ZIKV infection, a prospective joint study was conducted by a reference center for neurological patients and the Secretary of Health in Mexico City from July 2016 to November 2016. Methods: Serum, cerebrospinal fluid, urine, and saliva were tested by RT-PCR for ZIKV, dengue virus, and chikungunya virus in patients referred from states with reported transmissions of ZIKV infection, and with clinical symptoms of GBS according to the Brighton Collaboration criteria. Clinical, electrophysiological, and long-term disability data were collected. Results: In the year 2016 twenty-eight patients with GBS were diagnosed at our institute. In five hospitalized patients with GBS, RT-PCR was positive to ZIKV in any collected specimen. Dengue and chikungunya RT-PCR results were negative. All five patients had areflexic flaccid weakness, and cranial nerves affected in three. Electrophysiological patterns were demyelinating in two patients and axonal in three. Three patients were discharged improved in 10 days or less, and two patients required intensive care unit admission, and completely recovered during follow-up. Conclusion: Our results are similar to those reported from the state of Veracruz, Mexico, in which out of 33 samples of urine of patients with GBS two had a positive RT-PCR for ZIKV. Simultaneous processing of serum, CSF, urine, and saliva by RT-PCR may increase the success of diagnosis of GBS associated to ZIKV.

The role of teratogens in neural crest development

“…ZIKV infection has been linked to an increase in severe neurological complications in newborns including microcephaly (Martines et al, ; Martines et al, ; Melo, Chimelli, & Tanuri, ), cerebral calcifications and retinal damage. Neurological disorders associated with ZIKV disease now include the Guillain‐Barré syndrome (GBS; (Piontkivska, Plonski, Miyamoto, & Wayne, ; Soto‐Hernandez et al, ; Styczynski et al, ; Wright et al, ), myelitis, meningoencephalitis (Medina & Medina‐Montoya, ), ophthalmic manifestations (de Oliveira Dias et al, ), and acute transient polyneuritis (Nascimento et al, ). GBS is a type of peripheral neuropathy condition involving nerves extending into the head, trunk and limbs in children and adults (Cao‐Lormeau et al, ; Parra et al, ).…”

“…GBS is caused by an autoimmune disorder that damages the peripheral nervous system, involving motor and sensitive cranial nerves. Facial nerves (VII) are the most commonly damaged cranial nerves, which are affected in nearly half of patients (44–62%), whereas one third of bulbar nerves (IX, X, XI, and XII) are compromised (Soto‐Hernandez et al, ) (Hughes & Cornblath, ; Parry & Steinberg, ).…”

Zika Virus Pathogenesis: From Early Case Reports to Epidemics

“…Significantly more ZIKV patients with GBS had IgM antibodies against ZIKV (93%) than control group 1 patients, while ZIKV was detected in 100% of control group 2 patients, providing evidence for ZIKV as a risk factor for GBS [10]. During the South and Central American outbreak, ZIKV was confirmed as a potential trigger for GBS [20], with reports stemming from many countries, including Brazil, Colombia, Honduras, Nicaragua, and Mexico [9,13,14,21,22,23,24]. Reported symptoms were similar to the French Polynesian study, and almost all patients had evidence of ZIKV infection based on either detection of ZIKV RNA or antibodies against ZIKV, in addition to a recent ZIKV-like illness.…”

“…Reported symptoms were similar to the French Polynesian study, and almost all patients had evidence of ZIKV infection based on either detection of ZIKV RNA or antibodies against ZIKV, in addition to a recent ZIKV-like illness. Where reported, GBS onset tended to be parainfectious, with no asymptomatic period between ZIKV disease and GBS onset [9,13,14,23,24,25]. Additionally, while 25–33% of patients required admission to the intensive care unit (ICU), only three deaths were reported (due to respiratory failure and sepsis) among all GBS cases [21,22,24].…”

“…In adults, the primary neurological condition associated with ZIKV infection is Guillain-Barré syndrome (GBS), an acute peripheral neuropathy that causes ascending paralysis. The link between ZIKV infection and GBS was first recognized during the French Polynesian outbreak and was documented in several countries in the South and Central American outbreak that followed [9,10,11,12,13,14]. There are at least three subtypes of GBS: acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy (AMAN), and acute motor and sensory axonal neuropathy (AMSAN).…”