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Madden J, Spadaro A, Koyfman A, Long B. High risk and low prevalence diseases: Guillain-Barré syndrome. Am J Emerg Med 2024; 75:90-97. [PMID: 37925758 DOI: 10.1016/j.ajem.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is a rare but serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of GBS, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION GBS is a rare immune-mediated neurologic disorder with peripheral nerve injury. It most commonly presents weeks after a bacterial or viral infection, though there are a variety of associated inciting events. The diagnosis is challenging and often subtle, as only 25-30% of patients are diagnosed on their initial healthcare visit. Clinicians should consider GBS in patients with progressive ascending weakness involving the lower extremities associated with hyporeflexia, but the cranial nerves, respiratory system, and autonomic system may be involved. While the ED diagnosis should be based on clinical assessment, further evaluation includes laboratory testing, cerebrospinal fluid (CSF) analysis, and potentially neuroimaging. Not all patients demonstrate albumino-cytological dissociation on CSF testing. Several criteria exist to assist with diagnosis, including the National Institute of Neurological Disorders and Stroke criteria and the Brighton criteria. Management focuses first on assessment of the patient's hemodynamic and respiratory status, which may require emergent intervention. Significant fluctuations in heart rate and blood pressure may occur, and respiratory muscle weakness may result in the need for airway protection. Neurology consultation is recommended, and definitive treatment includes PLEX or IVIG. CONCLUSIONS An understanding of GBS can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Joshua Madden
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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2
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Song Y, Zheng X, Fang Y, Liu S, Liu K, Zhu J, Wu X. Current status of Guillain-Barré syndrome (GBS) in China: a 10-year comprehensive overview. Rev Neurosci 2023; 34:869-897. [PMID: 37145885 DOI: 10.1515/revneuro-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/13/2023] [Indexed: 05/07/2023]
Abstract
Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy; a disease involving the peripheral nervous system which is the most common cause of acute flaccid paralysis worldwide. So far, it is still lack of a comprehensive overview and understanding of the national epidemiological, clinical characteristics, and the risk factors of GBS in China, as well as differences between China and other countries and regions in these respects. With the global outbreak of the coronavirus disease 2019 (COVID-19), an epidemiological or phenotypic association between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and GBS has attracted great attention. In this review, we outlined the current clinical data of GBS in China by retrieving literature, extracting and synthesizing the data of GBS in China from 2010 to 2021. Besides, we compared the characteristics of epidemiology, preceding events and clinical profiles of GBS between China and other countries and regions. Furthermore, in addition to conventional intravenous immunoglobulin (IVIG) and plasma exchange (PE) therapy, the potential therapeutic effects with novel medications in GBS, such as complement inhibitors, etc., have become the research focus in treatments. We found that epidemiological and clinical findings of GBS in China are approximately consistent with those in the International GBS Outcome Study (IGOS) cohort. We provided an overall picture of the present clinical status of GBS in China and summarized the global research progress of GBS, aiming to further understand the characteristics of GBS and improve the future work of GBS worldwide, especially in countries with the middle and low incomes.
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Affiliation(s)
- Yanna Song
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, 510000 Guangzhou, China
| | - Xiaoxiao Zheng
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Yong Fang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Shan Liu
- The Second Hospital of Jilin University, Jilin University, Ziqiang Street 218, 130022 Changchun, China
| | - Kangding Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska University Hospital, 17177 Solna, Stockholm, Sweden
| | - Xiujuan Wu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
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Wachira VK, Farinasso CM, Silva RB, Peixoto HM, de Oliveira MRF. Incidence of Guillain-Barré syndrome in the world between 1985 and 2020: A systematic review. GLOBAL EPIDEMIOLOGY 2023; 5:100098. [PMID: 37638372 PMCID: PMC10445966 DOI: 10.1016/j.gloepi.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Introduction Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy that affects the peripheral nervous system. The study aimed to describe the incidence of GBS in the world up to the year 2020. Methods A systematic review was conducted. Searches were done in four databases, PUBMED, EMBASE, EBSCO and Biblioteca virtual em Saude (BVS), and in grey literature and manual search in the reference lists of eligible studies. Results A total of 72 studies were included. The incidence of GBS among the cohort studies varied from 0.30 to 6.08 cases per 100.000 habitants and 0.42 to 6.58 cases per 100.000 person-years. Among the self-controlled studies, the risk incidence ranged from 0.072 to 1 case per 100.000 habitants and 1.73 to 4.30 cases per 100.000 person-years. Conclusions The reported incidence of GBS in the world among the studies included in the review is slightly higher than that reported in previous studies. The highest incidence rates were associated with public health events of international concern.
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Affiliation(s)
- Virginia Kagure Wachira
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | | | | | - Henry Maia Peixoto
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, Brazil
| | - Maria Regina Fernandes de Oliveira
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, Brazil
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Arora H, Prajapati B, Seth P. Potential role of lncRNA in impairing cellular properties of human neural progenitor cells following exposure to Zika virus E protein. Exp Neurol 2023; 368:114493. [PMID: 37479020 DOI: 10.1016/j.expneurol.2023.114493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/08/2023] [Accepted: 07/18/2023] [Indexed: 07/23/2023]
Abstract
Zika virus (ZIKV) infection during the first trimester of the pregnancy may lead to Congenital zika syndrome in the neonates. The viral infection hampers foetal brain development and causes microcephaly. Human neural progenitor cells (hNPCs) play an important role in brain development, however they are highly susceptible to ZIKV infection. In this study, we elucidated the molecular mechanisms that lead to cellular alterations in hNPCs due to ZIKV E-protein. We investigated proliferation, differentiation, migration and inflammation in hNPCs, which may lead to microcephaly. In our study, we found that ZIKV E-protein causes cell cycle arrest, decrease in proliferation and increase in mitotic length of the dividing hNPCs. We observed CyclinD1 and upstream molecules (p21 and p53) of the pathway are dysregulated, and intracellular calcium at basal level as well as upon ATP stimulation were reduced following over expression of ZIKV E-protein. ZIKV E-protein transfected hNPCs exhibited pre-mature differentiation with pro-neural genes upregulated. Furthermore, ZIKV E-protein disrupted migrational properties of hNPCs and caused elevated levels of inflammatory chemokines and cytokines. To gain insights into molecular mechanisms of these effects on hNPCs, we explored the possible involvement of long non coding RNAs in ZIKV neuropathogenesis. We have shortlisted lncRNAs associated with differentially expressed genes from publicly available transcriptomic data and found some of those lncRNAs are differentially expressed upon E-protein transfection of hNPCs. Gene ontology analysis suggest these lncRNAs play an important role in regulation of viral life cycle, host's defence response and cell proliferation.
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Affiliation(s)
- Himali Arora
- Cellular and Molecular Neuroscience, Neurovirology Section, National Brain Research Centre, Manesar, Gurugram, Haryana, India
| | - Bharat Prajapati
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Pankaj Seth
- Cellular and Molecular Neuroscience, Neurovirology Section, National Brain Research Centre, Manesar, Gurugram, Haryana, India.
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Duvuru R, Raju S, Nawaz F. A Rare Case of Miller Fisher Syndrome in a 45-Year-Old Female. Cureus 2023; 15:e36387. [PMID: 37090296 PMCID: PMC10113916 DOI: 10.7759/cureus.36387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Miller Fisher syndrome (MFS) is an uncommon form of Guillain-Barré syndrome (GBS), a neurological condition that is acquired, degenerative, demyelinating, and frequently characterized by gradual, symmetrical ascending paralysis. Ophthalmoplegia, ataxia, and areflexia are common symptoms that follow a bacterial or viral infection. Here, we want to draw attention to a rare case of MFS in a 45-year-old Indian female who had dysphagia, dysphasia, ataxia, and dyskinesia while moving around. Unusually, she had no past medical history of Campylobacter jejuni infection, recent vaccinations, upper respiratory tract infections, or any sexually transmitted diseases. Since this disorder has excellent prognosis, early diagnosis and effective treatment are crucial to minimizing unnecessary medical intervention and psychological suffering.
