Guillain-Barree syndrome in patients with a recent history of Zika in Cucuta, Colombia: A descriptive case series of 19 patients from December 2015 to March 2016
Guillain-Barree syndrome in patients with a recent history of Zika in Cucuta, Colombia: A descriptive case series of 19 patients from December 2015 to March 2016
复制标题
DOI：
10.1016/j.jcrc.2016.08.016
复制
发表时间：
2017-02-01
影响因子：
3.7
通讯作者：
Castellanos, Gabriel
中科院分区：
文献类型：
--
作者：
Arias, Arturo;Torres-Tobar, Lilian;Castellanos, Gabriel
目的：寨卡病毒 (ZIKV) 感染是一种新兴的全球威胁，也是美洲的公共卫生问题。最近发现吉兰-巴里综合征 (GBS) 与寨卡病毒有关。本报告介绍了可能与 ZIKV 相关的 GBS 病例系列。方法：收集2015年12月1日至2016年4月30日在哥伦比亚库库塔5个重症监护病房接受治疗且有近期ZIKV病史的GBS患者的临床和人口统计学数据。分别对14例、10例和1例患者进行了电生理检查、腰椎穿刺和逆转录聚合酶链反应检测ZIKV。结果：19例GBS患者和近期有急性病毒综合征病史的患者对 ZIKV 感染者进行了研究（平均年龄，44 岁；范围，17-78 岁）。病毒症状出现后平均 10 天出现神经系统症状。 8例发现蛋白细胞解离。所有接受测试的患者均发现急性运动轴突神经病的电生理学标准。在 Brighton 分类中，5 名患者达到 GBS 诊断确定性 1 级、8 名患者达到 2 级、6 名患者达到 3 级。 15 名患者需要呼吸辅助，16 名患者接受静脉注射免疫球蛋白，3 名患者接受血浆置换。 79% 的患者出院时符合休斯 GBS 残疾量表 4 至 5 级，并且在观察期间没有患者死亡。 1 例患者观察到急性 ZIKV 感染，经逆转录聚合酶链反应证实。结论：本次 GBS 疫情的所有病例近期均有 ZIKV 感染史，这强化了 GBS 与 ZIKV 之间关联的现有证据。未来的遗传学和免疫学研究有必要进一步详细调查爆发的原因。 (C) 2016 Elsevier Inc. 保留所有权利。
Purpose: Zika virus (ZIKV) infection is an emerging global threat and a public health problem in the Americas. Guillain-Barree syndrome (GBS) has been recently associated to ZIKV. This report presents a case series of GBS possibly associated to ZIKV. Methods: Clinical and demographic data from patients with GBS treated in 5 intensive care units and with recent history of ZIKV in Cucuta, Colombia were collected from December 1 2015 to April 30 2016. Electrophysiological examination, lumbar puncture, and reverse transcriptase-polymerase chain reaction for ZIKV were performed in 14, 10, and 1 patients, respectively.Results: Nineteen patients with GBS and a recent history of acute viral syndrome compatible with ZIKV infection were studied (mean age, 44 years; range, 17-78). Neurologic symptoms developed at a median of 10 days after the onset of the viral symptoms. Albuminocytological dissociation was found in 8 cases. Electrophysiological criteria for acute motor axonal neuropathy were found in all patients tested. Five patients met level 1, 8 patients level 2, and 6 patients level 3 of diagnostic certainty for GBS in the Brighton classification. Fifteen patients required respiratory assistance, 16 received intravenous immunoglobulins, and 3 had plasmapheresis. Seventynine percent of patients were in Hughes GBS disability scale 4 to 5 at discharge and no patients died during the observation period. Acute ZIKV infection, confirmed by reverse transcriptase-polymerase chain reaction, was observed for 1 patient.Conclusions: All cases of this GBS outbreak had a recent history ZIKV infection, reinforcing existing evidence for the association between GBS and ZIKV. Future genetic and immunologic studies are warranted to further investigate the cause of the outbreak in detail. (C) 2016 Elsevier Inc. All rights reserved.