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Carrillo-Larco RM, Altez-Fernandez C, Ravaglia S, Vizcarra JA. COVID-19 and Guillain-Barre Syndrome: a systematic review of case reports. Wellcome Open Res 2020; 5:107. [PMID: 32995555 PMCID: PMC7509591 DOI: 10.12688/wellcomeopenres.15987.2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 01/20/2023] Open
Abstract
Background: Guillain-Barre Syndrome (GBS) is a neurological autoimmune disease that can lead to respiratory failure and death. Whether COVID-19 patients are at high risk of GBS is unknown. Through a systematic review of case reports, we aimed to summarize the main features of patients with GBS and COVID-19. Methods: Without any restrictions, we searched MEDLINE, Embase, Global Health, Scopus, Web of Science and MedXriv (April 23 rd, 2020). Two reviewers screened and studied titles, abstracts and reports. We extracted information to characterize sociodemographic variables, clinical presentation, laboratory results, treatments and outcomes. Results: Eight reports (n=12 patients) of GBS and COVID-19 were identified; one was a Miller Fisher case. The age ranged between 23 and 77 years, and there were more men (9/102). GBS symptoms started between 5 and 24 days after those of COVID-19. The protein levels in cerebrospinal fluid samples ranged between 40 and 193 mg/dl. None of the cerebrospinal fluid samples tested positive for COVID-19. Six patients debuted with ascendant weakness and three with facial weakness. Five patients had favourable evolution, four remained with relevant symptoms or required critical care and one died; the Miller Fisher case had successful resolution. Conclusions: GBS is emerging as a disease that may appear in COVID-19 patients. Although limited, preliminary evidence appears to suggest that GBS occurs after COVID-19 onset. Practitioners and investigators should have GBS in mind as they look after COVID-19 patients and conduct research on novel aspects of COVID-19. Comparison with GBS patients in the context of another viral outbreak (Zika), revealed similarities and differences that deserves further scrutiny and epidemiological studies.
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Affiliation(s)
- Rodrigo M. Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland, W2 1PG, UK
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
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Miranda RN, Ximenes R, Gebretekle GB, Bielecki JM, Sander B. Health-Related Quality of Life in Neurological Disorders Most Commonly Associated With Zika-Virus Infection: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:969-976. [PMID: 32762999 DOI: 10.1016/j.jval.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/31/2020] [Accepted: 03/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES In this systematic review, we synthesize the current evidence on health-related quality of life (HRQoL) for the two of the most relevant outcomes of Zika virus infection in humans, microcephaly and Guillain-Barré Syndrome (GBS). METHODS We searched the following databases: MEDLINE, Embase, CINAHL, LILACS, WHO's ICTRP clinical trials registries database and PROSPERO. Search terms included quality of life, microcephaly, and Guillain-Barré Syndrome. We included primary studies where HRQoL was quantitatively assessed for microcephaly and GBS using validated instruments. We used the Joanna Briggs Institute Critical Appraisal Tools to assess the risk of bias of individual studies. RESULTS From a total of 1,657 abstracts screened and 66 full texts reviewed, 21 studies met the eligibility criteria; one study for microcephaly and 20 for GBS. Adjusted disutilities for microcephaly compared to a normative childhood utility ranged from -0.745 to -0.820. For GBS, time traded-off the expected lifetime ranged from 16 days to 3 years. HRQoL follows the clinical course of GBS, with lower scores in the first months, recovery within the first year post onset, and stabilization after one year. CONCLUSIONS Included studies reported a wide range of HRQoL for GBS, due in part to a high level of heterogeneity in methods, inclusion criteria, follow-up and reporting of results. Opportunities exist for primary studies assessing the longitudinal HRQoL over the entire course of the diseases to inform clinical practice, economic evaluations and health policy.