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Affiliation(s)
- Ruthwik Duvuru
- Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
| | - Shivani Raju
- Neurology, The Oxford Medical College, Hospital & Research Centre, Bangalore, IND
| | - Faisal Nawaz
- Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE
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Ahmed A, El‐Amin R, Musa AM, Elsayed MA, Fahal LA, Ahmed ES, Ali Y, Nebie IE, Mohamed NS, Zinsstag J, Siddig EE, EL‐Sadig SM. Guillain-Barre syndrome associated with COVID-19 infection: A case series. Clin Case Rep 2023; 11:e6988. [PMID: 36852114 PMCID: PMC9957700 DOI: 10.1002/ccr3.6988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/03/2023] [Accepted: 02/06/2023] [Indexed: 02/27/2023] Open
Abstract
In this communication, we reported a series of six patients presented with Guillain-Barré syndrome that associated with COVID-19 infection, which was confirmed with RT-PCR. Here we discuss the laboratory investigation and case management, as well as clinical presentation and outcome of each case. The current report demonstrated the first case series of COVID-19-associated GBS-cases in Sudan.
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Affiliation(s)
- Ayman Ahmed
- Institute of Endemic DiseaseUniversity of KhartoumKhartoumSudan,Swiss Tropical and Public Health Institute (Swiss TPH)AllschwilSwitzerland,University of BaselBaselSwitzerland
| | - Rahba El‐Amin
- Faculty of MedicineUniversity of KhartoumKhartoumSudan
| | | | | | | | | | - Yousif Ali
- Health Emergencies and Epidemics Control General DirectorateSudan Federal Ministry of HealthKhartoumSudan
| | - Ipyn Eric Nebie
- Swiss Tropical and Public Health Institute (Swiss TPH)AllschwilSwitzerland,University of BaselBaselSwitzerland
| | - Nouh Saad Mohamed
- Molecular Biology UnitSirius Training and Research CentreKhartoumSudan
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute (Swiss TPH)AllschwilSwitzerland,University of BaselBaselSwitzerland
| | - Emmanuel Edwar Siddig
- Mycetoma Research CentreUniversity of KhartoumKhartoumSudan,Faculty of Medical Laboratory SciencesUniversity of KhartoumKhartoumSudan
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Charniga K, Cucunubá ZM, Walteros DM, Mercado M, Prieto F, Ospina M, Nouvellet P, Donnelly CA. Estimating Zika virus attack rates and risk of Zika virus-associated neurological complications in Colombian capital cities with a Bayesian model. ROYAL SOCIETY OPEN SCIENCE 2022; 9:220491. [PMID: 36465672 PMCID: PMC9709519 DOI: 10.1098/rsos.220491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/08/2022] [Indexed: 06/17/2023]
Abstract
Zika virus (ZIKV) is a mosquito-borne pathogen that caused a major epidemic in the Americas in 2015-2017. Although the majority of ZIKV infections are asymptomatic, the virus has been associated with congenital birth defects and neurological complications (NC) in adults. We combined multiple data sources to improve estimates of ZIKV infection attack rates (IARs), reporting rates of Zika virus disease (ZVD) and the risk of ZIKV-associated NC for 28 capital cities in Colombia. ZVD surveillance data were combined with post-epidemic seroprevalence data and a dataset on ZIKV-associated NC in a Bayesian hierarchical model. We found substantial heterogeneity in ZIKV IARs across cities. The overall estimated ZIKV IAR across the 28 cities was 0.38 (95% CrI: 0.17-0.92). The estimated ZVD reporting rate was 0.013 (95% CrI: 0.004-0.024), and 0.51 (95% CrI: 0.17-0.92) cases of ZIKV-associated NC were estimated to be reported per 10 000 ZIKV infections. When we assumed the same ZIKV IAR across sex or age group, we found important spatial heterogeneities in ZVD reporting rates and the risk of being reported as a ZVD case with NC. Our results highlight how additional data sources can be used to overcome biases in surveillance data and estimate key epidemiological parameters.
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Affiliation(s)
- Kelly Charniga
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Zulma M. Cucunubá
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | | | | | | | | | | | - Christl A. Donnelly
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
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Guillain-Barré syndrome outbreak in Tapachula temporally associated with the Zika virus introduction in Southern Mexico. Epidemiol Infect 2022; 150:e181. [PMID: 36384981 PMCID: PMC9980924 DOI: 10.1017/s0950268822001625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Guillain-Barré syndrome (GBS) has been previously associated with Zika virus infection. We analysed the data from all the patients with GBS diagnosis that were admitted to a referral hospital, in Tapachula City during the period from January 2013 to August 2016, comparing the incidence of GBS according to the temporality of the Zika outbreak in Southern Mexico. Additionally, we described the clinical and epidemiological characteristics of the GBS patients admitted before or after the Zika outbreak. We observed a sharp increase in the number of patients hospitalised due to GBS from the time the first confirmed Zika cases appeared in Mexico. Clinically we observed GBS cases before zika outbreak had more frequently history of respiratory/gastrointestinal symptoms and GBS during zika outbreak had significantly more frequently recent history of rash/conjunctivitis. Although we cannot affirm that the increased cases of GBS have a specific aetiologic association with Zika, our results suggest that this observed outbreak of in Tapachula, might have been associated to the emerging Zika epidemic, locally and suggests that rare complications associated with acute infections (such as GBS) might be useful in the surveillance systems for emerging infections.
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Guillain-Barré syndrome in association with COVID-19 vaccination: a systematic review. Immunol Res 2022; 70:752-764. [PMID: 36098903 PMCID: PMC9469827 DOI: 10.1007/s12026-022-09316-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022]
Abstract
Since the beginning of worldwide vaccination against coronavirus disease 2019 (COVID-19), studies have reported a possible association between vaccination and Guillain-Barré syndrome (GBS). In this regard, we conducted a systematic review assessing different demographic, clinical, and neurophysiological aspects of patients with GBS following immunization with COVID-19 vaccines. A comprehensive search of PubMed, Web of Science, Scopus, and Google Scholar was performed. Articles in English between January 2020 and November 2021 were included. Data on demographics, clinical characteristics, vaccines information, treatment approaches, and outcomes were extracted. The data of a total of 88 patients out of 41 studies was included. The mean age of patients was 58.7 ± 16.6 years and 55 cases (62.5%) were male. AstraZeneca was the most-reported vaccine associated with GBS with 52 cases (59.1%) followed by Pfizer with 20 cases (22.7%). GBS occurred after the first dose of vaccination in 70 cases (79.5%). The mean time interval between vaccination and symptom onset was 13.9 ± 7.4 days. Limb weakness (47.7%), sensory disturbance (38.6%), and facial weakness (27.3%) were the most common reported symptoms, respectively. Albuminocytologic dissociation was seen in 65% of patients who underwent lumbar puncture (n = 65). Acute inflammatory demyelinating polyradiculopathy was the most common GBS subtype, which was reported in 38 patients (43.2%). While one-fifth of patients underwent intubation (n = 17), a favorable outcome was achieved in the majority of subjects (n = 46, 63%). Overall, a small rise in GBS incidence, following various COVID-19 vaccines, was observed. Notably, 85% of affected individuals experienced at least a partial recovery.
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Characterization of Guillain-Barré Syndrome in the integrated development region of the Federal District and Surrounding Areas (RIDE), Brazil, between 2017 and 2019. Acta Trop 2022; 229:106366. [PMID: 35150642 DOI: 10.1016/j.actatropica.2022.106366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Guillain-Barré Syndrome (GBS) is an acute immune-mediated polyneuropathy that primarily affects the peripheral nerves. Following the Zika virus outbreak in Latin America, all the Latin American and Brazilian studies conducted reported an increase in the incidence of GBS. The present study aims to characterize the clinical and demographic profile of patients with GBS, according to electrophysiological estudies. METHODS This is a clinical cohort study based on data from medical charts and interviews conducted at the homes of GBS cases identified by three data sources, admitted to and treated at a tertiary referral hospital between March 2017 and May 2019. RESULTS There was a high level of diagnostic certainty among the 51 GBS cases monitored, with most classified as exhibiting acute inflammatory demyelinating polyneuropathy (AIDP). The majority of the individuals were of working age, with an average schooling level. Diarrhea and upper respiratory tract infection were the previous events most reported. Most cases were admitted to the hospital unable to walk and the main complication identified was aspiration pneumonia. CONCLUSION The findings indicate the need to rethink the care of patients with GBS in order to minimize the possibility of future complications during hospitalization that may lead to unfavorable outcomes.
