Postmortem Findings in Patient with Guillain-Barré Syndrome and Zika Virus Infection

Dirlikov, Emilio; Torres, José V.; Martines, Roosecelis B; Reagan‐Steiner, Sarah; Pérez, George Venero; Rivera, Aidsa; Major, Chelsea G.; Matos, Desiree; Muñoz‐Jordán, Jorge L.; Shieh, Wun Ju; Zaki, Sherif R.; Sharp, Tyler M.

doi:10.3201/eid2401.171331

Cited by 28 publications

(29 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Zika virus is a neurotropic arbovirus of the family Flaviviridae that recently received considerable attention due to its links to microcephaly and, less sensationally, to GBS (Cao-Lormeau et al, 2016 ). In Ifnar1 knockout mouse spinal cord and dorsal root ganglia-derived cultures (Cumberworth et al, 2017 ) as well as in a patient who died of Zika-GBS (Dirlikov et al, 2018 ), PNS neurons and Schwann cells appear rather refractory to infection. However, infection of dorsal root ganglia neurons in Ifnar1 knockout mice in vivo was reported recently (Oh et al, 2017 ).…”

Section: General Pathology and Mechanisms Of Axonal Injurymentioning

confidence: 99%

The Axon-Myelin Unit in Development and Degenerative Disease

et al. 2018

View full text Add to dashboard Cite

Axons are electrically excitable, cable-like neuronal processes that relay information between neurons within the nervous system and between neurons and peripheral target tissues. In the central and peripheral nervous systems, most axons over a critical diameter are enwrapped by myelin, which reduces internodal membrane capacitance and facilitates rapid conduction of electrical impulses. The spirally wrapped myelin sheath, which is an evolutionary specialisation of vertebrates, is produced by oligodendrocytes and Schwann cells; in most mammals myelination occurs during postnatal development and after axons have established connection with their targets. Myelin covers the vast majority of the axonal surface, influencing the axon's physical shape, the localisation of molecules on its membrane and the composition of the extracellular fluid (in the periaxonal space) that immerses it. Moreover, myelinating cells play a fundamental role in axonal support, at least in part by providing metabolic substrates to the underlying axon to fuel its energy requirements. The unique architecture of the myelinated axon, which is crucial to its function as a conduit over long distances, renders it particularly susceptible to injury and confers specific survival and maintenance requirements. In this review we will describe the normal morphology, ultrastructure and function of myelinated axons, and discuss how these change following disease, injury or experimental perturbation, with a particular focus on the role the myelinating cell plays in shaping and supporting the axon.

show abstract

Section: General Pathology and Mechanisms Of Axonal Injurymentioning

confidence: 99%

The Axon-Myelin Unit in Development and Degenerative Disease

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Among 13 ZIKV disease case-patients that experienced fatal outcome, two died following complications of Guillain-Barre syndrome [15,36], one from severe thrombocytopenia [21], and another with Leptospira spp. bacteria co-infection [37].…”

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background After Zika virus (ZIKV) emerged in the Americas, laboratory-based surveillance for arboviral diseases in Puerto Rico was adapted to include ZIKV disease. Methods and findings Suspected cases of arboviral disease reported to Puerto Rico Department of Health were tested for evidence of infection with Zika, dengue, and chikungunya viruses by RT-PCR and IgM ELISA. To describe spatiotemporal trends among confirmed ZIKV disease cases, we analyzed the relationship between municipality-level socio-demographic, climatic, and spatial factors, and both time to detection of the first ZIKV disease case and the midpoint of the outbreak. During November 2015-December 2016, a total of 71,618 suspected arboviral disease cases were reported, of which 39,717 (55.5%; 1.1 cases per 100 residents) tested positive for ZIKV infection. The epidemic peaked in August 2016, when 71.5% of arboviral disease cases reported weekly tested positive for ZIKV infection. Incidence of ZIKV disease was highest among 20-29-year-olds (1.6 cases per 100 residents), and most (62.3%) cases were female. The most frequently reported symptoms were rash (83.0%), headache (64.6%), and myalgia (63.3%). Few patients were hospitalized (1.2%), and 13 (<0.1%) died. Early detection of ZIKV disease cases was associated with increased population size (log hazard ratio [HR]:-0.22 [95% confidence interval-0.29,-0.14]), eastern longitude (log HR:-1.04 [-1.17,-0.91]), and proximity to a city (spline estimated degrees of freedom [edf] = 2.0). Earlier midpoints of the outbreak were associated with northern latitude (log HR:-0.30 [-0.32,-0.29]), eastern longitude (spline edf = 6.5), and higher mean monthly temperature PLOS NEGLECTED TROPICAL DISEASES

