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Zika and dengue but not chikungunya are associated with Guillain-Barré syndrome in Mexico: A case-control study

Israel Grijalva1, Concepción Grajales-Muñiz2, César González-Bonilla3

  • 1Medical Research Unit for Neurological Diseases, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.

Plos Neglected Tropical Diseases
|December 17, 2020
PubMed

Insights

Zika virus (ZIKV) infection is linked to Guillain-Barré syndrome (GBS) in Mexico, with ZIKV-associated GBS cases showing more severe symptoms and requiring more mechanical ventilation. This study highlights the neurological risks of arboviruses.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Epidemiology

Background:

  • Zika, dengue, and chikungunya viruses (ZIKV, CHIKV, DENV) are arboviruses known to cause neurological diseases like Guillain-Barré syndrome (GBS).
  • These arboviruses coexist in Mexico, raising concerns about increased GBS incidence and severity.
  • Understanding the specific associations between these viruses and GBS is crucial for public health in affected regions.

Purpose of the Study:

  • To determine the association between ZIKV, CHIKV, and DENV infections and GBS in a Mexican population.
  • To characterize the clinical presentation and severity of GBS cases linked to these arboviruses.
  • To assess the diagnostic utility of laboratory findings and symptomatology in identifying arboviral infections preceding GBS.

Main Methods:

  • A case-control study was conducted from July 2016 to June 2018 in Mexican hospitals.
  • Serum and urine samples were analyzed for ZIKV, DENV, and CHIKV using RT-qPCR and IgM serology.
  • Statistical analyses included Pearson's chi-squared, Fisher's exact, Mann-Whitney U tests, and 2x2 contingency tables to calculate odds ratios (OR) and 95% confidence intervals (95%CI).

Main Results:

  • Ninety-seven GBS cases and 184 controls were analyzed.
  • A significant association was found between GBS and acute ZIKV infection (OR, 8.04; p=0.047) and laboratory-confirmed ZIKV infection (OR, 16.45; p=0.001).
  • GBS cases associated with ZIKV showed more severe clinical manifestations, including greater functional impairment and higher rates of mechanical ventilation. Flavivirus (ZIKV and DENV) infection was also associated with GBS (OR, 6.35; p=0.001).

Conclusions:

  • Laboratory evidence confirms an association between ZIKV infection and GBS in the studied Mexican population.
  • ZIKV-associated GBS cases present with a more severe clinical picture compared to other arboviral infections.
  • No co-infections were identified in the GBS cases during this study period.

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