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Komarasamy TV, Adnan NAA, James W, Balasubramaniam VRMT. Zika Virus Neuropathogenesis: The Different Brain Cells, Host Factors and Mechanisms Involved. Front Immunol 2022; 13:773191. [PMID: 35371036 PMCID: PMC8966389 DOI: 10.3389/fimmu.2022.773191] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/21/2022] [Indexed: 12/16/2022] Open
Abstract
Zika virus (ZIKV), despite being discovered six decades earlier, became a major health concern only after an epidemic in French Polynesia and an increase in the number of microcephaly cases in Brazil. Substantial evidence has been found to support the link between ZIKV and neurological complications in infants. The virus targets various cells in the brain, including radial glial cells, neural progenitor cells (NPCs), astrocytes, microglial and glioblastoma stem cells. It affects the brain cells by exploiting different mechanisms, mainly through apoptosis and cell cycle dysregulation. The modulation of host immune response and the inflammatory process has also been demonstrated to play a critical role in ZIKV induced neurological complications. In addition to that, different ZIKV strains have exhibited specific neurotropism and unique molecular mechanisms. This review provides a comprehensive and up-to-date overview of ZIKV-induced neuroimmunopathogenesis by dissecting its main target cells in the brain, and the underlying cellular and molecular mechanisms. We highlighted the roles of the different ZIKV host factors and how they exploit specific host factors through various mechanisms. Overall, it covers key components for understanding the crosstalk between ZIKV and the brain.
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Affiliation(s)
- Thamil Vaani Komarasamy
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Nur Amelia Azreen Adnan
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - William James
- Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | - Vinod R M T Balasubramaniam
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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12
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Schuler-Faccini L, Del Campo M, García-Alix A, Ventura LO, Boquett JA, van der Linden V, Pessoa A, van der Linden Júnior H, Ventura CV, Leal MC, Kowalski TW, Rodrigues Gerzson L, Skilhan de Almeida C, Santi L, Beys-da-Silva WO, Quincozes-Santos A, Guimarães JA, Garcez PP, Gomes JDA, Vianna FSL, Anjos da Silva A, Fraga LR, Vieira Sanseverino MT, Muotri AR, Lopes da Rosa R, Abeche AM, Marcolongo-Pereira C, Souza DO. Neurodevelopment in Children Exposed to Zika in utero: Clinical and Molecular Aspects. Front Genet 2022; 13:758715. [PMID: 35350244 PMCID: PMC8957982 DOI: 10.3389/fgene.2022.758715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022] Open
Abstract
Five years after the identification of Zika virus as a human teratogen, we reviewed the early clinical manifestations, collectively called congenital Zika syndrome (CZS). Children with CZS have a very poor prognosis with extremely low performance in motor, cognitive, and language development domains, and practically all feature severe forms of cerebral palsy. However, these manifestations are the tip of the iceberg, with some children presenting milder forms of deficits. Additionally, neurodevelopment can be in the normal range in the majority of the non-microcephalic children born without brain or eye abnormalities. Vertical transmission and the resulting disruption in development of the brain are much less frequent when maternal infection occurs in the second half of the pregnancy. Experimental studies have alerted to the possibility of other behavioral outcomes both in prenatally infected children and in postnatal and adult infections. Cofactors play a vital role in the development of CZS and involve genetic, environmental, nutritional, and social determinants leading to the asymmetric distribution of cases. Some of these social variables also limit access to multidisciplinary professional treatment.
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Affiliation(s)
- Lavínia Schuler-Faccini
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - Miguel Del Campo
- Department of Pediatrics, School of Medicine, University of California San Diego, and Rady Children's Hospital San Diego, San Diego, CA, United States
| | | | - Liana O Ventura
- Department of Ophthalmology, Fundação Altino Ventura, FAV, Recife, Brazil
| | | | | | - André Pessoa
- Hospital Infantil Albert Sabin, Fortaleza, Brazil.,Universidade Estadual do Ceará, Fortaleza, Brazil
| | | | - Camila V Ventura
- Department of Ophthalmology, Fundação Altino Ventura, FAV, Recife, Brazil
| | | | - Thayne Woycinck Kowalski
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,CESUCA-Centro Universitário, Cachoeirinha, Brazil
| | | | | | - Lucélia Santi
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - Walter O Beys-da-Silva
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | - Jorge A Guimarães
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | | | - Fernanda Sales Luiz Vianna
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - André Anjos da Silva
- School of Medicine, Graduate Program in Medical Sciences-Universidade do Vale do Taquari-UNIVATES, Lajeado, Brazil.,School of Medicine, Universidade do Vale do Rio dos Sinos-UNISINOS, São Leopoldo, Brazil
| | - Lucas Rosa Fraga
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - Maria Teresa Vieira Sanseverino
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Alysson R Muotri
- Department of Pediatrics, School of Medicine, University of California San Diego, and Rady Children's Hospital San Diego, San Diego, CA, United States
| | | | - Alberto Mantovani Abeche
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | - Diogo O Souza
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
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Arriaga-Nieto L, Hernández-Bautista PF, Vallejos-Parás A, Grajales-Muñiz C, Rojas-Mendoza T, Cabrera-Gaytán DA, Grijalva-Otero I, Cacho-Díaz B, Jaimes-Betancourt L, Padilla-Velazquez R, Valle-Alvarado G, Perez-Andrade Y, Ovalle-Luna OD, Rivera-Mahey M. Predict the incidence of Guillain Barré Syndrome and arbovirus infection in Mexico, 2014-2019. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000137. [PMID: 36962143 PMCID: PMC10022261 DOI: 10.1371/journal.pgph.0000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
The Dengue (DENV), Zika (ZIKV), and Chikungunya (CHIKV) virus infections have been linked to Guillain-Barré syndrome (GBS). GBS has an estimated lethality of 4% to 8%, even with effective treatment. Mexico is considered a hyperendemic country for DENV due to the circulation of four serotypes, and the ZIKV and CHIKV viruses have also been circulating in the country. The objective of this study was to predict the number of GBS cases in relation to the cumulative incidence of ZIKV / DENV / CHIKV in Mexico from 2014 to 2019. A six-year time series ecological study was carried out from GBS cases registered in the Acute Flaccid Paralysis (AFP) Epidemiological Surveillance System (ESS), and DENV, ZIKV and CHIKV estimated cases from cases registered in the epidemiological vector-borne diseases surveillance system. The results shows that the incidence of GBS in Mexico is positively correlated with DENV and ZIKV. For every 1,000 estimated DENV cases, 1.45 GBS cases occurred on average, and for every 1,000 estimated ZIKV cases, 1.93 GBS cases occurred on average. A negative correlation between GBS and CHIKV estimated cases was found. The increase in the incidence of GBS cases in Mexico can be predicted by observing DENV and ZIKV cases through the epidemiological surveillance systems. These results can be useful in public health by providing the opportunity to improve capacities for the prevention of arbovirus diseases and for the timely procurement of supplies for the treatment of GBS.
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Affiliation(s)
- Lumumba Arriaga-Nieto
- Epidemiologic Surveillance Coordination, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Alfonso Vallejos-Parás
- Epidemiologic Surveillance Coordination, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Teresita Rojas-Mendoza
- Coordination of Supplies Quality Control, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Israel Grijalva-Otero
- Medical Research Unit for Neurological Diseases, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Leticia Jaimes-Betancourt
- Epidemiology Department, Family Medicine Unit 7, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Gabriel Valle-Alvarado
- Epidemiologic Surveillance Coordination, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Yadira Perez-Andrade
- Epidemiologic Surveillance Coordination, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Oscar David Ovalle-Luna
- Epidemiologic Surveillance Coordination, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Mónica Rivera-Mahey
- Epidemiologic Surveillance Coordination, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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14
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Varadhachary AS. Recognition and Management of Neuromuscular Emergencies. Neurol Clin 2021; 40:157-174. [PMID: 34798967 DOI: 10.1016/j.ncl.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute neuromuscular disorders represent an important subset of neurologic consultation requests in the inpatient setting. Although most neuromuscular disorders are subacute to chronic, hospital-based neurologists encounter neuromuscular disorders presenting with rapidly progressive or severe weakness affecting limb movement, respiratory, and bulbar function. Recalling fundamentals of neurologic localization assists in prompt recognition and diagnosis. Despite the differing localizations and the causal diagnoses, the initial management principles of acute myopathies, neuropathies, and neuromuscular junction disorders are similar.
