1
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Kim S, Kang M, Park JS, Seok HY. Letter to the Editor: Guillain-Barré Syndrome Needs to Be Considered as a Cause of Idiopathic Bilateral Vocal Fold Paralysis. J Korean Med Sci 2022; 37:e315. [PMID: 36281489 PMCID: PMC9592941 DOI: 10.3346/jkms.2022.37.e315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sohyeon Kim
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Minsung Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea.
| | - Hung Youl Seok
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
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2
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Fakhari MS, Poorsaadat L, Mahmoodiyeh B. Guillain-Barré syndrome following COVID-19 vaccine: A case report. Clin Case Rep 2022; 10:e6451. [PMID: 36254149 PMCID: PMC9558586 DOI: 10.1002/ccr3.6451] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
Coronavirus disease is a viral infection affecting different organs with various morbidities and mortality. Vaccines are used to control the disease. COVID-19 vaccines have brought many benefits but their adverse effects should not be ignored. Here, we report a case of Guillain-Barré Syndrome Following Sinopharm COVID-19 Vaccine.
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Affiliation(s)
| | - Leila Poorsaadat
- Department of Neurology, School of MedicineArak University of Medical SciencesArakIran
| | - Behnam Mahmoodiyeh
- Department of Anesthesiology, School of MedicineArak University of Medical SciencesArakIran
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3
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Rashid A, Khan Z, Alam J. Acquired hemophilia A with SARS-CoV-2 mRNA vaccine: first case from Pakistan. Scand J Clin Lab Invest 2022; 82:432-434. [PMID: 35767232 DOI: 10.1080/00365513.2022.2092902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/30/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Anila Rashid
- Department of Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Zurrya Khan
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Junaid Alam
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
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4
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Hilts A, Schreiber A, Singh A. A Clinical Case of COVID-19 Vaccine-Associated Guillain-Barré Syndrome. Am J Case Rep 2022; 23:e936896. [PMID: 35945825 PMCID: PMC9377719 DOI: 10.12659/ajcr.936896] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Guillain-Barre syndrome (GBS) is an autoimmune condition that presents as weakness, numbness, paresthesia, and areflexia. GBS may occur following infection or vaccination. The pathogenesis of GBS is characterized by inflammatory infiltrates and segmental demyelination. The mechanism of GBS following COVID-19 vaccination is hypothesized to arise from an autoimmune-mediated mechanism leading to an increase in inflammatory cytokines. While there were no reported cases of GBS during the mRNA COVID-19 vaccination clinical trials, there have been a few case reports of GBS following COVID-19 vaccination. CASE REPORT We report a case of symmetric weakness and paresthesia that began 3 days after the patient received his first dose of the Moderna COVID-19 vaccine. Cerebrospinal fluid (CSF) studies demonstrated albuminocytologic dissociation. The combination of the patient's CSF findings and clinical symptoms was concerning for Guillain-Barre syndrome. Given the clinical findings 3 days following COVID-19 vaccination, there was a high concern for COVID-19 vaccine-induced GBS. The patient was treated with IVIG followed by plasmapheresis but failed to show significant improvement from either treatment. CONCLUSIONS Our case report demonstrates occurrence of GBS soon after the patient received the COVID-19 Moderna vaccine. Although rare, there is some evidence to support an association between COVID-19 vaccination and GBS, but this is generally limited to case reports and case series. Clinicians, however, should remain vigilant to mitigate potential risks, such as autonomic dysfunction, respiratory failure, permanent disability, and death in patients who develop GBS after vaccination.
