Guillain-Barré syndrome related to Zika virus infection: A systematic review and meta-analysis of the clinical and electrophysiological phenotype

Abstract

Background The Zika virus (ZIKV) has been associated with Guillain-Barré syndrome (GBS) in epidemiological studies. Whether ZIKV-associated GBS is related to a specific clinical or electrophysiological phenotype has not been established. To this end, we performed a systematic review and meta-analysis of all published studies on ZIKV-related GBS. Methods We searched Pubmed, EMBASE and LILACS, and included all papers, reports or bulletins with full text in English, Spanish or Portuguese, reporting original data of patients with GBS and a suspected, probable or confirmed recent ZIKV infection. Data were extracted according to a predefined protocol, and pooled proportions were calculated. Results Thirty-five studies were included (13 single case reports and 22 case series, case-control or cohort studies), reporting on a total of 601 GBS patients with a suspected, probable or confirmed ZIKV infection. Data from 21 studies and 587 cases were available to be summarized. ZIKV infection was confirmed in 21%, probable in 22% and suspected in 57% of cases. ZIKV PCR was positive in 30% (95%CI 15-47) of tested patients. The most common clinical features were: limb weakness 97% (95%CI 93-99), diminished/absent reflexes 96% (95%CI 88-100), sensory symptoms 82% (95%CI 76-88), and facial palsy 51% (95%CI 44-58). Median time between infectious and neurological symptoms was 5-12 days. Most PLOS NEGLECTED TROPICAL DISEASES

Guillain-Barré Syndrome Outbreak in Peru 2019 Associated With Campylobacter jejuni Infection

“…This profile is in contrast to the clinical profile that has been reported in association with ZIKV or COVID-19, where most patients have facial palsy, sensory and motor deficits, and a demyelinating electrophysiologic subtype. 37,38 However, there was not a uniform relationship between C jejuni serotype and clinical, electrodiagnostic, and antiganglioside profile. This may be due to methodological factors that prevent unambiguous case definition and ascertainment.…”

Response to: SARS‐CoV‐2 associated Guillain‐Barré syndrome in 62 patients

“…Presence of the bacterial or viral agent in the cerebrospinal fluid (CSF) may support a direct neurotrophic effect of the virus, even if this has been seldom reported in previous cases of GBS. For instance, in a series of 244 tested cases of GBS associated with ZIKA virus, only 10 cases had positive ZIKV polymerase chain reaction in the CSF [4]. The very high frequency of anosmia and hypogeusia (up to 50% of infected patients), the short incubation period of these symptoms (about 7 days), their long persistence in some patients and resistance to immune therapy [5,6] might be compatible with a direct transneuronal dissemination related to viral neurotropism.…”

Guillain-Barré syndrome during the Zika virus outbreak in Northeast Brazil: An observational cohort study

“…[2][3][4] And although most infections with ZIKV are asymptomatic, or cause mild disease, in some patients severe neurological complications occur, and the most frequently reported neurological complication in adults is the Guillain-Barré syndrome (GBS). [5][6][7][8][9] In patients with DENV and CHIKV infection neurological complications, including GBS, have also been reported in smaller studies. [10][11][12][13] GBS is an immune-mediated polyradiculoneuropathy that is triggered by preceding infections.…”

“…14,15 However, a uniform description of the clinical phenotype or the anti-ganglioside antibody signature of ZIKV-related GBS has not emerged in previous studies. 5,8,[16][17][18][19][20] Furthermore, little is known about the role of other circulating arboviruses, such as DENV and CHIKV, as potential triggers for GBS. 10 To study the relation between GBS and circulating arbovirus infections, we describe a large, well-defined, and unselected cohort of GBS patients with evidence of a preceding arbovirus infection from a single center in Northeast Brazil that was tested for arboviruses and a broad J o u r n a l P r e -p r o o f Journal Pre-proof spectrum of anti-ganglioside antibodies.…”