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Affiliation(s)
- Arun S Varadhachary
- Department of Neurology, Washington University in St. Louis, Campus Box 8111, 660 South Euclid Ave, St. Louis, MO 63110, USA.
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15
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Diouf B, Sene NM, Ndiaye EH, Gaye A, Ngom EHM, Gueye A, Seck F, Diagne CT, Dia I, Diallo M, Diallo D. Resting Behavior of Blood-Fed Females and Host Feeding Preferences of Aedes aegypti (Diptera: Culicidae) Morphological Forms in Senegal. JOURNAL OF MEDICAL ENTOMOLOGY 2021; 58:2467-2473. [PMID: 34165556 DOI: 10.1093/jme/tjab111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Indexed: 06/13/2023]
Abstract
Aedes aegypti (Linnaeus) is the main vector of most arboviruses in tropical and subtropical urban areas. In West Africa, particularly in Senegal, domestic and wild populations have been described. Both Ae. aegypti aegypti (Aaa) and Ae. aegypti formosus (Aaf) were found in progenies of Ae. aegypti families from several localities of Senegal. However, nothing is known about their resting and trophic behavior, which are key data for vector control. To fill this gap, blood-fed mosquitoes were collected monthly indoors and outdoors with BackPack aspirators and BG-Sentinel 2 traps between July and November 2019 from four urban sites. The enzyme-linked immunosorbent assay technique was used to analyze blood-fed Aaa and Aaf specimens. Both forms were found resting in all investigated places with the highest proportions found in scrap metals (51.7% for Aaa and 44.1% for Aaf) and used tires (19.2% for Aaa and 26.1% for Aaf). Blood-fed Aaf females showed lower occupation of the indoors environment compared to Aaa. Overall, the percentages of single bloodmeals from human were 80.5% (916/1138) for Aaa and 71.1% (263/370) for Aaf. A low frequency of other domestic hosts, including bovine, ovine, and cat were detected for both forms. This study provides the first data on resting and trophic behavior of Aaa and Aaf in Senegal. Both forms showed differences in their resting behavior but fed primarily on human and highlight the risk of arboviruses transmission in urban areas.
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Affiliation(s)
- Babacar Diouf
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, Dakar, Senegal
| | - Ndeye Marie Sene
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, Dakar, Senegal
| | - El Hadj Ndiaye
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, Dakar, Senegal
| | - Alioune Gaye
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, Dakar, Senegal
| | | | - Assiyatou Gueye
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, Dakar, Senegal
| | - Fatoumata Seck
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, Dakar, Senegal
| | | | - Ibrahima Dia
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, Dakar, Senegal
| | - Mawlouth Diallo
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, Dakar, Senegal
| | - Diawo Diallo
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, Dakar, Senegal
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16
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Kumar NP, Kumar A, Panneer D, Abidha S, Muthukumaravel S, Sankari T, Ajithlal PM, Mathew J, Koothradan S, Paramasivan R, Muniyaraj M, Singh H, Saxena R, Vijayachari P, Sunish IP, Shriram AN, Dutta P, Patgiri SJ, Bhattacharyya DR, Hoti SL, Chattopadhyay D, Roy S, Mahapatra N, Pati S, Chand G, Mishra AK, Barde P, Jambulingam P. Nation-wide vector surveillance on Zika and Dengue did not indicate transmission of the American lineage-pandemic Zika virus in India. Int J Infect Dis 2021; 113:119-124. [PMID: 34601144 DOI: 10.1016/j.ijid.2021.09.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Following the Public Health Emergency of International Concern declared on Zika by the World Health Organization during 2016, the Indian Council of Medical Research carried out nationwide vector surveillance for Zika and Dengue viruses (ZIKV and DENV) in India as a preparedness measure in 2016-19. METHODS High-risk zones distributed to 49 Districts in 14 states/union territories were included in the study. Seven ICMR institutions participated, following a standard operating protocol. Aedes specimens sampled weekly were processed by multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) for ZIKV/DENV and random samples crosschecked with real-time RT-PCR for ZIKV. RESULTS Altogether, 79 492 Aedes specimens in 6492 pools were processed; 3 (0.05%) and 63 (0.97%) pools, respectively, were found positive for ZIKV and DENV. ZIKV infections were recorded in Aedes aegypti sampled during the 2018 sporadic Zika outbreak in Jaipur, Rajasthan. However, these belonged to the Asian lineage of the virus, already circulating in the country. Both Ae. aegypti and Aedes albopictus distributed to 8 states/union territories were found to be infected with DENV. Both sexes of Ae. albopictus were infected, indicating transovarial transmission. CONCLUSION This investigation evinced no active transmission of the American lineage-pandemic Zika virus in India during the pandemic period.
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Affiliation(s)
- N Pradeep Kumar
- ICMR-Vector Control Research Centre Field Station, Kottayam, Kerala, India.
| | - Ashwani Kumar
- ICMR-Vector Control Research Centre, Puducherry, India
| | - D Panneer
- ICMR-Vector Control Research Centre, Puducherry, India
| | - S Abidha
- ICMR-Vector Control Research Centre Field Station, Kottayam, Kerala, India
| | | | - T Sankari
- ICMR-Vector Control Research Centre, Puducherry, India
| | - P M Ajithlal
- ICMR-Vector Control Research Centre Field Station, Kottayam, Kerala, India
| | - Jessu Mathew
- ICMR-Vector Control Research Centre Field Station, Kottayam, Kerala, India
| | - Suhana Koothradan
- ICMR-Vector Control Research Centre Field Station, Kottayam, Kerala, India
| | - R Paramasivan
- ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
| | - M Muniyaraj
- ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
| | - Himmat Singh
- ICMR- National Institute for Malaria Research, New Delhi, India
| | - Rekha Saxena
- ICMR- National Institute for Malaria Research, New Delhi, India
| | - P Vijayachari
- ICMR- Regional Medical Research Centre, Port Blair, Andaman Nicobar Islands, India
| | - I P Sunish
- ICMR- Regional Medical Research Centre, Port Blair, Andaman Nicobar Islands, India
| | - A N Shriram
- ICMR-Vector Control Research Centre, Puducherry, India
| | - Prafulla Dutta
- ICMR-Regional Medical Research Centre (NE), Dibrugarh, Assam, India
| | | | | | - S L Hoti
- ICMR-National Institute of Medicinal Plants Research, Belagavi, Karnataka, India
| | - D Chattopadhyay
- ICMR-National Institute of Medicinal Plants Research, Belagavi, Karnataka, India
| | - Subarna Roy
- ICMR-National Institute of Medicinal Plants Research, Belagavi, Karnataka, India
| | - Namita Mahapatra
- ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Gyan Chand
- ICMR- National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - A K Mishra
- ICMR- National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Pradip Barde
- ICMR- National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - P Jambulingam
- ICMR-Vector Control Research Centre, Puducherry, India
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17
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Halani S, Tombindo PE, O'Reilly R, Miranda RN, Erdman LK, Whitehead C, Bielecki JM, Ramsay L, Ximenes R, Boyle J, Krueger C, Willmott S, Morris SK, Murphy KE, Sander B. Clinical manifestations and health outcomes associated with Zika virus infections in adults: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009516. [PMID: 34252102 PMCID: PMC8297931 DOI: 10.1371/journal.pntd.0009516] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/22/2021] [Accepted: 05/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Zika virus (ZIKV) has generated global interest in the last five years mostly due to its resurgence in the Americas between 2015 and 2016. It was previously thought to be a self-limiting infection causing febrile illness in less than one quarter of those infected. However, a rise in birth defects amongst children born to infected pregnant women, as well as increases in neurological manifestations in adults has been demonstrated. We systemically reviewed the literature to understand clinical manifestations and health outcomes in adults globally. Methods This review was registered prospectively with PROPSERO (CRD 42018096558). We systematically searched for studies in six databases from inception to the end of September 2020. There were no language restrictions. Critical appraisal was completed using the Joanna Briggs Institute Critical Appraisal Tools. Findings We identified 73 studies globally that reported clinical outcomes in ZIKV-infected adults, of which 55 studies were from the Americas. For further analysis, we considered studies that met 70% of critical appraisal criteria and described subjects with confirmed ZIKV. The most common symptoms included: exanthema (5,456/6,129; 89%), arthralgia (3,809/6,093; 63%), fever (3,787/6,124; 62%), conjunctivitis (2,738/3,283; 45%), myalgia (2,498/5,192; 48%), headache (2,165/4,722; 46%), and diarrhea (337/2,622; 13%). 36/14,335 (0.3%) of infected cases developed neurologic sequelae, of which 75% were Guillain-Barré Syndrome (GBS). Several subjects reported recovery from peak of neurological complications, though some endured chronic disability. Mortality was rare (0.1%) and hospitalization (11%) was often associated with co-morbidities or GBS. Conclusions The ZIKV literature in adults was predominantly from the Americas. The most common systemic symptoms were exanthema, fever, arthralgia, and conjunctivitis; GBS was the most prevalent neurological complication. Future ZIKV studies are warranted with standardization of testing and case definitions, consistent co-infection testing, reporting of laboratory abnormalities, separation of adult and pediatric outcomes, and assessing for causation between ZIKV and neurological sequelae. Interest in Zika virus (ZIKV) has increased in the last decade due to its emergence and rapid spread in the Americas. In this review, we examine ZIKV clinical manifestations and sequelae in adults. Among studies reporting subjects with confirmed ZIKV and critical appraisal scores of at least 70%, symptoms reported include exanthema, fever, arthralgia, conjunctivitis, myalgia, headache, and diarrhea. Neurological sequelae in this group occurred in 0.3% of subjects, of which 75% were Guillain-Barré Syndrome (GBS). Recovery from GBS was variable: some patients returned to health and others endured chronic disability. Mortality was rare (0.1%). Hospitalization (11%) was often associated co-morbidities or GBS; this percentage perhaps reflects studies in which all reported subjects were hospitalized. Synthesizing reported data is challenging given the wide range of case definitions and ZIKV testing practices.