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Affiliation(s)
- Rafael N Miranda
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada.
| | - Raphael Ximenes
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - Gebremedhin B Gebretekle
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada; School of Pharmacy, Addis Ababa University, Ethiopia
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - Beate Sander
- University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada
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3
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Carrillo-Larco RM, Altez-Fernandez C, Ravaglia S, Vizcarra JA. COVID-19 and Guillain-Barre Syndrome: a systematic review of case reports. Wellcome Open Res 2020; 5:107. [PMID: 32995555 PMCID: PMC7509591 DOI: 10.12688/wellcomeopenres.15987.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/13/2023] Open
Abstract
Background: Guillain-Barre Syndrome (GBS) is a neurological autoimmune disease that can lead to respiratory failure and death. Whether COVID-19 patients are at high risk of GBS is unknown. Through a systematic review of case reports, we aimed to summarize the main features of patients with GBS and COVID-19. Methods: Without any restrictions, we searched MEDLINE, Embase, Global Health, Scopus, Web of Science and MedXriv (April 23 rd, 2020). Two reviewers screened and studied titles, abstracts and reports. We extracted information to characterize sociodemographic variables, clinical presentation, laboratory results, treatments and outcomes. Results: Eight reports (n=12 patients) of GBS and COVID-19 were identified; one was a Miller Fisher case. Overall, the median age was 62.5 (interquartile range (IQR)=54.5-70.5) years, and there were more men (9/102). GBS symptoms started between 5 and 24 days after those of COVID-19. The median protein levels in cerebrospinal fluid samples was 101.5 mg/dl (IQR=51-145). None of the cerebrospinal fluid samples tested positive for COVID-19. Six patients debuted with ascendant weakness and three with facial weakness. Five patients had favourable evolution, four remained with relevant symptoms or required critical care and one died; the Miller Fisher case had successful resolution. Conclusions: GBS is emerging as a disease that may appear in COVID-19 patients. Although limited, preliminary evidence appears to suggest that GBS occurs after COVID-19 onset. Practitioners and investigators should have GBS in mind as they look after COVID-19 patients and conduct research on novel aspects of COVID-19. Comparison with GBS patients in the context of another viral outbreak (Zika), revealed similarities and differences that deserves further scrutiny and epidemiological studies.
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Affiliation(s)
- Rodrigo M. Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland, W2 1PG, UK
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
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4
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Gómez Á, Díaz A, Carrión-Penagos J, Reyes J, Reyes S. Clinical and electrophysiological characteristics of Guillain-Barré syndrome in Colombia. J Peripher Nerv Syst 2019; 24:268-271. [PMID: 31386254 DOI: 10.1111/jns.12340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/16/2019] [Accepted: 08/02/2019] [Indexed: 12/18/2022]
Abstract
Despite the wide literature describing the features of Guillain-Barré syndrome (GBS) in different populations worldwide, Colombian data are very scarce. We aim to characterize patients with GBS in a general hospital setting in Colombia. We conducted a retrospective chart review of GBS cases managed at the Hospital Universitario Fundación Santa Fe de Bogotá, from 2011 to 2016. Twenty-three patients were included. The most commonly reported symptoms were paresthesias (65%), pain (61%), proximal (22%) and distal (74%) limb weakness, and facial palsy (30%). 9% of patients had Fisher syndrome and 21% had other variants: Bickerstaff, pharyngeal-cervical-brachial pattern, and facial diplegia. There was a predominance of the demyelinating form (70%), with only 22% of patients presenting with the axonal variants. Our results are concordant with previous studies in Colombia.
