Zika Virus infection and Guillain-Barré syndrome in Northeastern Mexico: A case-control study

Abstract

Background Beginning August 2017, we conducted a prospective case-control investigation in Monterrey, Mexico to assess the association between Zika virus (ZIKV) and Guillain-Barré syndrome (GBS). Methods For each of 50 GBS case-patients, we enrolled 2-3 afebrile controls (141 controls in total) matched by sex, age group, and presentation to same hospital within 7 days. Results PCR results for ZIKV in blood and/or urine were available on all subjects; serum ZIKV IgM antibody for 52% of case-patients and 80% of controls. Subjects were asked about antecedent illness in the two months prior to neurological onset (for case-patients) or interview (for controls). Laboratory evidence of ZIKV infection alone (PCR+ or IgM+) was not significantly different between case-patients and controls (OR: 1.26, 95% CI: 0.45-3.54) but antecedent symptomatic ZIKV infection [a typical ZIKV symptom (rash, joint pain, or conjunctivitis) plus

Untitled

“…On the contrary, these results differ from other regions of Asia, including Bangladesh and the Americas (Cúcuta and Barranquilla, in Colombia) as well, in which the demyelinating type AIDP subtype was the most frequent [21,23,26]. Interestingly, both AMAN and AIDP cases were found in Northeastern Mexico [27].…”

“…Some describe a greater severity of GBS symptoms [12,13,21]. However, only eight reports with an appropriate design to show a positive or negative association were found [9,[21][22][23][24][25][26][27].…”

“…Some recent studies have also reported this association: Salinas et al (2017) reported rash, fever, arthralgia and myalgia [23]; Styczynski et al (2017) reported rash, headache, fever, arthralgias and myalgias [24]. Interestingly, Gongora-Rivera et al [27] found typical ZIKV symptoms (rash, joint pain and conjunctivitis) associated with laboratory evidence of ZIKV infection. When considering the symptoms reported in these studies as well as our own findings, the most significant symptoms are rash, arthralgia, fever, myalgia, conjunctivitis and headache.…”

“…The selection of controls with no fever might have generated an overestimation of the exposure (ZIKV and DENV) in cases and an underestimation in controls. This fact should be considered for future studies, although it was recently shown that a study that only included GBS cases without febrile illness in the last 5 days before the onset of GBS was significantly different from controls without fever [27].…”

Guillain-Barré syndrome during the Zika virus outbreak in Northeast Brazil: An observational cohort study

“…14,15 However, a uniform description of the clinical phenotype or the anti-ganglioside antibody signature of ZIKV-related GBS has not emerged in previous studies. 5,8,[16][17][18][19][20] Furthermore, little is known about the role of other circulating arboviruses, such as DENV and CHIKV, as potential triggers for GBS. 10 To study the relation between GBS and circulating arbovirus infections, we describe a large, well-defined, and unselected cohort of GBS patients with evidence of a preceding arbovirus infection from a single center in Northeast Brazil that was tested for arboviruses and a broad J o u r n a l P r e -p r o o f Journal Pre-proof spectrum of anti-ganglioside antibodies.…”