Fur­ther ev­i­dence links Zika, Guil­lain-Barre syn­drome

The Philippine Star - - OPINION - CHARLES C. CHANTE, MD

Ev­i­dence of Zika virus found in Colom­bian pa­tients with Guil­lain-Barre syn­drome sup­ports the the­ory that Zika virus in­fec­tion and Guil­lain-Barre syn­drome are re­lated and could oc­cur parain­fec­tiously, a study showed.

“Study pro­vides vi­ro­logic ev­i­dence of (Zika virus) in­fec­tion in pa­tients with Guil­lain-Barre syn­drome,” wrote the Hos­pi­tal Univer­si­tario del Valle in Valle del Cauca, Colom­bia.

The Zika study looked at 68 pa­tients with Guil­lainBarre syn­drome, all of whom re­ceived their di­ag­noses at one of six uni­ver­sity-based health care cen­ters across Colom­bia between Jan­uary and March 2016.

The me­dian age was 47 years, 56% were male, and 90% were of mixed race. All 68 pa­tients were eval­u­ated clin­i­cally for Guil­lain-Barre syn­drome and un­der­went neu­ro­logic eval­u­a­tion as well.

Of the 68 sub­jects, 42 also un­der­went lab­o­ra­tory test­ing to find Zika virus RNA in blood, cere­brospinal fluid, or urine, via re­verse-tran­scrip­tase poly­merase chain re­ac­tion test­ing.

The re­sults in­di­cated that 66 of 68 sub­jects (97%) had symp­toms con­sis­tent with a Zika virus in­fec­tion prior to the onset of Guil­lain-Barre syn­drome.

The me­dian num­ber of data between the onset of Zika-like symp­toms and the onset of Guil­lain-Barre syn­drome in pa­tients was found to be 7 days (in­terquar­tile range, 3-10 days).

Seven­teen of the 42 pa­tients (40%) who un­der­went lab­o­ra­tory test­ing tested pos­i­tive for Zika virus RNA in their sam­ple, with 16 of those 17 pos­i­tive tests com­ing from urine sam­ples.

In ad­di­tion, 18 of the 42 lab­o­ra­tory-tested sub­jected had “clin­i­cal and im­muno­logic find­ings (that) sup­ported” a Zika virus in­fec­tion, the Zika study in­ves­ti­ga­tors re­ported.

“The onset of the Guil­lain-Barre syn­drome can par­al­lel the onset of sys­temic man­i­fes­ta­tions of (Zika virus) in­fec­tion, in­di­cat­ing a so-called parain­fec­tious onset, which sug­gests that fac­tors dif­fer­ent from the known post in­fec­tious mech­a­nisms may be present in (Zika virus)-re­lated Guil­lain-Barre syn­drome,” the re­port that re­sults of a prospec­tive study of 68 Colom­bian pa­tients who had a syn­drome con­sis­tent with the Guil­lain-Barre syn­drome, 66 of whom had pre­vi­ously had symp­toms of Zika virus (ZIKV) in­fec­tion.

Ma­jor strengths of this study in­clude the doc­u­men­ta­tion of a tem­po­ral re­la­tion­ship between the Guil­lainBarre syn­drome and ZIKV in­fec­tion (marked by a sub­stan­tial in­crease in the in­ci­dence of the Guil­lain-Barre syn­drome af­ter the in­tro­duc­tion of ZIKV, from 20 to 90 cases per month through­out Colom­bia), the cri­te­ria ap­plied for the di­ag­no­sis of the Guil­lain-Barre syn­drome, and the molec­u­lar and sero­logic fla­vivirus data from analy­ses of serum, cere­brospinal fluid and urine.

The dif­fi­cul­ties in di­ag­nos­ing ZIKV in­fec­tion are borne out this study, as only 17 pa­tients had de­fin­i­tive lab­o­ra­tory ev­i­dence of re­cent ZIKV in­fec­tion. Of these 17

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