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Affiliation(s)
- Ángela Gómez
- Department of Neurology, Hospital Universitario-Fundación Santa Fe de Bogotá, Bogotá, Colombia.,School of Medicine, Universidad de los Andes, Bogotá, Colombia.,School of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Andrés Díaz
- Department of Neurology, Hospital Universitario-Fundación Santa Fe de Bogotá, Bogotá, Colombia.,School of Medicine, Universidad de los Andes, Bogotá, Colombia.,School of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Julián Carrión-Penagos
- Department of Neurology, Hospital Universitario-Fundación Santa Fe de Bogotá, Bogotá, Colombia.,School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Julián Reyes
- Department of Neurology, Hospital Universitario-Fundación Santa Fe de Bogotá, Bogotá, Colombia.,School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Saúl Reyes
- Department of Neurology, Hospital Universitario-Fundación Santa Fe de Bogotá, Bogotá, Colombia.,School of Medicine, Universidad El Bosque, Bogotá, Colombia
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Millán S, Díaz C, David Pardo DG, Castro Guzmán G. Clinical and neurophysiological characteristics of patients with Guillain-Barré syndrome at Hospital Universitario San Ignacio, Bogotá, Colombia between 2009 and 2017. J Peripher Nerv Syst 2019; 24:272-275. [PMID: 31410933 DOI: 10.1111/jns.12345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/27/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
Guillain-Barré syndrome (GBS) is the most common acute peripheral polyneuropathy in the world. The estimated incidence in Colombia is 1.2-1.7 cases per 100 000 inhabitants, although during 2016 an increase in the incidence of the disease was documented, apparently associated with an epidemiological peak of the Zika virus. We conducted to describe the clinical and neurophysiological characteristics of adult patients with GBS treated at Hospital Universitario San Ignacio, Bogota, Colombia, between 2009 and 2017. An observational, descriptive, cross-sectional study was designed.
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Affiliation(s)
- Sonia Millán
- Department of Neurology, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Cindy Díaz
- Department of Neurology, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - David G David Pardo
- School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia.,Department of Neurosciences and Aging, Pontificia Universidad Javeriana, Bogotá, Colombia
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6
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Walteros DM, Soares J, Styczynski AR, Abrams JY, Galindo-Buitrago JI, Acosta-Reyes J, Bravo-Ribero E, Arteta ZE, Solano-Sanchez A, Prieto FE, Gonzalez-Duarte M, Navarro-Lechuga E, Salinas JL, Belay ED, Schonberger LB, Damon IK, Ospina ML, Sejvar JJ. Long-term outcomes of Guillain-Barré syndrome possibly associated with Zika virus infection. PLoS One 2019; 14:e0220049. [PMID: 31369576 PMCID: PMC6675241 DOI: 10.1371/journal.pone.0220049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/08/2019] [Indexed: 01/09/2023] Open
Abstract
Background This prospective cohort investigation analyzed the long-term functional and neurologic outcomes of patients with Zika virus-associated Guillain-Barré syndrome (GBS) in Barranquilla, Colombia. Methods Thirty-four Zika virus-associated GBS cases were assessed a median of 17 months following acute GBS illness. We assessed demographics, results of Overall Disability Sum Scores (ODSS), Hughes Disability Score (HDS), Zung Depression Scale (ZDS), and Health Related Quality of Life (HRQL) questionnaires; and compared outcomes indices with a normative sample of neighborhood-selected control subjects in Barranquilla without GBS. Results Median age at time of acute neurologic onset was 49 years (range, 10–80); 17 (50%) were male. No deaths occurred. At long-term follow-up, 25 (73%) patients had a HDS 0–1, indicating complete / near complete recovery. Among the group, HDS (mean 1.4, range 0–4), ODSS (mean 1.9, range 0–9) and ZDS score (mean 34.4, range 20–56) indicated mild / moderate ongoing disability. Adjusting for age and sex, Zika virus-associated GBS cases were similar to a population comparison group (n = 368) in Barranquilla without GBS in terms of prevalence of physical or mental health complaints, though GBS patients were more likely to have an ODSS of ≥ 1 (OR 8.8, 95% CI 3.2–24.5) and to suffer from moderate / moderate-severe depression (OR 3.89, 95% CI 1.23–11.17) than the comparison group. Conclusions Long-term outcomes of Zika virus-associated GBS are consistent with those associated with other antecedent antigenic stimuli in terms of mortality and ongoing long-term morbidity, as published in the literature. Persons with Zika virus-associated GBS more frequently reported disability and depression after approximately one year compared with those without GBS.