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Affiliation(s)
| | | | - Ryan O'Reilly
- University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Rafael N Miranda
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Laura K Erdman
- University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Clare Whitehead
- University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia.,Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Lauren Ramsay
- University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Raphael Ximenes
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Escola de Matemática Aplicada, Fundação Getúlio Vargas, Praia de Botafogo, Rio de Janeiro, Brasil
| | | | - Carsten Krueger
- University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shannon Willmott
- University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaun K Morris
- University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada.,Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kellie E Murphy
- University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Beate Sander
- University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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18
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Kuppusamy C, Shanmugam B, Ezhumalai S. Psychiatric Social Work Services In Neurology Emergency Care Setting. NATIONAL JOURNAL OF PROFESSIONAL SOCIAL WORK 2021; 22:160-167. [PMID: 35309501 PMCID: PMC8932406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Psychiatric social workers are important multi-disciplinary team members, and they assess patients and their families social, emotional, environmental, financial, and support needs in emergency settings. They support patients and their families through difficult times and improve patient lives. AIM To study the profile of patients availed psychiatric social work services in neurology casualty and emergency settings. MATERIALS & METHODS The study was retrospective in nature. The ex-post facto research design was used in the study. Data were obtained from a casualty & emergency psychiatric social work referral registry maintained by the psychiatric social work team at the Neurology emergency setting at NIMHANS, Bangalore. Patients referred for psychiatric social work interventions from April 2020 to March 2021 were considered for the study purpose. Frequency and percentages were used to describe the data. RESULTS Psychiatric social work services at the neurology emergency setting were started in July 2018. Social workers get referrals from triage (four hours to 24 hours), followed by priority ward (72 hours to two weeks), observation ward (72 hours days - two weeks) and emergency ICU. There are 100 beds available for neuro-emergency settings. Of ≈15,939 patients who availed the neurology emergency services, 159 patients were referred for psychiatric social work services. A majority (61.6%) received neuro-education about their illness; awareness about their illness were given to patients and their family members. More than half of them were given guidance for availing treatment welfare benefits under below poverty line and Ayushman Bharath Scheme (54%), 43.3% received supportive psychotherapy, 35.2% pre-discharge counselling, one-third received crisis intervention,12.6% family interventions, 10.7% were facilitated for hospital charges waiver off, few unknown patients management and tracing their family members. Most patients were diagnosed with a stroke, GBS, neuro-infections, and seizure disorder patients who sought psychiatric social work services in emergency and casualty settings. Assessment of their functionality revealed that most were partially independent and dependent. Social workers work from 9 am to 9 pm in the neuro-emergency setting. Immediate social work referrals were made for unknown patients, tracing the caregivers who left the emergency ward without permission, which required financial assistance and communicating poor prognosis (breaking the bad news). CONCLUSION The most common psychiatric social work intervention provided in the neurology emergency care setting were education about the illness, facilitating poor patients to avail social welfare benefits, supportive psychotherapy and crisis intervention.
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Affiliation(s)
- Chithiraivalli Kuppusamy
- Department of Psychiatric Social Work, National Institute of Mental Health And Neurosciences, Bangalore, India
| | - Backiyaraj Shanmugam
- Department of Psychiatric Social Work, National Institute of Mental Health And Neurosciences, Bangalore, India
| | - Sinu Ezhumalai
- Department of Psychiatric Social Work, National Institute of Mental Health And Neurosciences, Bangalore, India
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19
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Leung C. Guillain-Barre syndrome should be monitored upon mass vaccination against SARS-CoV-2. Hum Vaccin Immunother 2021; 17:2957-2958. [PMID: 34032555 DOI: 10.1080/21645515.2021.1922061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In response to the recent pandemic, vaccines have been developed for large-scale immunization. Despite safety and efficacy verified by health authorities, Guillain-Barre syndrome (GBS) remains a risk of unexpected adverse reactions. Since COVID-19-related GBS cases have largely been reported in Europe, vaccines involving viral genetic materials can potentially trigger GBS, as demonstrated in clinical trials in the Americas. Therefore, medical professionals should be aware of GBS as a potential adverse reaction in SARS-CoV-2 vaccination. Consultation with a neurologist may be needed. Nevertheless, this is not to say that the use of vaccines against SARS-CoV-2 should be suspended and that the association between GBS and the vaccine is confirmed or excluded. The benefits of vaccine still outweigh potential adverse effects.
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20
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Malaga M, Rodriguez-Calienes A, Marquez-Nakamatsu A, Recuay K, Merzthal L, Bustamante-Paytan D, Sifuentes JM, Castillo-Kohatsu G, Alva-Diaz C. Predicting Mechanical Ventilation Using the EGRIS in Guillain-Barré Syndrome in a Latin American Country. Neurocrit Care 2021; 35:775-782. [PMID: 34021483 DOI: 10.1007/s12028-021-01218-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Up to one fifth of patients with Guillain-Barré syndrome (GBS) require mechanical ventilation (MV). The Erasmus GBS Respiratory Insufficiency Score (EGRIS) is a clinical predictive model developed in Europe to predict MV requirements among patients with GBS. However, there are significant differences between the Latin American and European population, especially in the distribution of GBS subtypes. Therefore, determining if the EGRIS is able to predict MV in a Latin American population is of clinical significance. METHODS We retrospectively analyzed clinical and laboratory data of 177 patients with GBS in three Peruvian hospitals. We performed a multivariate logistic regression of the factors making up the EGRIS. Finally, we evaluated the EGRIS discrimination through a receiver operating characteristic curve and determined its calibration through a calibration curve and a Hosmer-Lemeshow test, a test used to determine the goodness of fit. RESULTS We found that 14.1% of our patients required MV. One predictive factor of a patient's need for early MV was the number of days between the onset of motor symptoms and hospitalization. The Medical Research Council sum score did not alter the likelihood of early MV. Bulbar weakness increased the likelihood without showing statistical significance. In contrast, facial weakness was a protective factor of it. The EGRIS was significantly higher in patients who required early MV than in those who did not (P = 0.018). It showed an area under the curve (AUC) of 0.63, with an insignificant Hosmer-Lemeshow test result. CONCLUSIONS Although the EGRIS was higher in patients who required early MV than in those who did not, it only showed a moderate discrimination capacity (AUC = 0.63). Facial weakness, an item of the EGRIS, was not found to be a predictive factor in our population. We suggest assessing whether these findings are due to subtype predominance and whether a modified version of the EGRIS could improve performance.