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5
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Rohilla R, Kakkar AK, Divyashree K, Mohindra R, Suri V. Recombinant protein subunit COVID-19 vaccine-induced Guillain-Barré Syndrome in an adolescent: A case report. Br J Clin Pharmacol 2022; 89:556-560. [PMID: 35856283 PMCID: PMC9350234 DOI: 10.1111/bcp.15466] [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: 06/07/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 01/19/2023] Open
Abstract
Guillain-Barré Syndrome (GBS), an autoimmune neurological disease of peripheral nerves, has been causally associated with COVID-19 vaccination in adults. However, no such report has been published so far in children. We describe a 13-year-old female child who presented to the emergency department with complaints of bilateral upper limb, lower limb and truncal weakness over 3 days following first dose of recombinant protein subunit COVID-19 vaccine (Corbevax). Clinical examination and nerve conduction studies showed pure motor axonal polyneuropathy with absent compound muscle action potential (CMAP) in all sampled nerves of upper and lower limbs which was consistent with the diagnosis of GBS after ruling out possible alternative aetiologies. A temporal association between first dose of protein subunit COVID-19 vaccine administered a day prior and symptom onset was noted. The causality assessment using the World Health Organization (WHO) tool for adverse event following immunization (AEFI) assessment indicated vaccine product-related reaction categorized as A1. The patient's clinical condition improved after seven sessions of plasmapheresis. The purpose of this report is to create awareness among health care professionals about COVID-19 vaccine-induced GBS in children as early diagnosis and management can be critical in avoiding complications and improving patient outcomes.
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Affiliation(s)
- Rachna Rohilla
- Department of PharmacologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Ashish Kumar Kakkar
- Department of PharmacologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Krishna Divyashree
- Department of Internal MedicinePostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Ritin Mohindra
- Department of Internal MedicinePostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Vikas Suri
- Department of Internal MedicinePostgraduate Institute of Medical Education and ResearchChandigarhIndia
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6
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Konishi T. Mutations in SARS-CoV-2 are on the increase against the acquired immunity. PLoS One 2022; 17:e0271305. [PMID: 35816505 PMCID: PMC9273074 DOI: 10.1371/journal.pone.0271305] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/27/2022] [Indexed: 12/19/2022] Open
Abstract
Monovalent vaccines using mRNA or adenoviruses have provided substantial protection against the COVID-19 pandemic in many countries. However, viral mutations have hampered the efficacy of this approach. The Omicron variant, which appeared in Dec 2021, has caused a pandemic that has exerted pressure on the healthcare system worldwide. The COVID-19 vaccines are not very effective against this variant, resulting in an increased rate of infection and mortality. Owing to the rapidly increasing number of patients, few countries, such as Australia, New Zealand, and Taiwan, which aimed at zero-COVID cases, have discontinued their attempts to contain the spread of infection by imposing strict lockdowns, for example. Therefore, the administration of booster vaccinations has been initiated; however, there are concerns about their effectiveness, sustainability, and possible dangers. There is also the question of how a variant with such isolated mutations originated and whether this is likely to continue in the future. Here, we compare the mutations in the Omicron variant with others by direct PCA to consider questions pertaining to their evolution and characterisation. The Omicron variant, like the other variants, has mutated in humans. The accumulated mutations overwhelmed the acquired immunity and caused a pandemic. Similar mutations are likely to occur in the future. Additionally, the variants infecting animals were investigated; they rapidly mutated in animals and varied from the human strains. These animal-adapted strains are probably not highly infectious or pathogenic to humans. Hence, the possibility of using these strains as vaccines will be discussed.
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Affiliation(s)
- Tomokazu Konishi
- Graduate School of Bioresource Sciences, Akita Prefectural University, Akita, Japan
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7
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Luitel P, Poudel B, Upadhyay D, Paudel S, Tiwari N, Gajurel BP, Karn R, Rajbhandari R, Shrestha A, Gautam N, Ojha R. Guillain-Barré syndrome following coronavirus disease vaccine: First report from Nepal. SAGE Open Med Case Rep 2022; 10:2050313X221100876. [PMID: 35646371 PMCID: PMC9130842 DOI: 10.1177/2050313x221100876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/27/2022] [Indexed: 12/19/2022] Open
Abstract
ChAdOx1 nCoV-19 is an effective and well-tolerated coronavirus disease 2019 vaccine. However, rare cases of serious adverse events have been reported with it. We report a patient who did not have active or prior coronavirus disease 2019 infection, who developed Guillain-Barré syndrome 7 days following the first dose of ChAdOx1 nCoV-19 vaccination. He was treated with intravenous immunoglobulin, with stabilization of the disease. Proper monitoring and prompt reporting of such cases are required to ensure the safety of the vaccine.