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Affiliation(s)
| | - Jesus Soares
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ashley R. Styczynski
- Stanford University Department of Infectious Diseases, Palo Alto, California, United States of America
| | - Joseph Y. Abrams
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | | | | | | | | | | | | | - Jorge L. Salinas
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States of America
| | - Ermias D. Belay
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Inger K. Damon
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - James J. Sejvar
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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7
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Gastrointestinal, respiratory and/or arboviral infections? What is the cause of the Guillain-Barré syndrome epidemics in Perú? Current status – 2019. Travel Med Infect Dis 2019; 30:114-116. [DOI: 10.1016/j.tmaid.2019.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 01/31/2023]
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8
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Restrepo-Jiménez P, Rodríguez Y, González P, Chang C, Gershwin ME, Anaya JM. The immunotherapy of Guillain-Barré syndrome. Expert Opin Biol Ther 2018; 18:619-631. [DOI: 10.1080/14712598.2018.1468885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Paula Restrepo-Jiménez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Yhojan Rodríguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Paulina González
- Neurology Service, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Davis, CA, USA
| | - M. Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Davis, CA, USA
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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9
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Acosta-Ampudia Y, Monsalve DM, Castillo-Medina LF, Rodríguez Y, Pacheco Y, Halstead S, Willison HJ, Anaya JM, Ramírez-Santana C. Autoimmune Neurological Conditions Associated With Zika Virus Infection. Front Mol Neurosci 2018; 11:116. [PMID: 29695953 PMCID: PMC5904274 DOI: 10.3389/fnmol.2018.00116] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/26/2018] [Indexed: 12/20/2022] Open
Abstract
Zika virus (ZIKV) is an emerging flavivirus rapidly spreading throughout the tropical Americas. Aedes mosquitoes is the principal way of transmission of the virus to humans. ZIKV can be spread by transplacental, perinatal, and body fluids. ZIKV infection is often asymptomatic and those with symptoms present minor illness after 3 to 12 days of incubation, characterized by a mild and self-limiting disease with low-grade fever, conjunctivitis, widespread pruritic maculopapular rash, arthralgia and myalgia. ZIKV has been linked to a number of central and peripheral nervous system injuries such as Guillain-Barré syndrome (GBS), transverse myelitis (TM), meningoencephalitis, ophthalmological manifestations, and other neurological complications. Nevertheless, mechanisms of host-pathogen neuro-immune interactions remain incompletely elucidated. This review provides a critical discussion about the possible mechanisms underlying the development of autoimmune neurological conditions associated with Zika virus infection.
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Affiliation(s)
- Yeny Acosta-Ampudia
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Diana M Monsalve
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Luis F Castillo-Medina
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Yhojan Rodríguez
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Yovana Pacheco
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Susan Halstead
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Hugh J Willison
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Carolina Ramírez-Santana
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
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Uncini A, González-Bravo DC, Acosta-Ampudia YY, Ojeda EC, Rodríguez Y, Monsalve DM, Ramírez-Santana C, Vega DA, Paipilla D, Torres L, Molano-González N, Osorio JE, Anaya JM. Clinical and nerve conduction features in Guillain−Barré syndrome associated with Zika virus infection in Cúcuta, Colombia. Eur J Neurol 2018; 25:644-650. [DOI: 10.1111/ene.13552] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. Uncini
