Guillain-Barr ́e syndrome during the Zika virus outbreak in Northeast Brazil: An observational cohort study
Authors:
Sonja E. Leonhard de Albuquerque d, Carlos Alexandre Antunes de Brito e, Lívia Brito Bezerra de Albuquerque f, Mark A. Ellul c, g, Rafael Freitas de Oliveira França h, Dawn Gourlay b, Michael J. Griffiths c, i, Ad ́elia Maria de Miranda Henriques-Souza j, Maria ́I. de Morais Machado j, Raquel Medialdea-Carrera c, Ravi Mehta c, Roberta da Paz Melo k, Solange D. Mesquita k, A ́lvaro J.P. Moreirak, Lindomar J. Penah, Marcela Lopes Santosd, Lance Turtlec,l, Tom Solomonc,g, Hugh J. Willisonb, Bart C. Jacobsa,m,, Maria L. Brito Ferreirak,
Abstract:
Objective: To determine the clinical phenotype of Guillain-Barr ́e syndrome (GBS) after Zika virus (ZIKV) infection, the anti-glycolipid antibody signature, and the role of other circulating arthropod-borne viruses, we describe a cohort of GBS patients identified during ZIKV and chikungunya virus (CHIKV) outbreaks in Northeast Brazil.
Methods: We prospectively recruited GBS patients from a regional neurology center in Northeast Brazil between December 2014 and February 2017. Serum and CSF were tested for ZIKV, CHIKV, and dengue virus (DENV), by RT-PCR and antibodies, and serum was tested for GBS-associated antibodies to glycolipids.
Results: Seventy-one patients were identified. Forty-eight (68%) had laboratory evidence of a recent arbovirus infection; 25 (52%) ZIKV, 8 (17%) CHIKV, 1 (2%) DENV, and 14 (29%) ZIKV and CHIKV. Most patients with a recent arbovirus infection had motor and sensory symptoms (72%), a demyelinating electrophysiological subtype (67%) and a facial palsy (58%). Patients with a recent infection with ZIKV and CHIKV had a longer hospital admission and more frequent mechanical ventilation compared to the other patients. No specific anti-glycolipid antibody signature was identified in association with arbovirus infection, although significant antibody titres to GM1, GalC, LM1, and GalNAc-GD1a were found infrequently.
Conclusion: A large proportion of cases had laboratory evidence of a recent infection with ZIKV or CHIKV, and recent infection with both viruses was found in almost one third of patients. Most patients with a recent arbovirus infection had a sensorimotor, demyelinating GBS. We did not find a specific anti-glycolipid antibody signature in association with arbovirus-related GBS.
Journal:
Journal of the Neurological Sciences