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Affiliation(s)
- Prajjwol Luitel
- Tribhuvan University Institute of
Medicine, Kathmandu, Nepal
| | - Bibek Poudel
- Tribhuvan University Institute of
Medicine, Kathmandu, Nepal
| | | | - Sujan Paudel
- Tribhuvan University Institute of
Medicine, Kathmandu, Nepal
| | - Nishan Tiwari
- Tribhuvan University Institute of
Medicine, Kathmandu, Nepal
| | - Bikram Prasad Gajurel
- Department of Neurology, Tribhuvan
University Institute of Medicine, Kathmandu, Nepal
| | - Ragesh Karn
- Department of Neurology, Tribhuvan
University Institute of Medicine, Kathmandu, Nepal
| | - Reema Rajbhandari
- Department of Neurology, Tribhuvan
University Institute of Medicine, Kathmandu, Nepal
| | - Aashish Shrestha
- Department of Neurology, Tribhuvan
University Institute of Medicine, Kathmandu, Nepal
| | - Niraj Gautam
- Department of Neurology, Tribhuvan
University Institute of Medicine, Kathmandu, Nepal
| | - Rajeev Ojha
- Department of Neurology, Tribhuvan
University Institute of Medicine, Kathmandu, Nepal
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8
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Jain RS, Vyas A, Sripadma PV, Rao K. Post COVID-19 Vaccination GBS-Association or Causation? Ann Indian Acad Neurol 2022; 25:294-296. [PMID: 35693658 PMCID: PMC9175424 DOI: 10.4103/aian.aian_292_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rajendra S. Jain
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
| | - Arvind Vyas
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
| | - PV Sripadma
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
| | - Kaavya Rao
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
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9
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Čenščák D, Ungermann L, Štětkářová I, Ehler E. Guillan-Barré Syndrome after First Vaccination Dose against COVID-19: Case Report. ACTA MEDICA (HRADEC KRÁLOVÉ) 2021; 64:183-186. [PMID: 34779385 DOI: 10.14712/18059694.2021.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A number of neurological complications have been reported after the administration of flu vaccine, including Guillain-Barré syndrome (GBS), especially after vaccination against swine flu. Only facial nerve neuropathy has thus far been reported after vaccination against COVID-19. More recently, there was a case of an elderly woman with GBS. In our report, we describe a case of a 42-year-old, previously almost healthy male who developed sensory symptoms 14 days after the first dose of Pfizer vaccine. One week later, the patient developed right facial nerve palsy and lower limb weakness and was no longer able to walk. Albuminocytological dissociation was detected in the cerebrospinal fluid, and there were inflammatory radicular changes in MRI scans of the lumbosacral spine. EMG indicated significant demyelinating polyradiculoneuritis and no antibodies against gangliosides were demonstrated. A 5-day course of immunoglobulins at a dose of 2 g/kg lead to a significant improvement and the patient was soon able to walk. In conclusion, we report a case of Guillan-Barré syndrome after COVID-19 vaccine in a young patient with a rapid diagnosis and prompt administration of immunoglobulins.
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Affiliation(s)
- Daniel Čenščák
- Department of Neurology, District Hospital Pardubice, Czech Republic
| | - Leoš Ungermann
- Department of Radiology, Faculty of Health-Care study, Pardubice University, District Hospital Pardubice, Czech Republic
| | - Ivana Štětkářová
- Department of Neurology, 3rd Medical Faculty Charles University, Prague, and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Edvard Ehler
- Department of Neurology, Faculty of Health-Care Study, Pardubice University, District Hospital Pardubice, Czech Republic.
