Zika Virus and Guillain-Barré Syndrome

05/03/2023

Zika Virus and Guillain-Barré SyndromeMichael Wilson, MD

05/03/2023

What is Guillain-Barré Syndrome (GBS)?

Acute monophasic paralyzing illness Impaired conduction along peripheral nerves (typically demyelinating) Incidence: 1-2 per 100,000 people per year Occurs worldwide M > F All age groups affected (more common with increasing age) Mortality is under 5% Several subtypes including acute motor axonal neuropathy (AMAN)

Preparedness for the Zika Virus: A Public Health Emergency

05/03/2023

What Causes GBS?

Typically preceded by an infection 1-8 weeks prior

• Campylobacter jejuni

• Haemophilus influenzae

• Mycoplasma pneumoniae

• Cytomegalovirus

• Epstein-Barr virus

• HIV-1

• Influenza-like illnesses


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What does GBS Look Like?

(Mostly) symmetric muscle weakness

• Most commonly starts in the legs

• Early arm and facial muscle involvement in ~10% Paresthesias in the hands and feet are common Pain in the back and extremities is an early feature in 2/3 of patients Progressing over days Absent or depressed deep tendon reflexes 10-30% of patients develop severe respiratory weakness Dysautonomia


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How do you diagnose GBS?

Clinical syndrome over typical timeline History of preceding infection Cerebrospinal fluid studies

• Elevated protein

• Normal white blood cell count Electromyography and nerve conduction studies

• Demyelinating polyradiculoneuropathy Serum antibodies can be associated with some GBS subtypes


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How Do You Treat GBS?

Immunotherapy

• Plasma exchange

• Intravenous immunoglobulins Supportive care

• Respiratory support

• Autonomic dysfunction


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Zika and GBS in Latin America

Brazil• 19% increase in GBS cases nationwide from 2014 to 2015

• Northeastern states reported 121 cases (1/15 – 7/15)

El Salvador• 104 GBS cases from 12/1/15-1/30/16 (yearly average: 169 cases)

Colombia

• 5 week period: 86 cases (weekly average: 5 cases) Venezuela

• 252 GBS cases in January 2016 (66 in the state of Zulia)

European Centre for Disease Prevention and Control. Rapid Risk Assessment. Zika virus disease epidemic. ECDC; 2016.


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Zika and GBS in French Polynesia

Case-control study during Zika outbreak from October 2013 to April 2014 GBS cases (n=42; 74% men; median age of 42 yo)

• 3-10 patients per year from 2009-2012 Two control groups:

• Patients with non-febrile illness (n=98) matched for age, sex and residence

• Patients with Zika virus infection (n=70) without neuro symptoms (RT-PCR confirmed)

Cao-Lormeau VM, Blake A, Mons S, et al. Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet 2016


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Zika IgM Ab positive in 93% of GBS cases vs 17% in non-febrile control group Neutralizing Zika Ab present in 100% of GBS patients vs 56% of non-febrile

control group (p<0.0001) Median interval between viral syndrome and GBS was 6 days Rapid progression to symptom nadir: 6 days Nerve conduction studies consistent with AMAN subtype 38% of patients required intensive care


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All survived 3 months after discharge, 57% of patients walked without assistance Incidence estimated at 0.24 cases per 1,000 Zika virus infections

• Similar to Campylobacter jejuni incidence Dengue serologies similar across all three groups


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Summary: Zika and GBS

Increased incidence of GBS coinciding with Zika virus outbreaks in multiple countries

Link between Zika virus and GBS is still unclear Prospective studies are urgently needed to further define the strength of the

possible association between Zika virus infection and GBS Zika also reported in conjunction with meningoencephalitis and myelitis


Health & Medicine

Zika Virus and Guillain-Barré Syndrome