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

To determine the clinical phenotype of Guillain-Barré 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) outbrea...

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Published in:	Journal of the neurological sciences Vol. 420; p. 117272
Main Authors:	Leonhard, Sonja E., Halstead, Susan, Lant, Suzannah B., Militão de Albuquerque, Maria de Fatima Pessoa, de Brito, Carlos Alexandre Antunes, de Albuquerque, Lívia Brito Bezerra, Ellul, Mark A., de Oliveira França, Rafael Freitas, Gourlay, Dawn, Griffiths, Michael J., de Miranda Henriques-Souza, Adélia Maria, de Morais Machado, Maria Í., Medialdea-Carrera, Raquel, Mehta, Ravi, da Paz Melo, Roberta, Mesquita, Solange D., Moreira, Álvaro J.P., Pena, Lindomar J., Santos, Marcela Lopes, Turtle, Lance, Solomon, Tom, Willison, Hugh J., Jacobs, Bart C., Brito Ferreira, Maria L.
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 15-01-2021
Subjects:	Arbovirus Brazil - epidemiology Chikungunya virus Cohort Studies Disease Outbreaks Guillain-Barre Syndrome - epidemiology Guillain-Barré syndrome Humans Neuroinflammatory disease Zika Virus Zika Virus Infection - complications Zika Virus Infection - epidemiology Brazil Zika virus Neuroinflammatory disease Arbovirus Guillain-Barré syndrome Chikungunya virus
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Summary:	To determine the clinical phenotype of Guillain-Barré 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. 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. 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. 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. •Recent infection with chikungunya virus may be associated with Guillain-Barré syndrome•Recent infection with both Zika virus and chikungunya virus was associated with a severe disease course•Patients with a preceding arbovirus infection generally had a sensorimotor demyelinating subtype of GBS•No glycolipid antibody signature was found in association with arbovirus-related GBS
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	0022-510X 1878-5883
DOI:	10.1016/j.jns.2020.117272