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10
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Rajabally YA, Peric S, Bozovic I, Loo LK, Kalac A, Palibrk A, Basta I. Antecedent infections and vaccinations in chronic inflammatory demyelinating polyneuropathy: A European collaborative study. Muscle Nerve 2021; 64:657-661. [PMID: 34263956 DOI: 10.1002/mus.27374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/04/2021] [Accepted: 07/09/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION/AIMS Chronic inflammatory demyelinating polyneuropathy (CIDP) may be rarely preceded by infection. A causative link remains unproven, in contrast to Guillain-Barré syndrome (GBS), which is commonly postinfectious with well-demonstrated pathophysiological mechanisms of molecular mimicry following Campylobacter jejuni enteritis. Uncommonly, infections are reported before the onset of CIDP. In this study we aimed to determine the frequency and characteristics of CIDP occurring after antecedent infections or vaccinations in two large European cohorts. METHODS We reviewed the records of 268 subjects with "definite" or "probable" CIDP from the Inflammatory Neuropathy Clinic, Birmingham, UK (129 subjects), and from the Serbian national CIDP database (139 subjects). RESULTS Twenty-five of 268 (9.3%) subjects had a respiratory or gastrointestinal infection in the 6 weeks preceding CIDP onset, and 3 of 268 (1.1%) had received an influenza vaccination. CIDP disease onset occurred at a younger age (mean [standard deviation], 44.25 [17.36] years vs 54.05 [15.19] years; P < .005) and acute-onset CIDP was more common (42.9% vs 12.1%; odds ratio, 5.46; 95% confidence interval, 2.35-12.68; P < .001) in subjects with preceding infections or vaccinations. No differences in CIDP subtype, rates of cerebrospinal fluid protein level elevation, disability, or likelihood of treatment response, were observed. DISCUSSION Antecedent infections or vaccinations may precede about 10% of cases of CIDP and are more common in younger subjects. Acute-onset CIDP is more frequent after antecedent events. These findings may suggest specific pathophysiological mechanisms in such cases.
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Affiliation(s)
- Yusuf A Rajabally
- Inflammatory Neuropathy Clinic, University Hospitals Birmingham, Birmingham, UK.,Aston Medical School, Aston University, Birmingham, UK
| | - Stojan Peric
- Neurology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivo Bozovic
- Neurology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lay K Loo
- Inflammatory Neuropathy Clinic, University Hospitals Birmingham, Birmingham, UK
| | - Aida Kalac
- Neurology Clinic, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Aleksa Palibrk
- Neurology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Basta
- Neurology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
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11
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Papri N, Islam Z, Leonhard SE, Mohammad QD, Endtz HP, Jacobs BC. Guillain-Barré syndrome in low-income and middle-income countries: challenges and prospects. Nat Rev Neurol 2021; 17:285-296. [PMID: 33649531 PMCID: PMC7920001 DOI: 10.1038/s41582-021-00467-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/31/2023]
Abstract
The epidemiology, clinical characteristics, management and outcome of Guillain-Barré syndrome (GBS) differ between low-income and middle-income countries (LMIC) and high-income countries (HIC). At present, limited data are available on GBS in LMIC and the true incidence of GBS in many LMIC remains unknown. Increased understanding of GBS in LMIC is needed because poor hygiene and high exposure to infections render populations in LMIC vulnerable to GBS outbreaks. Furthermore, insufficient diagnostic and health-care facilities in LMIC contribute to delayed diagnosis in patients with severe presentations of GBS. In addition, the lack of national clinical guidelines and absence of affordable, effective treatments contribute to worse outcomes and higher mortality in LMIC than HIC. Systematic population-based surveillance studies, cohort and case-control studies are required to understand the incidence and risk factors for GBS. Novel, targeted and cost-effective treatment strategies need to be developed in the context of health system challenges in LMIC. To ensure integrative rehabilitation services in LMIC, existing prognostic models must be validated, and responsive outcome measures that are cross-culturally applicable must be developed. Therefore, fundamental and applied research to improve the clinical management of GBS in LMIC should become a critical focus of future research programmes.
