Zika and dengue but not chikungunya are associated with Guillain-Barré syndrome in Mexico: A case-control study

Abstract

Background Zika, dengue and chikungunya viruses (ZIKV, CHIKV and DENV) are temporally associated with neurological diseases, such as Guillain-Barré syndrome (GBS). Because these three arboviruses coexist in Mexico, the frequency and severity of GBS could theoretically increase. This study aims to determine the association between these arboviruses and GBS in a Mexican population and to establish the clinical characteristics of the patients, including the severity of the infection. A case-control study was conducted (2016/07/01-2018/06/30) in Instituto Mexicano del Seguro Social (Mexican Social Security Institute) hospitals, using serum and urine samples that were collected to determine exposure to ZIKV, DENV, CHIKV by RT-qPCR and serology (IgM). For the categorical variables analysis, Pearson’s χ2 or Fisher exact tests were used, and the Mann-Whitney U test for continuous variables. To determine the association of GBS and viral infection diagnosis through laboratory and symptomatology before admission, we calculated the odds ratio (OR) and 95% confidence intervals (95%CI) using a 2x2 contingency table. A p-value ≤ 0.05 was considered as significant. Ninety-seven GBS cases and 184 controls were included. The association of GBS with ZIKV acute infection (OR, 8.04; 95% CI, 0.89–73.01, p = 0.047), as well as laboratory evidence of ZIKV infection (OR, 16.45; 95% CI, 2.03–133.56; p = 0.001) or Flavivirus (ZIKV and DENV) infection (OR, 6.35; 95% CI, 1.99–20.28; p = 0.001) was observed. Cases of GBS associated with ZIKV demonstrated a greater impairment of functional status and a higher percentage of mechanical ventilation. According to laboratory results, an association between ZIKV or ZIKV and DENV infection in patients with GBS was found. Cases of GBS associated with ZIKV exhibited a more severe clinical picture. Cases with co-infection were not found.

Guillain-Barre Syndrome and Antibodies to Arboviruses (Dengue, Chikungunya and Japanese Encephalitis)

“…The authors suggested that CHIK too is an important cause of GBS and coinfection with Zika might increase the severity of GBS. However, in a recent study of 97 patients from Mexico,[ 8 ] Zika (8) and Dengue (4) were found to have a stronger association with GBS than CHIK (1).…”

Implications of Innate Immunity in Post-Acute Sequelae of Non-Persistent Viral Infections

“…While Zika virus (ZIKV) is only characterized by mild acute symptoms, recent outbreaks in French Polynesia (2013) and the American continent (2016) showed severe long-term neurological complications in infants and adults [60,61]. The most prominent neuropathological condition of congenital infection is microcephaly, whereas infection in adults may result in encephalitis, myelitis and Guillain-Barre syndrome (GBS) [62][63][64]. GBS is characterized as a sudden onset weakness of the limbs associated with loss of reflexes and ascending paralysis [114].…”

Viral and Prion Infections Associated with Central Nervous System Syndromes in Brazil

“…Peripheral nervous system (PNS) involvement in DENV infection occurs in 5% of neurological symptoms, and includes Guillain-Barré syndrome (GBS), which is not commonly observed; hypokalemic quadriparesis or plegia; mononeuritis multiplex; brachial plexitis; diaphragmatic paralysis; and myositis [ 80 , 92 , 93 , 94 , 95 , 96 ]. GBS is an immune-mediated disorder of the PNS that manifests as acute onset of ascending paralysis and sensory symptoms [ 97 ], and is the most common cause of acute flaccid paralysis globally [ 98 ].…”