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Affiliation(s)
- Marco Malaga
- Grupo Estudiantil de Investigación en Neurociencias, Universidad de San Martin de Porres, Lima, Peru
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
| | - Aaron Rodriguez-Calienes
- Grupo Estudiantil de Investigación en Neurociencias, Universidad de San Martin de Porres, Lima, Peru
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
| | - Adrian Marquez-Nakamatsu
- Grupo Estudiantil de Investigación en Neurociencias, Universidad de San Martin de Porres, Lima, Peru
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
| | - Katherine Recuay
- Grupo Estudiantil de Investigación en Neurociencias, Universidad de San Martin de Porres, Lima, Peru
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
| | - Luis Merzthal
- Grupo Estudiantil de Investigación en Neurociencias, Universidad de San Martin de Porres, Lima, Peru
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
| | - Diego Bustamante-Paytan
- Grupo Estudiantil de Investigación en Neurociencias, Universidad de San Martin de Porres, Lima, Peru
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
| | - Juan Manuel Sifuentes
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
- Centro de Investigación Básica en Enfermedades Neuromusculares y de Motoneurona, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Guillermo Castillo-Kohatsu
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
- Servicio de Neurología, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Carlos Alva-Diaz
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru.
- Servicio de Neurología, Departamento de Medicina, Hospital Daniel Alcides Carrión, Callao, Peru.
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21
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Chiesa M, Decima R, Bertinat A, Poggi L, Hackembruch H, Montenegro C, Chiparelli H, Vázquez C. Incidence of Guillain-Barré syndrome in an Uruguayan population. A prospective cohort study. J Peripher Nerv Syst 2021; 26:209-215. [PMID: 33945181 DOI: 10.1111/jns.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022]
Abstract
Guillain-Barre syndrome (GBS) is an acute autoimmune peripheral inflammatory neuropathy and the most frequent cause of non-poliovirus acute flaccid paralysis worldwide. Background annual GBS incidence rates (IRs) in Latin America (LA) varies from 0.40 to 2.12/100000 persons per year. We performed a prospective population-based epidemiological study to determine the incidence and clinical profile of GBS in the most densely populated regions in Uruguay. The incidence of GBS in the population living in Montevideo and Canelones was studied in the period between June 01, 2018 and May 31, 2020. Patients older than 16 years of age diagnosed with GBS were prospectively enrolled. The mean global annual IR in the Uruguayan population was 1.7/100000 persons (95% CI 1.25-2.25). The highest rate was observed in the 65 to 74 age group among men (5.25/100000 per year) and in the 55 to 64 age group among women (2/100.000 per year). The mean age was 53.9 ± 19.5, years, without difference by sex (53.5 women, 54.5 men). The in-hospital mortality rate was 5.8%. A total of 51 patients were diagnosed with GBS: 42 (82%) had typical GBS, 5 (10%) Miller-Fisher syndrome (MFS), 3 (7%) a bilateral facial nerve palsy, 1 patient had a GBS-MFS overlap (2.3%). This is the first population-based GBS incidence study in LA using a prospective design. Our IR can be a useful tool in establishing the background rate to examine future disease trends caused by the introduction of new viruses or vaccines in Uruguay.
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Affiliation(s)
- Mercedes Chiesa
- Department of Neurology, Assistant of Neurophysiology, Hospital de Clínicas, Montevideo, Uruguay
| | - Rodrigo Decima
- Department of Neurology, Neurology resident, Hospital de Clínicas, Montevideo, Uruguay
| | | | - Luciana Poggi
- Medical doctor, Hospital de Clínicas, Montevideo, Uruguay
| | - Heber Hackembruch
- Department of Neurology, Adjunct-Professor of Neurophysiology, Hospital de Clínicas, Montevideo, Uruguay
| | - Cecilia Montenegro
- Adjunct Professor of Immunology in the Laboratory of Hospital de Clínicas, Montevideo, Uruguay
| | - Hector Chiparelli
- Virologist doctor, Director of the virology department of the public health laboratory
| | - Cristina Vázquez
- Department of Neurology, Clinical Professor of Neurology, Hospital de Clínicas, Montevideo, Uruguay
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22
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Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet 2021; 397:1214-1228. [PMID: 33647239 DOI: 10.1016/s0140-6736(21)00517-1] [Citation(s) in RCA: 240] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/07/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022]
Abstract
Guillain-Barré syndrome is the most common cause of acute flaccid paralysis worldwide. Most patients present with an antecedent illness, most commonly upper respiratory tract infection, before the onset of progressive motor weakness. Several microorganisms have been associated with Guillain-Barré syndrome, most notably Campylobacter jejuni, Zika virus, and in 2020, the severe acute respiratory syndrome coronavirus 2. In C jejuni-related Guillain-Barré syndrome, there is good evidence to support an autoantibody-mediated immune process that is triggered by molecular mimicry between structural components of peripheral nerves and the microorganism. Making a diagnosis of so-called classical Guillain-Barré syndrome is straightforward; however, the existing diagnostic criteria have limitations and can result in some variants of the syndrome being missed. Most patients with Guillain-Barré syndrome do well with immunotherapy, but a substantial proportion are left with disability, and death can occur. Results from the International Guillain-Barré Syndrome Outcome Study suggest that geographical variations exist in Guillain-Barré syndrome, including insufficient access to immunotherapy in low-income countries. There is a need to provide improved access to treatment for all patients with Guillain-Barré syndrome, and to develop effective disease-modifying therapies that can limit the extent of nerve injury. Clinical trials are currently underway to investigate some of the potential therapeutic candidates, including complement inhibitors, which, together with emerging data from large international collaborative studies on the syndrome, will contribute substantially to understanding the many facets of this disease.
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Affiliation(s)
- Nortina Shahrizaila
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Helmar C Lehmann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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23
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Belaunzarán-Zamudio PF, Ortega-Villa AM, Mimenza-Alvarado AJ, Guerra-De-Blas PDC, Aguilar-Navarro SG, Sepúlveda-Delgado J, Hunsberger S, Salgado RV, Ramos-Castañeda J, Rincón León HA, Rodríguez de La Rosa P, Nájera Cancino JG, Beigel J, Caballero Sosa S, Ruiz Hernández E, Powers JH, Ruiz-Palacios GM, Lane C. Comparison of the Impact of Zika and Dengue Virus Infection, and Other Acute Illnesses of Unidentified Origin on Cognitive Functions in a Prospective Cohort in Chiapas Mexico. Front Neurol 2021; 12:631801. [PMID: 33828518 PMCID: PMC8019918 DOI: 10.3389/fneur.2021.631801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023] Open
Abstract
Zika has been associated with a variety of severe neurologic manifestations including meningitis and encephalitis. We hypothesized that it may also cause mild to subclinical neurocognitive alterations during acute infection or over the long term. In this observational cohort study, we explored whether Zika cause subclinical or mild neurocognitive alterations, estimate its frequency and duration, and compare it to other acute illnesses in a cohort of people with suspected Zika infection, in the region of Tapachula in Chiapas, Mexico during 2016-2018. We enrolled patients who were at least 12 years old with suspected Zika virus infection and followed them up for 6 months. During each visit participants underwent a complete clinical exam, including a screening test for neurocognitive dysfunction (Montreal Cognitive Assessment score). We enrolled 406 patients [37 with Zika, 73 with dengue and 296 with other acute illnesses of unidentified origin (AIUO)]. We observed a mild and transient impact over cognitive functions in patients with Zika, dengue and with other AIUO. The probability of having an abnormal MoCA score (<26 points) was significantly higher in patients with Zika and AIUO than in those with dengue. Patients with Zika and AIUO had lower memory scores than patients with dengue (Zika vs. Dengue: -0.378, 95% CI-0.678 to -0.078; p = 0.014: Zika vs. AIUO 0.264, 95% CI 0.059, 0.469; p = 0.012). The low memory performance in patients with Zika and AIUO accounts for most of the differences in the overall MoCA score when compared with patients with dengue. Our results show a decrease in cognitive function during acute illness and provides no evidence to support the hypothesis that Zika might cause neurocognitive alterations longer than the period of acute infection or different to other infectious diseases. While effects on memory or perhaps other cognitive functions over the long term are possible, larger studies using more refined tools for neurocognitive functioning assessment are needed to identify these. Trial Registration: NCT02831699.