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Affiliation(s)
- Nowshin Papri
- grid.414142.60000 0004 0600 7174Laboratory of Gut–Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh ,grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Zhahirul Islam
- grid.414142.60000 0004 0600 7174Laboratory of Gut–Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Sonja E. Leonhard
- grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Quazi D. Mohammad
- grid.489064.7National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Hubert P. Endtz
- grid.5645.2000000040459992XDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, Netherlands ,grid.434215.50000 0001 2106 3244Fondation Mérieux, Lyon, France
| | - Bart C. Jacobs
- grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands ,grid.5645.2000000040459992XDepartment of Immunology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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12
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Soni R, Heindl SE, Wiltshire DA, Vahora IS, Khan S. Antigenic Variability a Potential Factor in Assessing Relationship Between Guillain Barré Syndrome and Influenza Vaccine - Up to Date Literature Review. Cureus 2020; 12:e10208. [PMID: 33033684 PMCID: PMC7532881 DOI: 10.7759/cureus.10208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is a possible serious adverse event of the influenza vaccine but it is yet to be proven. The objective of our traditional literature review is to assess the potential relationship between GBS and influenza vaccine. A traditional literature review has been carried out by selecting 26 articles from PubMed published between 2011 and 2020. Twenty-six articles met the selection criteria (eight observational studies, four systematic literature review, three meta-analyses, two case-control, two retrospective cohort, and seven case series). Selected studies were focused on monitoring the safety of influenza vaccines, the relative safety of pandemic and seasonal influenza vaccines, influenza vaccine a potential etiology of GBS, and pathogenesis of post-vaccination GBS. Few studies have shown a higher incidence of GBS with a pandemic influenza vaccine compared to the seasonal influenza vaccine, while several studies have concluded a small increase in the possibility of GBS following any type of influenza vaccine. There were some studies that estimated no association possibly due to the presence of confounding factors such as influenza-like illness, low power of the study, and reporting bias in post-vaccination surveillance programs. GSB should be taken into consideration as one of the less common but serious side effects of the influenza vaccine but it should not adversely affect the acceptance of the influenza vaccination program. Continuous monitoring of influenza vaccine safety should be performed regularly.
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Affiliation(s)
- Ravi Soni
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Stacey E Heindl
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Dwayne A Wiltshire
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ilmaben S Vahora
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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13
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Taiwo FT, Ezuduemoih DE, Adebayo PB. Post-Vaccination Pharyngeal-Cervical-Brachial Variant of Guillain-Barré Syndrome. Cureus 2020; 12:e9804. [PMID: 32953316 PMCID: PMC7494422 DOI: 10.7759/cureus.9804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022] Open
Abstract
The pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome (GBS) is very rare. It is characterized by weakness of the upper extremities associated with bulbar symptoms and facial diplegia. Documented cases were post-infectious, a post-vaccination occurrence has not been documented in the available literature. Even rarer is the occurrence of any variant of GBS following the mumps measles rubella (MMR) vaccine. The neurophysiological hallmark of PCB variant of GBS is a combination of myelinopathy and axonopathy, hence, its consideration as a subtype of the acute motor axonal neuropathy (AMAN) variant. It should be suspected in any case of acute-onset flaccid symmetrical weakness of the upper extremities, as early diagnosis and treatment are key to preventing fatal bulbar weakness. Here we report a case of a middle-aged man, who presented with features of PCB a fortnight after being vaccinated for MMR.