show abstract

“…5 Increased GBS incidence during ZIKV epidemics has provided a unique opportunity to further delineate the clinical features and pathophysiology of GBS. [6][7][8][9][10][11] The Puerto Rico Department of Health (PRDH), in San Juan, reported the first case of ZIKV disease in December 2015. Staff at the Adult's University Hospital (San Juan) suspected antecedent ZIKV infection in a patient with GBS who was seen in January 2016; specimen testing by the PRDH and the US Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, detected evidence of ZIKV infection.…”

mentioning

confidence: 99%

Clinical Features of Guillain-Barré Syndrome With vs Without Zika Virus Infection, Puerto Rico, 2016

et al. 2018

Self Cite

View full text Add to dashboard Cite

The pathophysiologic mechanisms of Guillain-Barré syndrome (GBS) associated with Zika virus (ZIKV) infection may be indicated by differences in clinical features. OBJECTIVE To identify specific clinical features of GBS associated with ZIKV infection. DESIGN, SETTING, AND PARTICIPANTS During the ZIKV epidemic in Puerto Rico, prospective and retrospective strategies were used to identify patients with GBS who had neurologic illness onset in 2016 and were hospitalized at all 57 nonspecialized hospitals and 2 rehabilitation centers in Puerto Rico. Guillain-Barré syndrome diagnosis was confirmed via medical record review using the Brighton Collaboration criteria. Specimens (serum, urine, cerebrospinal fluid, and saliva) from patients with GBS were tested for evidence of ZIKV infection by real-time reverse transcriptase-polymerase chain reaction; serum and cerebrospinal fluid were also tested by IgM enzyme-linked immunosorbent assay. In this analysis of public health surveillance data, a total of 123 confirmed GBS cases were identified, of which 107 had specimens submitted for testing; there were 71 patients with and 36 patients without evidence of ZIKV infection. Follow-up telephone interviews with patients were conducted 6 months after neurologic illness onset; 60 patients with and 27 patients without evidence of ZIKV infection participated. MAIN OUTCOMES AND MEASURES Acute and long-term clinical characteristics of GBS associated with ZIKV infection. RESULTS Of 123 patients with confirmed GBS, the median age was 54 years (age range, 4-88 years), and 68 patients (55.3%) were male. The following clinical features were more frequent among patients with GBS and evidence of ZIKV infection compared with patients with GBS without evidence of ZIKV infection: facial weakness (44 [62.0%] vs 10 [27.8%]; P < .001), dysphagia (38 [53.5%] vs 9 [25.0%]; P = .005), shortness of breath (33 [46.5%] vs 9 [25.0%]; P = .03), facial paresthesia (13 [18.3%] vs 1 [2.8%]; P = .03), elevated levels of protein in cerebrospinal fluid (49 [94.2%] vs 23 [71.9%]; P = .008), admission to the intensive care unit (47 [66.2%] vs 16 [44.4%]; P = .03), and required mechanical ventilation (22 [31.0%] vs 4 [11.1%]; P = .02). Six months after neurologic illness onset, patients with GBS and evidence of ZIKV infection more frequently reported having excessive or inadequate tearing (30 [53.6%] vs 6 [26.1%]; P = .03), difficulty drinking from a cup (10 [17.9%] vs 0; P = .03), and self-reported substantial pain (15 [27.3%] vs 1 [4.3%]; P = .03). CONCLUSIONS AND RELEVANCE In this study, GBS associated with ZIKV infection was found to have higher morbidity during the acute phase and more frequent cranial neuropathy during acute neuropathy and 6 months afterward. Results indicate GBS pathophysiologic mechanisms that may be more common after ZIKV infection.

show abstract

Postmortem Findings in Patient with Guillain-Barré Syndrome and Zika Virus Infection

Cited by 28 publications

References 15 publications

The Axon-Myelin Unit in Development and Degenerative Disease

The Axon-Myelin Unit in Development and Degenerative Disease

Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico

Clinical Features of Guillain-Barré Syndrome With vs Without Zika Virus Infection, Puerto Rico, 2016

Contact Info

Product

Resources

About