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Affiliation(s)
- Pablo F. Belaunzarán-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Ana M. Ortega-Villa
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Alberto J. Mimenza-Alvarado
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Geriatrics & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Sara G. Aguilar-Navarro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jesús Sepúlveda-Delgado
- Directorate of Research, Hospital Regional de Alta Especialidad Ciudad Salud, Tapachula & Medical Science Research, Hospital General de Zona 1, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Sally Hunsberger
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | | | - José Ramos-Castañeda
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Departamento de Inmunidad, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | | | - José Gabriel Nájera Cancino
- Directorate of Research, Hospital Regional de Alta Especialidad Ciudad Salud, Tapachula & Medical Science Research, Hospital General de Zona 1, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - John Beigel
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Sandra Caballero Sosa
- Clínica Hospital Dr. Roberto Nettel Flores, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Tapachula, Mexico
| | | | - John H. Powers
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Guillermo M. Ruiz-Palacios
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Clifford Lane
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
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24
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Wilder-Smith A, Osman S. Public health emergencies of international concern: a historic overview. J Travel Med 2020; 27:6025447. [PMID: 33284964 PMCID: PMC7798963 DOI: 10.1093/jtm/taaa227] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022]
Abstract
RATIONALE The International Health Regulations (IHR) have been the governing framework for global health security since 2007. Declaring public health emergencies of international concern (PHEIC) is a cornerstone of the IHR. Here we review how PHEIC are formally declared, the diseases for which such declarations have been made from 2007 to 2020 and justifications for such declarations. KEY FINDINGS Six events were declared PHEIC between 2007 and 2020: the 2009 H1N1 influenza pandemic, Ebola (West African outbreak 2013-2015, outbreak in Democratic Republic of Congo 2018-2020), poliomyelitis (2014 to present), Zika (2016) and COVID-19 (2020 to present). Poliomyelitis is the longest PHEIC. Zika was the first PHEIC for an arboviral disease. For several other emerging diseases a PHEIC was not declared despite the fact that the public health impact of the event was considered serious and associated with potential for international spread. RECOMMENDATIONS The binary nature of a PHEIC declaration is often not helpful for events where a tiered or graded approach is needed. The strength of PHEIC declarations is the ability to rapidly mobilize international coordination, streamline funding and accelerate the advancement of the development of vaccines, therapeutics and diagnostics under emergency use authorization. The ultimate purpose of such declaration is to catalyse timely evidence-based action, to limit the public health and societal impacts of emerging and re-emerging disease risks while preventing unwarranted travel and trade restrictions.
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Affiliation(s)
- Annelies Wilder-Smith
- Global Health and Epidemiology, University of Umea, 901 87 Umea, Sweden.,Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 365, 6900 Heidelberg, Germany
| | - Sarah Osman
- Global Health and Epidemiology, University of Umea, 901 87 Umea, Sweden
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25
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Wachira VK, Nascimento GL, Peixoto HM, de Oliveira MRF. Burden of Disease of Guillain-Barré Syndrome in Brazil before and during the Zika virus epidemic 2014-2016. Trop Med Int Health 2020; 26:66-81. [PMID: 33151584 DOI: 10.1111/tmi.13508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To estimate the burden of disease of Guillain-Barré syndrome (GBS) in Brazil in 2014, 1 year before the Zika virus epidemic, and in 2015 and 2016 during the epidemic. METHODS The burden of disease of GBS was estimated using the summary measure of population health: Disability Adjusted Life Years (DALY), that combines both mortality (Years of Life Lost YLLs) and morbidity (Years Lived with Disability) components. The study population was composed of GBS hospitalised cases and deaths from the information systems of the Brazilian Unified Health System. RESULTS The GBS incidence rate in 2014, 2015 and 2016 was 0.74, 0.96, 1.02/100 000 respectively, and the mortality rate in the same period was 0.08, 0.009 and 0.11/100 000 habitants. The DALYs calculated using the point estimate of GBS disability weight and its values of the confidence interval (0.198 and 0.414) were 5725.90 (5711.79-5742.89) in 2014, 6054.61 (6035.57-6077.54) in 2015 and 7588.49 (7570.20-7610.51) in 2016. The DALYs were high among the male population and in age groups between 20 and 50 years. CONCLUSIONS The increase in DALYs in the years 2015 and 2016 compared to 2014 probably resulted from the introduction of ZIKV in Brazil, reinforcing the importance of investments in the prevention of ZIKV infection and in the care of GBS patients.
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Affiliation(s)
- Virginia Kagure Wachira
- Center of Tropical Medicine, Faculty of Medicine, Universidade de Brasília, Brasília, Brazil
| | | | - Henry Maia Peixoto
- Center of Tropical Medicine, Faculty of Medicine, Universidade de Brasília, Brasília, Brazil.,National Institute of Science and Technology for Health Technology Assessment, Porto Alegre, Brazil
| | - Maria Regina Fernandes de Oliveira
- Center of Tropical Medicine, Faculty of Medicine, Universidade de Brasília, Brasília, Brazil.,National Institute of Science and Technology for Health Technology Assessment, Porto Alegre, Brazil
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26
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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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27
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Castanospermine reduces Zika virus infection-associated seizure by inhibiting both the viral load and inflammation in mouse models. Antiviral Res 2020; 183:104935. [PMID: 32949636 PMCID: PMC7492813 DOI: 10.1016/j.antiviral.2020.104935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
Zika virus (ZIKV) outbreaks have been reported worldwide, including a recent occurrence in Brazil where it spread rapidly, and an association with increased cases of microcephaly was observed in addition to neurological issues such as GBS that were reported during previous outbreaks. Following infection of neuronal tissues, ZIKV can cause inflammation, which may lead to neuronal abnormalities, including seizures and paralysis. Therefore, a drug containing both anti-viral and immunosuppressive properties would be of great importance in combating ZIKV related neurological abnormalities. Castanospermine (CST) is potentially a right candidate drug as it reduced viral load and brain inflammation with the resulting appearance of delayed neuronal disorders, including seizures and paralysis in an Ifnar1−/− mouse. Anti-ZIKV activity of castanospermine (CST) In vivo and in vitro. CST reduces ZIKV induced inflammation of brain. CST delays the ZIKV induced seizure and improves neuronal disorders such as motor function. CST gives marginal improvement in survivability in Ifnar1−/− mice.
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28
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Mathis S, Soulages A, Le Masson G, Vallat JM. Epidemics and outbreaks of peripheral nervous system disorders: I. infectious and immune-mediated causes. J Neurol 2020; 268:879-890. [PMID: 32914207 PMCID: PMC7483039 DOI: 10.1007/s00415-020-10215-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022]
Abstract
The history of mankind is marked by numerous epidemics, some of which involved diseases of the peripheral nervous system, either infectious or otherwise. We describe here the three main infectious causes of epidemics that affect the peripheral nervous system: leprosy, poliomyelitis and diphtheria. We then discuss the main epidemics of immune-mediated origin.
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Affiliation(s)
- Stéphane Mathis
- Department of Neurology, Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), Place Amélie Raba-Léon, 33076, Bordeaux, France.
| | - Antoine Soulages
- Department of Neurology, Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Gwendal Le Masson
- Department of Neurology, Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), Place Amélie Raba-Léon, 33076, Bordeaux, France.,University of Bordeaux, U1215, 33000, Bordeaux, France.,INSERM, Neurocentre Magendie, 'Physiopathologie de La Plasticité Neuronale', U1215, 33000, Bordeaux, France
| | - Jean-Michel Vallat
- Department of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital, 2 Avenue Martin Luther King, 87042, Limoges, France
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29
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Wilder-Smith A. Dengue vaccine development by the year 2020: challenges and prospects. Curr Opin Virol 2020; 43:71-78. [PMID: 33086187 PMCID: PMC7568693 DOI: 10.1016/j.coviro.2020.09.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/29/2022]
Abstract
The first licensed dengue vaccine led to considerable controversy, and to date, no dengue vaccine is in widespread use. All three leading dengue vaccine candidates are live attenuated vaccines, with the main difference between them being the type of backbone and the extent of chimerization. While CYD-TDV (the first licensed dengue vaccine) does not include non-structural proteins of dengue, TAK-003 contains the dengue virus serotype 2 backbone, and the Butantan/Merck vaccine contains three full-genomes of the four dengue virus serotypes. While dengue-primed individuals can already benefit from vaccination against all four serotypes with the first licensed dengue vaccine CYD-TDV, the need for dengue-naive population has not yet been met. To improve tetravalent protection, sequential vaccination should be considered in addition to a heterologous prime-boost approach.
