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Guillain-Barré Syndrome Associated With Zika Virus Infection in Martinique in 2016: A Prospective Study.

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.

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  • Authors+Show Affiliations

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    Infectious and Tropical Diseases Unit, University Hospital of Martinique. Intensive Care Unit, University Hospital of Martinique.

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    Laboratory of Virology, University Hospital of Martinique, Université des Antilles EA4537, Fort de France.

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    Intensive Care Unit, University Hospital of Martinique.

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    French National Public Health Agency, Regional Unit Antilles Guyane, Saint-Maurice.

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    Electrophysiological Department.

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    Rehabilitation Unit.

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    French National Public Health Agency, Regional Unit Antilles Guyane, Saint-Maurice.

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    Emergency Department.

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    Laboratory of Virology, University Hospital of Martinique, Université des Antilles EA4537, Fort de France.

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    Laboratory of Virology, University Hospital of Martinique, Fort de France.

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    Intensive Care Unit, University Hospital of Martinique.

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    French National Public Health Agency, Regional Unit Antilles Guyane, Saint-Maurice.

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    Intensive Care Unit, University Hospital of Martinique.

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    Infectious and Tropical Diseases Unit, University Hospital of Martinique.

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    French Armed Forces Biomedical Research Institute, Marseille.

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    Neurology Department, University Hospital of Martinique.

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    Infectious and Tropical Diseases Unit, University Hospital of Martinique, Université des Antilles, EA4537, INSERM CIC1424, Fort de France, France.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    29020245