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New evidence supports link between Zika virus infection, Guillain-Barré syndrome
A recent analysis of patients with Guillain-Barré syndrome in Colombia further strengthened the association between the disorder and Zika virus infection, according to researchers from Johns Hopkins University.
The study, published in the New England Journal of Medicine, may be the largest of its kind to assess the role of Zika virus (ZIKV) infection in the development of Guillain-Barré syndrome (GBS), Carlos A. Pardo, MD, associate professor of neurology and pathology at the Johns Hopkins University School of Medicine, said in a press release.
The analysis included 68 patients with GBS who were treated at one of six university-based facilities in Colombia from January to March. Upon examination, half of the patients had bilateral facial paralysis. The majority (78%) of those who underwent nerve-conduction studies and electromyography were diagnosed with the acute inflammatory demyelinating polyneuropathy subtype of GBS. Nearly all patients (97%) reported symptoms of ZIKV infection such as fever, rash, headache, myalgia, nonpurulent conjunctivitis and arthralgia prior to the onset of GBS.
Reverse-transcription PCR was performed on urine, serum and cerebrospinal fluid (CSF) samples collected from 42 patients, 17 of whom tested positive for ZIKV infection. The virus was primarily detected in urine samples, underscoring the value of urine as a diagnostic tool, the researchers reported. Laboratory testing with enzyme-linked immunosorbent assays revealed that an additional 18 patients had evidence of a recent flavivirus infection. All patients tested negative for dengue virus (DENV) infection.
Among those tested, nearly half developed a rapid onset of neurologic symptoms during or shortly after experiencing symptoms of infection, with a median duration of 7 days between the onset of infection and GBS. According to the researchers, the temporal profile of GBS symptoms in their analysis differs from the “classical” post-infectious profile of GBS that is observed with other conditions, such as Campylobacter jejuni infection.
The link between GBS and ZIKV infection was further supported by an increase in GBS cases after ZIKV was first introduced in Colombia in late 2015 and early 2016. The Colombian Instituto Nacional de Salud estimated that there were approximately 20 GBS cases per month from 2009 to 2015, and 90 cases per month up to week 12 in 2016.
“The identification of the ZIKV genome by RT-PCR in biologic samples from 17 patients with [GBS], together with the presence of immune responses (IgG, IgM, or both) to flaviviruses in the CSF in most of the patients tested, supports the involvement of ZIKV in these cases of [GBS] during the outbreak of ZIKV infection in Colombia,” Pardo and colleagues concluded. “In addition, the clinical features of a preceding viral illness consistent with ZIKV infection and the evidence indicating that DENV infection was not present are also supportive of such a relationship.” – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.