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Affiliation(s)
- Annelies Wilder-Smith
- London School of Hygiene and Tropical Medicine, UK; Heidelberg Institute of Global Health, University of Heidelberg, Germany.
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30
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Abstract
Alphaviruses, members of the enveloped, positive-sense, single-stranded RNA Togaviridae family, represent a reemerging public health threat as mosquito vectors expand into new geographic territories. The Old World alphaviruses, which include chikungunya virus, Ross River virus, and Sindbis virus, tend to cause a clinical syndrome characterized by fever, rash, and arthritis, whereas the New World alphaviruses, which consist of Venezuelan equine encephalitis virus, eastern equine encephalitis virus, and western equine encephalitis virus, induce encephalomyelitis. Following recovery from the acute phase of infection, many patients are left with debilitating persistent joint and neurological complications that can last for years. Clues from human cases and studies using animal models strongly suggest that much of the disease and pathology induced by alphavirus infection, particularly atypical and chronic manifestations, is mediated by the immune system rather than directly by the virus. This review discusses the current understanding of the immunopathogenesis of the arthritogenic and neurotropic alphaviruses accumulated through both natural infection of humans and experimental infection of animals, particularly mice. As treatment following alphavirus infection is currently limited to supportive care, understanding the contribution of the immune system to the disease process is critical to developing safe and effective therapies.
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Affiliation(s)
- Victoria K Baxter
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mark T Heise
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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31
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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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32
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Diouf B, Gaye A, Diagne CT, Diallo M, Diallo D. Zika virus in southeastern Senegal: survival of the vectors and the virus during the dry season. BMC Infect Dis 2020; 20:371. [PMID: 32448116 PMCID: PMC7247193 DOI: 10.1186/s12879-020-05093-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/14/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Zika virus (ZIKV, genus Flavivirus, family Flaviviridae) is transmitted mainly by Aedes mosquitoes. This virus has become an emerging concern of global public health with recent epidemics associated to neurological complications in the pacific and America. ZIKV is the most frequently amplified arbovirus in southeastern Senegal. However, this virus and its adult vectors are undetectable during the dry season. The aim of this study was to investigate how ZIKV and its vectors are maintained locally during the dry season. METHODS Soil, sand, and detritus contained in 1339 potential breeding sites (tree holes, rock holes, fruit husks, discarded containers, used tires) were collected in forest, savannah, barren and village land covers and flooded for eggs hatching. The emerging larvae were reared to adult, identified, and blood fed for F1 production. The F0 and F1 adults were identified and tested for ZIKV by Reverse Transcriptase-Real time Polymerase Chain Reaction. RESULTS A total of 1016 specimens, including 13 Aedes species, emerged in samples collected in the land covers and breeding sites investigated. Ae. aegypti was the dominant species representing 56.6% of this fauna with a high plasticity. Ae. furcifer and Ae. luteocephalus were found in forest tree holes, Ae. taylori in forest and village tree holes, Ae. vittatus in rock holes. ZIKV was detected from 4 out of the 82 mosquito pools tested. Positive pools included Ae. bromeliae (2 pools), Ae. unilineatus (1 pool), and Ae. vittatus (1 pool), indicating that the virus is maintained in these Aedes eggs during the dry season. CONCLUSION Our investigation identified breeding sites types and land cover classes where several ZIKV vectors are maintained, and their maintenance rates during the dry season in southeastern Senegal. The maintenance of the virus in these vectors in nature could explain its early amplification at the start of the rainy season in this area.
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Affiliation(s)
- Babacar Diouf
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, 36 Avenue Pasteur, BP 220, Dakar, Senegal.
| | - Alioune Gaye
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, 36 Avenue Pasteur, BP 220, Dakar, Senegal
| | - Cheikh Tidiane Diagne
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, 36 Avenue Pasteur, BP 220, Dakar, Senegal
| | - Mawlouth Diallo
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, 36 Avenue Pasteur, BP 220, Dakar, Senegal
| | - Diawo Diallo
- Pôle de Zoologie Médicale, Institut Pasteur de Dakar, 36 Avenue Pasteur, BP 220, Dakar, Senegal.
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33
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Qi J, Yin Y, Yu W, Shen L, Xu J, Hu T. Conjugation of β-Glucan with the Hydrazone and Disulfide Linkers Markedly Improves the Immunogenicity of Zika Virus E Protein. Mol Pharm 2020; 17:1933-1944. [DOI: 10.1021/acs.molpharmaceut.0c00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jinming Qi
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
- University of Chinese Academy of Sciences, Beijing 100190, China
| | - Ying Yin
- Laboratory of Vaccine and Antibody Engineering, Beijing Institute of Biotechnology, Beijing 100071, China
| | - Weili Yu
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
| | - Lijuan Shen
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
| | - Junjie Xu
- Laboratory of Vaccine and Antibody Engineering, Beijing Institute of Biotechnology, Beijing 100071, China
| | - Tao Hu
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
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Wang X, Zheng B, Ashraf U, Zhang H, Cao C, Li Q, Chen Z, Imran M, Chen H, Cao S, Ye J. Artemisinin inhibits the replication of flaviviruses by promoting the type I interferon production. Antiviral Res 2020; 179:104810. [PMID: 32360948 DOI: 10.1016/j.antiviral.2020.104810] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/28/2020] [Accepted: 04/25/2020] [Indexed: 11/18/2022]
Abstract
Flaviviruses are considered to be major emerging human pathogens globally. Currently available anti-flavivirus approaches are ineffective, thus there is a desperate need for broad-spectrum drugs that can be active against existing and emerging flaviviruses. Artemisinin has been found to cause an antiviral effect against several viruses; however, its antiviral effect against flaviviruses remains unexplored. Here the antiviral activity of artemisinin against flaviviruses such as JEV, DENV, and ZIKV was evaluated by measuring the hallmark features of virus replication both in vitro and in vivo. Mechanistically, the artemisinin-induced antiviral effect was associated with enhanced host type I interferon response. The blocking of interferon signaling inhibited the artemisinin-induced interferon-stimulated genes expression and rescued the artemisinin-suppressed virus replication. This study demonstrated for the first time the antiviral activity of artemisinin against flaviviruses with a novel antiviral mechanism. The therapeutic application of artemisinin may constitute a broad-spectrum approach to cure infections caused by flaviviruses.
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Affiliation(s)
- Xugang Wang
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; Laboratory of Animal Virology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; The Cooperative Innovation Center for Sustainable Pig Production, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China
| | - Bohan Zheng
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; Laboratory of Animal Virology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; The Cooperative Innovation Center for Sustainable Pig Production, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China
| | - Usama Ashraf
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; Laboratory of Animal Virology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China
| | - Hao Zhang
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; Laboratory of Animal Virology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; The Cooperative Innovation Center for Sustainable Pig Production, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China
| | - Chen Cao
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; Laboratory of Animal Virology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; The Cooperative Innovation Center for Sustainable Pig Production, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China
| | - Qi Li
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; Laboratory of Animal Virology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; The Cooperative Innovation Center for Sustainable Pig Production, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China
| | - Zheng Chen
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; Laboratory of Animal Virology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; The Cooperative Innovation Center for Sustainable Pig Production, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China
| | - Muhammad Imran
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; Laboratory of Animal Virology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; The Cooperative Innovation Center for Sustainable Pig Production, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China
| | - Huanchun Chen
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; Laboratory of Animal Virology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; The Cooperative Innovation Center for Sustainable Pig Production, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China
| | - Shengbo Cao
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; Laboratory of Animal Virology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; The Cooperative Innovation Center for Sustainable Pig Production, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China
| | - Jing Ye
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; Laboratory of Animal Virology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China; The Cooperative Innovation Center for Sustainable Pig Production, Huazhong Agricultural University, Wuhan, Hubei, 430070, PR China.
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