Benoît Rozé1,2, Fatiha Najioullah3, Jean-Louis Fergé2, Frédérique Dorléans4, Kossivi Apetse5, Jose-Luis Barnay6, Elise Daudens-Vaysse4, Yannick Brouste7, Raymond Césaire3, Laurence Fagour8, Ruddy Valentino2, Martine Ledrans4, Hossein Mehdaoui2, Sylvie Abel1, Isabelle Leparc-Goffart9, Aissatou Signate10, André Cabié11. 1. Infectious and Tropical Diseases Unit, University Hospital of Martinique. 2. Intensive Care Unit, University Hospital of Martinique. 3. Laboratory of Virology, University Hospital of Martinique, Université des Antilles EA4537, Fort de France. 4. French National Public Health Agency, Regional Unit Antilles Guyane, Saint-Maurice. 5. Electrophysiological Department. 6. Rehabilitation Unit. 7. Emergency Department. 8. Laboratory of Virology, University Hospital of Martinique, Fort de France. 9. French Armed Forces Biomedical Research Institute, Marseille. 10. Neurology Department, University Hospital of Martinique. 11. Infectious and Tropical Diseases Unit, University Hospital of Martinique, Université des Antilles, EA4537, INSERM CIC1424, Fort de France, France.
Abstract
BACKGROUND: Guillain-Barré syndrome (GBS) has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies, mostly on the basis of serological tests, with the problematic cross-reacting antibodies of the Flavivirus genus. Some GBS cases do not exhibit a high level of diagnostic certainty. This prospective study aimed to describe the clinical profiles and the frequency of GBS associated with ZIKV during the ZIKV outbreak in Martinique in 2016. METHODS: We recorded prospective data from GBS meeting levels 1 or 2 of diagnostic certainty for the Brighton Collaboration, with proof of recent ZIKV infection and negative screening for etiologies of GBS. RESULTS: Of the sample of 34 patients with suspected GBS during the outbreak, 30 had a proven presence of GBS, and 23 had a recent ZIKV infection. The estimated GBS incidence rate ratio (2016 vs 2006-2015) was 4.52 (95% confidence interval, 2.80-7.64; P = .0001). Recent ZIKV infection was confirmed by urine reverse-transcription polymerase chain reaction (RT-PCR) analysis in 17 cases and by serology in 6 cases. Patients, 65% of whom were male, had a median age of 61 years (interquartile range, 56-71 years) and experienced severe GBS. Electrophysiological tests were consistent with the primary demyelinating form of the disease. CONCLUSIONS: ZIKV infection is usually benign, when symptomatic, but in countries at risk of ZIKV epidemics, adequate intensive care bed capacity is required for management of severe GBS cases. Arbovirus RNA detection by RT-PCR should be part of the management of GBS cases.
BACKGROUND: Guillain-Barré syndrome (GBS) has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies, mostly on the basis of serological tests, with the problematic cross-reacting antibodies of the Flavivirus genus. Some GBS cases do not exhibit a high level of diagnostic certainty. This prospective study aimed to describe the clinical profiles and the frequency of GBS associated with ZIKV during the ZIKV outbreak in Martinique in 2016. METHODS: We recorded prospective data from GBS meeting levels 1 or 2 of diagnostic certainty for the Brighton Collaboration, with proof of recent ZIKV infection and negative screening for etiologies of GBS. RESULTS: Of the sample of 34 patients with suspected GBS during the outbreak, 30 had a proven presence of GBS, and 23 had a recent ZIKV infection. The estimated GBS incidence rate ratio (2016 vs 2006-2015) was 4.52 (95% confidence interval, 2.80-7.64; P = .0001). Recent ZIKV infection was confirmed by urine reverse-transcription polymerase chain reaction (RT-PCR) analysis in 17 cases and by serology in 6 cases. Patients, 65% of whom were male, had a median age of 61 years (interquartile range, 56-71 years) and experienced severe GBS. Electrophysiological tests were consistent with the primary demyelinating form of the disease. CONCLUSIONS: ZIKV infection is usually benign, when symptomatic, but in countries at risk of ZIKV epidemics, adequate intensive care bed capacity is required for management of severe GBS cases. Arbovirus RNA detection by RT-PCR should be part of the management of GBS cases.
Authors: Anthony Cousien; Sylvie Abel; Alice Monthieux; Alessio Andronico; Isabelle Calmont; Minerva Cervantes; Raymond Césaire; Pierre Gallian; Xavier de Lamballerie; Cédric Laouénan; Fatiha Najioullah; Sandrine Pierre-François; Mathilde Pircher; Henrik Salje; Quirine A Ten Bosch; André Cabié; Simon Cauchemez Journal: Am J Epidemiol Date: 2019-07-01 Impact factor: 4.897
Authors: Mariola Mascarenhas; Sophiya Garasia; Philippe Berthiaume; Tricia Corrin; Judy Greig; Victoria Ng; Ian Young; Lisa Waddell Journal: PLoS One Date: 2018-11-29 Impact factor: 3.240