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14
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Vaccines and the risk of Guillain-Barré syndrome. Eur J Epidemiol 2019; 35:363-370. [PMID: 31858323 DOI: 10.1007/s10654-019-00596-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/11/2019] [Indexed: 02/05/2023]
Abstract
The role of vaccination in the development of Guillain-Barré syndrome (GBS) is controversial, although cases of GBS have been reported following a wide range of vaccines. A nested case-control study was conducted between January 2011 and December 2015 in three Chinese cities. Four controls were matched to a case by gender, age, address and index date. An independent expert committee validated the diagnoses of cases and controls according to the Brighton Collaboration GBS case definition. Data on vaccinations were obtained from computerized vaccination records. Causal relations were assessed by conditional logistic regression. 1056 cases of GBS and 4312 controls were included in the analyses. Among paediatric and adult population, adjusted ORs for GBS occurrence within 180 days following vaccination were 0.94 (95% CI 0.54-1.62) and 1.09 (95% CI 0.88-1.32), respectively. No increased risk of GBS was detected for vaccination against hepatitis B, influenza, hepatitis A, varicella, rabies, polio(live), diphtheria, pertuss(acellular), tetanusis, measles, mumps, rubella, Japanese Encephalitis, and meningitis vaccines. Adjusted ORs for the recurrence of GBS after vaccination among paediatric and adult population were 0.85 (95% CI 0.07-9.50) and 1.18 (95% CI 0.49-2.65), respectively. In this large retrospective study, we did not find evidence of an increased risk of GBS and its recurrence among either paediatric (≤ 18 years) or adult (> 18 years) individuals within the 180 days following vaccinations of any kind, including influenza vaccination.
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15
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Babazadeh A, Mohseni Afshar Z, Javanian M, Mohammadnia-Afrouzi M, Karkhah A, Masrour-Roudsari J, Sabbagh P, Koppolu V, Vasigala VK, Ebrahimpour S. Influenza Vaccination and Guillain-Barré Syndrome: Reality or Fear. J Transl Int Med 2019; 7:137-142. [PMID: 32010599 PMCID: PMC6985921 DOI: 10.2478/jtim-2019-0028] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an inflammatory disorder and an acute immune-mediated demyelinating neuropathy that causes reduced signal transmissions, progressive muscle weakness, and paralysis. The etiology of the syndrome still remains controversial and uncertain. GBS can be initiated and triggered by respiratory tract infections such as influenza, and intestinal infections such as Campylobacter jejuni. In addition, there is considerable evidence suggesting links between influenza vaccination and GBS. As reported previously, the incidence of GBS in individuals receiving swine flu vaccine was about one to two cases per million. Despite the influenza vaccine efficacy, its association with an immune-mediated demyelinating process can be challenging as millions of people get vaccinated every year. In this review we will discuss the association between influenza infection and vaccination with GBS by focusing on the possible immunopathological mechanisms.
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Affiliation(s)
- Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran
| | - Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Javanian
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran
| | - Mousa Mohammadnia-Afrouzi
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran
| | - Ahmad Karkhah
- Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Jila Masrour-Roudsari
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran
| | - Parisa Sabbagh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran
| | - Veerendra Koppolu
- Scientist Biopharmaceutical Development Medimmune Gaithersburg, MD 20878, USA
| | | | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran
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16
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Yuen C, Kamson D, Soliven B, Kramer C, Goldenberg F, Rezania K. Severe Relapse of Vaccine-Induced Guillain-Barré Syndrome After Treatment With Nivolumab. J Clin Neuromuscul Dis 2019; 20:194-199. [PMID: 31135622 DOI: 10.1097/cnd.0000000000000230] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cancer immunotherapy with checkpoint inhibitors may result in neuromuscular immune-related adverse reactions, including Guillain-Barré syndrome (GBS)-like disease. On the other hand, checkpoint inhibitor therapy may result in exacerbation of underlying autoimmune diseases such as myasthenia gravis and multiple sclerosis. We present a patient who developed a severe and fatal relapse of postvaccination GBS after he was treated with nivolumab, a monoclonal antibody directed to programmed death-1 (PD-1), during a GBS treatment-related fluctuation. We recommend that caution be exercised in starting treatment with PD-1 inhibitors in the acute stage or early in the recovery period of GBS.
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Affiliation(s)
- Carlen Yuen
- Department of Neurology, University of Chicago Medical Center, Chicago, IL
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17
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The value of Autoimmune Syndrome Induced by Adjuvant (ASIA) - Shedding light on orphan diseases in autoimmunity. Autoimmun Rev 2018. [DOI: 10.1016/j.autrev.2017.11.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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