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Published on: August 23, 2016
Zika Virus infection and Guillain-Barré syndrome in Northeastern Mexico: A case-control study
Fernando Gongora-Rivera1, Israel Grijalva2, Adrian Infante-Valenzuela1
1Department of Neurology, University Hospital José Eleuterio González, Universidad Autonoma de Nuevo León, Monterrey, Nuevo León, Mexico.
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 laboratory evidence of ZIKV infection] was higher among case-patients (OR: 12.45, 95% CI: 1.45-106.64). GBS case-patients with laboratory evidence of ZIKV infection were significantly more likely to have had typical ZIKV symptoms than controls with laboratory evidence of ZIKV infection (OR: 17.5, 95% CI: 3.2-96.6). This association remained significant even when only GBS case-patients who were afebrile for 5 days before onset were included in the analysis, (OR 9.57 (95% CI: 1.07 to 85.35).
Conclusions:
During ZIKV epidemics, this study indicates that increases in GBS will occur primarily among those with antecedent symptomatic ZIKV.
Insights
Zika virus (ZIKV) infection is linked to Guillain-Barré syndrome (GBS), especially when ZIKV symptoms like rash or joint pain are present. This association is significant even in afebrile GBS cases.
Area of Science:
- Neurology
- Infectious Diseases
- Epidemiology
Background:
- The Zika virus (ZIKV) outbreak prompted investigations into its neurological complications.
- Guillain-Barré syndrome (GBS) has been anecdotally linked to ZIKV infections.
Purpose of the Study:
- To prospectively assess the association between Zika virus infection and Guillain-Barré syndrome.
- To determine if symptomatic ZIKV infection increases GBS risk.
Main Methods:
- A prospective case-control study was conducted in Monterrey, Mexico, starting August 2017.
- 50 GBS cases were compared with 141 matched controls (sex, age, hospital presentation).
- Laboratory tests (PCR, IgM) and antecedent illness questionnaires were used to identify ZIKV infection and symptoms.
Main Results:
- Laboratory evidence of ZIKV infection alone was not significantly different between GBS cases and controls.
- Antecedent symptomatic ZIKV infection (typical symptoms + lab evidence) was significantly higher in GBS cases (OR: 12.45).
- GBS cases with ZIKV infection were more likely to report typical ZIKV symptoms (OR: 17.5).
Conclusions:
- Increases in GBS during ZIKV epidemics are primarily associated with symptomatic ZIKV infections.
- Symptomatic ZIKV infection is a significant risk factor for developing GBS.
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