- Department of Neuroscience, Imaging and Clinical Sciences; University ‘G. d'Annunzio’; Chieti-Pescara Italy
| | - D. C. González-Bravo
- Center for Autoimmune Diseases Research (CREA); School of Medicine and Health Sciences; Universidad del Rosario; Bogotá Colombia
| | - Y. Y. Acosta-Ampudia
- Center for Autoimmune Diseases Research (CREA); School of Medicine and Health Sciences; Universidad del Rosario; Bogotá Colombia
| | - E. C. Ojeda
- Center for Autoimmune Diseases Research (CREA); School of Medicine and Health Sciences; Universidad del Rosario; Bogotá Colombia
| | - Y. Rodríguez
- Center for Autoimmune Diseases Research (CREA); School of Medicine and Health Sciences; Universidad del Rosario; Bogotá Colombia
| | - D. M. Monsalve
- Center for Autoimmune Diseases Research (CREA); School of Medicine and Health Sciences; Universidad del Rosario; Bogotá Colombia
| | - C. Ramírez-Santana
- Center for Autoimmune Diseases Research (CREA); School of Medicine and Health Sciences; Universidad del Rosario; Bogotá Colombia
| | - D. A. Vega
- Center for Autoimmune Diseases Research (CREA); School of Medicine and Health Sciences; Universidad del Rosario; Bogotá Colombia
| | - D. Paipilla
- Neurophysiology Laboratory; SOMEFYR Clinic; Cúcuta Colombia
| | - L. Torres
- Neurophysiology Laboratory; SOMEFYR Clinic; Cúcuta Colombia
| | - N. Molano-González
- Center for Autoimmune Diseases Research (CREA); School of Medicine and Health Sciences; Universidad del Rosario; Bogotá Colombia
| | - J. E. Osorio
- Department of Pathobiological Sciences; University of Wisconsin-Madison; Madison WI USA
| | - J.-M. Anaya
- Center for Autoimmune Diseases Research (CREA); School of Medicine and Health Sciences; Universidad del Rosario; Bogotá Colombia
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Garg R, Jain A, Rizvi I. Guillain–Barré syndrome caused by Zika virus: A wake-up call for India. Neurol India 2018; 66:1290-1292. [DOI: 10.4103/0028-3886.241356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Zika, Guillain-Barré y anestesiología: un punto de intersección entre la salud pública y la práctica clínica. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zika, Guillain-Barré and anesthesiology: A point of intersection between public health and clinical practice☆: Zika, Guillain-Barré y anestesiología: un punto de intersección entre la salud pública y la práctica clínica. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201710000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Pacheco-Coral ADP. Zika, Guillain–Barré and anesthesiology: A point of intersection between public health and clinical practice. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Neuroimaging findings of postnatally acquired Zika virus infection: a pictorial essay. Jpn J Radiol 2017; 35:341-349. [PMID: 28447317 DOI: 10.1007/s11604-017-0641-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
Zika virus (ZIKV) is a mosquito-borne arbovirus from the Flaviviridae family, first discovered in 1947. There has been no report of severe complications caused by this virus in humans until recently. However, it is confirmed now that prenatally acquired ZIKV infection may cause severe congenital brain abnormalities in the infected fetuses. In addition, there has been an increasing number of reports during recent years about the causal relationship between postnatally acquired ZIKV infection and severe neurologic complications (mostly immune-mediated ones). Hence, ZIKV should not be considered as benign as it was initially thought, but it might be seen as a serious global threat to human health that may severely affect not only fetuses. In this pictorial essay, we aim to describe and illustrate the currently recognized spectrum of neuroimaging findings in postnatally acquired ZIKV infection. Although neurologic complications do not frequently occur in postnatal ZIKV infection, it is important to be aware of them because they may cause high morbidity and mortality in the affected patients. In addition to clinical and laboratory findings, neuroimaging may help in the diagnostic work-up to make the correct diagnosis, determine the extent of the disease, and follow the clinical course.
