Zika virus infection in the returning traveller: what every neurologist should know

Leonhard, Sonja E.; Lant, Suzannah; Jacobs, Bart C.; Wilder‐Smith, Annelies; Ferreira, Maria Lúcia Brito; Solomon, Tom; Willison, Hugh J.

doi:10.1136/practneurol-2017-001789

Cited by 21 publications

(9 citation statements)

References 34 publications

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“…Enhanced surveillance and increased research have provided us with new data to assess GBS incidence in this region. Because of its severity and lethality in the absence of adequate care, investments are needed to provide information on GBS to populations at-risk and to build healthcare providers’ capacity to diagnose GBS and follow appropriate care protocols [83, 84]. GBS poses an additional burden to health care systems, particularly in resource-limited settings.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Background A severe neurological disorder, Guillain-Barré syndrome (GBS) is the leading cause of acute flaccid paralysis. Enhanced surveillance of GBS in Latin America and the Caribbean (LAC) following the 2015–2016 Zika virus (ZIKV) epidemic presents an opportunity to estimate, for the first time, the regional incidence of GBS. Methods and findings For this systematic review and meta-analysis, we searched nine scientific databases and grey literature from January 1, 1980 to October 1, 2018. Sources with primary data on incident GBS cases in LAC within a well-defined population and timeframe, published in English, Spanish, Portuguese, or French, were included. We calculated the annual GBS incidence rates (IRs) and 95% confidence intervals (CIs) for each source based on published data. Following an assessment of heterogeneity, we used random-effects meta-analysis to calculate the pooled annual IR of GBS. The study is registered with PROSPERO, number CRD42018086659. Of the 6568 initial citation hits, 31 were eligible for inclusion. Background annual GBS IRs in Latin America ranged from 0.40 in Brazil to 2.12/100,000 in Chile. The pooled annual IR in the Caribbean was 1.64 (95% CI 1.29–2.12, I 2 <0.01, p = 0.44). During the ZIKV epidemic, GBS IRs ranged from 0.62 in Mexico to 9.35/100,000 in Martinique. GBS increased 2.6 (95% CI 2.3–2.9) times during ZIKV and 1.9 (95% CI 1.1–3.4) times during chikungunya outbreaks over background rates. A limitation of this review is that the studies included employed different methodologies to find and ascertain cases of GBS, which could contribute to IR heterogeneity. In addition, it is important to consider that data on GBS are lacking for many countries in the region. Conclusions Background IRs of GBS appear to peak during arboviral disease outbreaks. The current review contributes to an understanding of the epidemiology of GBS in the LAC region, which can inform healthcare system planning and preparedness, particularly during arboviral epidemics. Trial registration Registered with PROSPERO: CRD42018086659 .

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Indeed, direct depletion of CD8 T cells from IFNAR deficient mice indicates that the CD8 T cell response may induce ZIKV-associated paralysis and augment pathogenesis ( 26 , 27 ). Given the neurotropism of ZIKV and the fact that a fraction of postnatal ZIKV infections in humans may result in various forms of neuropathology including fatal encephalitis ( 9 , 10 , 28 ), we found it pertinent to determine whether CD8 T cells could contribute significantly to antiviral protection in the CNS and if that were the case, what are the factors deciding the disease outcome.…”

Section: Introductionmentioning

confidence: 99%

Effector CD8 T Cell-Dependent Zika Virus Control in the CNS: A Matter of Time and Numbers

et al. 2020

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Zika virus (ZIKV), a mosquito-borne flavivirus, came into the spotlight in 2016 when it was found to be associated with an increased rate of microcephalic newborns in Brazil. The virus has further been recognized to cause neurologic complications in children and adults in the form of myelitis, encephalitis, acute disseminated encephalomyelitis (ADEM) and Guillain Barre Syndrome in a fraction of infected individuals. With the ultimate goal of identifying correlates of protection to guide the design of an effective vaccine, the study of the immune response to ZIKV infection has become the focus of research worldwide. Both innate and adaptive immune responses seem to be essential for controlling the infection. Induction of sufficient levels of neutralizing antibodies has been strongly correlated with protection against reinfection in various models, while the role of CD8 T cells as antiviral effectors in the CNS has been controversial. In an attempt to improve our understanding regarding the role of ZIKV-induced CD8 T cells in protective immunity inside the CNS, we have expanded on previous studies in intracranially infected mice. In a recent study, we have demonstrated that, peripheral ZIKV infection in adult C57BL/6 mice induces a robust CD8 T cell response that peaks within a week. In the present study, we used B cell deficient as well as wild-type mice to show that there is a race between CXCR3-dependent recruitment of the effector CD8 T cells and local ZIKV replication, and that CD8 T cells are capable of local viral control if they arrive in the brain early after viral invasion, in appropriate numbers and differentiation state. Our data highlight the benefits of considering this subset when designing vaccines against Zika virus.

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“…Astrocytes act as initiators and drivers of ZIKV infection within the developing brain. Thus, given the ability of this virus to infect not only brain cells and brain cell precursors, and its ability to penetrate the placental barrier, ZIKV infection results in various neurological conditions associated with the central nervous system (CNS) [(meningo)encephalitis, myelitis and acute disseminated encephalomyetis (ADEM)] and with the peripheral nervous system (PNS) (Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy and acute transient polyneuritis) (Zhang et al, 2017; Leonhard et al, 2018; Mehta et al, 2018). Many of these clinical abnormalities are associated with problems occurring during the development of the brain in the fetus or in adult CNS and PNS.…”

Section: Introductionmentioning

confidence: 99%

Zika Virus Infection Disrupts Astrocytic Proteins Involved in Synapse Control and Axon Guidance

2019

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The first human Zika virus (ZIKV) outbreak was reported in Micronesia in 2007, followed by one in Brazil in 2015. Recent studies have reported cases in Europe, Oceania and Latin America. In 2016, ZIKV transmission was also reported in the US and the World Health Organization declared it a Public Health Emergency of International Concern. Because various neurological conditions are associated with ZIKV, such as microcephaly, Guillain-Barré syndrome, and other disorders of both the central and peripheral nervous systems, including encephalopathy, (meningo)encephalitis and myelitis, and because of the lack of reliable patient diagnosis, numerous ongoing studies seek to understand molecular mechanisms underlying ZIKV pathogenesis. Astrocytes are one of the most abundant cells in the CNS. They control axonal guidance, synaptic signaling, neurotransmitter trafficking and maintenance of neurons, and are targeted by ZIKV. In this study, we used a newly developed multiplexed aptamer-based technique (SOMAScan) to examine > 1300 human astrocyte cell proteins. We identified almost 300 astrocyte proteins significantly dysregulated by ZIKV infection that span diverse functions and signaling pathways, including protein translation, synaptic control, cell migration and differentiation.

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Zika virus infection in the returning traveller: what every neurologist should know

Cited by 21 publications

References 34 publications

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

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

Effector CD8 T Cell-Dependent Zika Virus Control in the CNS: A Matter of Time and Numbers

Zika Virus Infection Disrupts Astrocytic Proteins Involved in Synapse Control and Axon Guidance

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