Guillain-Barre syndrome complicating chikungunya virus infection

Abstract

Chikungunya virus (CHIKV) is a mosquito-borne alphavirus which presents with symptoms of fever, rash, arthralgia, and occasional neurologic disease. While outbreaks have been earlier reported from India and other parts of the world, the recent outbreak in India witnessed more than 1000 cases. Various systemic and rarely neurological complications have been reported with CHIKV. We report two cases of Guillain-Barré syndrome (GBS) with CHIKV. GBS is a rare neurological complication which may occur after subsidence of fever and constitutional symptoms by several neurotropic viruses. We describe two cases of severe GBS which presented with rapidly progressive flaccid quadriparesis progressing to difficulty in swallowing and breathing. Both required mechanical ventilation and improved partly with plasmapharesis. The cases emphasize on (1) description of the rare complication in a setting of outbreak with CHIKV, (2) acute axonal as well as demyelinating neuropathy may occur with CHIKV, (3) accurate identification of this entity during outbreaks with dengue, both of which are vector borne and may present with similar complications.

Guillain-Barré syndrome associated with arboviruses in the state of Pernambuco in 2016

“…The first neurological alterations found in GBS cases associated with arboviruses referred to movement and walking, which is in accordance with previous findings [25,33,40]. A study carried out in France in 2009 reported two GBS cases after chikungunya; the patients were a 48 and 51-year-old women, presenting progressive movement weakness, lack of tendon reflex, and sensory disorder [25].…”

“…There is a smaller number of GBS case reports after chikungunya compared to those reported for dengue and Zika virus [33]. However, 15 confirmed/ probable post-chikungunya GBS cases were recorded in this research, totaling 35.0% of the notified cases.…”

“…In 2016, in Colombia, a case was reported in which a 77-year-old woman presented progressive movement weakness and sensory disorder after chikungunya infection [40]. In India, in 2017, two other cases of GBS after chikungunya were reported in men, aged 18 and 30 years old, and presenting limb and face muscle weakness and dysphagia [33].…”

The neurological complications of chikungunya virus: A systematic review

“…Clinically, chikungunya‐associated GBS resembles GBS associated with other infections such as Campylobacter jejuni , presenting with symmetrical, bilateral flaccid weakness, often with paraesthesia and/or cranial nerve palsy . The 4 reports in the literature detailing the time interval between chikungunya infection and onset of neurological features describe a prodrome of 3 to 17 days, compatible with a parainfectious or postinfectious syndrome (Table ) …”

Sex Matters in Neuroinfectious Diseases

“…A second major outbreak in French Polynesia from October 2013 to April 2014, during which approximately 31,000 persons were infected, 65 provided the first indication that Zika virus could cause neurologic disease. 66 A major uptick in the incidence of Guillain-Barré syndrome, which has been described with other arbovirus infections, 67,68 temporally coincided with the French Polynesia outbreak (►Fig. 2).…”