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Wijdicks EFM, Klein CJ. Guillain-Barré Syndrome. Mayo Clin Proc 2017; 92:467-479. [PMID: 28259232 DOI: 10.1016/j.mayocp.2016.12.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/29/2016] [Accepted: 12/12/2016] [Indexed: 02/05/2023]
Abstract
Guillain-Barré syndrome is an acute inflammatory immune-mediated polyradiculoneuropathy presenting typically with tingling, progressive weakness, and pain. Variants and formes frustes may complicate recognition. The best known variant is the sensory ataxic form of Miller Fisher syndrome, which also affects the oculomotor nerves and the brain stem. Divergent pathologic mechanisms lead to demyelinating, axonal, or mixed demyelinating-axonal damage. In the demyelinating form, yet to be identified antigens are inferred by complement activation, myelin destruction, and macrophage-activated cleanup. In the axonal and Miller Fisher variants, gangliosides (GM1, GD1a, GQ1b) are targeted by immunoglobulins and share antigenic epitopes with some bacterial and viral antigens. Campylobacter jejuni infection is associated with an axonal-onset variant; affected patients commonly experience more rapid deterioration. Many other antecedent infectious agents have been recognized including the most recently identified, Zika virus. Supportive care remains the mainstay of therapy. Plasma exchange or intravenous immunoglobin hastens recovery. Combination immunotherapy is not more effective, and the efficacy of prolonged immunotherapy is unproven. One in 3 patients will have deterioration severe enough to require prolonged intensive care monitoring or mechanical ventilation. Full recovery is often seen; most patients regain ambulation, even in severe cases, but disability remains in up to 10% and perhaps more. Numerous challenges remain including early identification and control of infectious triggers, improved access of modern neurointensive care worldwide, and translating our understanding of pathogenesis into meaningful preventive or assistive therapies. This review provides a historical perspective at the centenary of the first description of the syndrome, insights into its pathogenesis, triage, initial immunotherapy, and management in the intensive care unit.
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Affiliation(s)
- Eelco F M Wijdicks
- Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN.
| | - Christopher J Klein
- Division of Peripheral Nerve Diseases, Department of Neurology, Mayo Clinic, Rochester, MN
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Pinto-Díaz CA, Rodríguez Y, Monsalve DM, Acosta-Ampudia Y, Molano-González N, Anaya JM, Ramírez-Santana C. Autoimmunity in Guillain-Barré syndrome associated with Zika virus infection and beyond. Autoimmun Rev 2017; 16:327-334. [PMID: 28216074 DOI: 10.1016/j.autrev.2017.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/05/2016] [Indexed: 12/15/2022]
Abstract
Autoimmune diseases share common immunopathogenic mechanisms (i.e., the autoimmune tautology), which explain the clinical similarities among them as well as their familial clustering. Guillain-Barré syndrome (GBS), an autoimmune peripheral neuropathy, has been recently associated with Zika virus (ZIKV) infection. Based on a series of cases, this review article provides a comparative analysis of GBS associated with ZIKV infection, contrasted with the general characteristics of GBS in light of the autoimmune tautology, including gender differences in prevalence, subphenotypes, polyautoimmunity, familial autoimmunity, age at onset, pathophysiology, ecology, genetics, ancestry, and treatment.
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Affiliation(s)
- Carlos A Pinto-Díaz
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Yhojan Rodríguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Diana M Monsalve
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Yeny Acosta-Ampudia
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Nicolás Molano-González
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Carolina Ramírez-Santana
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia.
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Anaya JM, Rodríguez Y, Monsalve DM, Vega D, Ojeda E, González-Bravo D, Rodríguez-Jiménez M, Pinto-Díaz CA, Chaparro P, Gunturiz ML, Ansari AA, Gershwin ME, Molano-González N, Ramírez-Santana C, Acosta-Ampudia Y. A comprehensive analysis and immunobiology of autoimmune neurological syndromes during the Zika virus outbreak in Cúcuta, Colombia. J Autoimmun 2017; 77:123-138. [PMID: 28062188 DOI: 10.1016/j.jaut.2016.12.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/20/2016] [Accepted: 12/24/2016] [Indexed: 01/24/2023]
Abstract
We have focused on the epidemiology and immunobiology of Zika virus (ZIKV) infection and factors associated with the development of Guillain-Barré syndrome (GBS) and other neurological syndromes in Cúcuta, the capital of North Santander department, Colombia. Data of patients with ZIKV disease reported to the national population-based surveillance system were used to calculate the basic reproduction number (R0) and the attack rates (ARs) as well as to develop epidemiological maps. Patients with neurological syndromes were contacted and their diagnoses were confirmed. A case-control study in which 29 patients with GBS associated with ZIKV compared with 74-matched control patients with ZIKV infection alone was undertaken. Antibodies against arboviruses and other infections that may trigger GBS were evaluated. The estimated value of R0 ranged between 2.68 (95% CI 2.54-2.67) to 4.57 (95% CI 4.18-5.01). The sex-specific ARs were 1306 per 100,000 females, and 552 per 100,000 males. A non-linear interaction between age and gender on the ARs was observed. The incidence of GBS in Cúcuta increased 4.41 times secondary to ZIKV infection. The lag time between ZIKV infection and neurological symptoms was 7 days (interquartile range 2-14.5). Patients with GBS appeared to represent a lower socioeconomic status and were living near to environmentally contaminated areas. All GBS patients were positive for IgG antibodies against both ZIKV and Dengue virus, and 69% were positive for Chikungunya virus. Noteworthy, GBS was associated with a previous infection with M. pneumoniae (OR: 3.95; 95% CI 1.44-13.01; p = 0.006). No differences in antibody levels against C. jejuni, Epstein-Barr virus and cytomegalovirus were observed. High rates of cranial nerves involvement and dysautonomia were present in 82% and 75.9%, respectively. Intensive care unit (ICU) admission was necessary in 69% of the GBS patients. Most of the patients disclosed a high disability condition (Hughes grade 4). Dysautonomia was the main risk factor of poor GBS prognosis (i.e., ICU admission and disability). Thirteen patients were diagnosed with other neurological syndromes different to GBS (6 with transverse myelitis, 3 with encephalitis, 3 with peripheral facial palsy and one with thoraco-lumbosacral myelopathy). Our data confirm an increased transmission of ZIKV in Cúcuta, and provide support to the view that severe neurological syndromes are related to ZIKV disease. The complex ways by which previous infections and socioeconomic status interact to increase the risk of GBS in people infected by ZIKV should be further investigated.
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Affiliation(s)
- Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
| | - Yhojan Rodríguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Diana M Monsalve
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Daniel Vega
- Intensive Care Unit, Mederi - Hospital Universitario Mayor, Bogotá, Colombia
| | - Ernesto Ojeda
- Neurology Department, Mederi - Hospital Universitario Mayor, Bogotá, Colombia
| | - Diana González-Bravo
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Mónica Rodríguez-Jiménez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Carlos A Pinto-Díaz
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | | | | | - Aftab A Ansari
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Davis, CA, USA.
| | - Nicolás Molano-González
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Carolina Ramírez-Santana
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Yeny Acosta-Ampudia
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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Barcellos C, Xavier DR, Pavão AL, Boccolini CS, Pina MF, Pedroso M, Romero D, Romão AR. Increased Hospitalizations for Neuropathies as Indicators of Zika Virus Infection, according to Health Information System Data, Brazil. Emerg Infect Dis 2016; 22:1894-1899. [PMID: 27603576 PMCID: PMC5088029 DOI: 10.3201/eid2211.160901] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Neurologic manifestations of Zika infection must be adequately recognized and treated; our study methods can be used for monitoring and warning systems. Evidence is increasing that Zika virus can cause extensive damage to the central nervous system, affecting both fetuses and adults. We sought to identify traces of possible clinical manifestations of nervous system diseases among the registers of hospital admissions recorded in the Brazilian Unified Health System. Time series of several diagnoses from the International Classification of Diseases, 10th Revision, were analyzed by using control diagrams, during January 2008–February 2016. Beginning in mid-2014, we observed an unprecedented and significant rise in the hospitalization rate for congenital malformations of the nervous system, Guillain-Barré syndrome, encephalitis, myelitis, and encephalomyelitis. These conditions are compatible with viral infection and inflammation-associated manifestations and may have been due to the entrance of Zika virus into Brazil. These findings show the necessity of adequately diagnosing and treating suspected cases of Zika virus infection and also that health surveillance systems can be improved by using routine data.
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Role of environmental factors in autoimmunity: pearls from the 10th international Congress on autoimmunity, Leipzig, Germany 2016. Immunol Res 2016; 65:1-4. [PMID: 27561788 DOI: 10.1007/s12026-016-8857-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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