Clinical and nerve conduction features in Guillain−Barré syndrome associated with Zika virus infection in Cúcuta, Colombia

Antonio Uncini, D. C. González-Bravo, Y. Y. Acosta-Ampudia, E. C. Ojeda, Y. Rodríguez, D. M. Monsalve, C. Ramírez-Santana, D. A. Vega, D. Paipilla, L. Torres, N. Molano-González, J. E. Osorio, J. M. Anaya

Research output: Contribution to journalArticle

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Abstract

Background and purpose: Zika virus (ZIKV) infection has been associated with an increased incidence of Guillain−Barré syndrome (GBS) but the relative frequency of acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and axonal GBS subtypes is controversial. Methods: Twenty GBS patients diagnosed according to the Brighton criteria during the ZIKV outbreak in Cúcuta, Colombia, were evaluated clinically and electrophysiologically. The electrodiagnosis of GBS subtypes was made according to a recently described criteria set that demonstrated a high diagnostic accuracy on the basis of a single test. The electrophysiological features of 34 Italian AIDP patients were used as control. Results: All patients had symptoms compatible with ZIKV infection before the onset of GBS and ZIKV infection was laboratory confirmed through a plaque reduction neutralization test (PRNT90) in 100% of patients. The median time from onset of ZIKV infection symptoms to GBS was 5 days (interquartile range 1–6 days). Cranial nerve palsy was present in 85% of patients (facial palsy in 75%, bulbar nerve involvement in 60%), autonomic dysfunction in 85%, and 50% of patients required invasive mechanical ventilation. AIDP was diagnosed in 70% of patients. 40% of nerves of AIDP patients showed a prevalent distal demyelinating involvement but this pattern was not different from the Italian AIDP patients without ZIKV infection. Conclusions: Guillain−Barré syndrome associated with ZIKV infection in Cúcuta is characterized by a high frequency of cranial nerve involvement, autonomic dysfunction and requirement of mechanical ventilation indicating an aggressive and severe course. AIDP is the most frequent electrophysiological subtype. Demyelination is prevalent distally but this pattern is not specific for ZIKV infection.

Original languageEnglish (US)
Pages (from-to)644-650
Number of pages7
JournalEuropean Journal of Neurology
Volume25
Issue number4
DOIs
StatePublished - Apr 1 2018

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Uncini, Antonio ; González-Bravo, D. C. ; Acosta-Ampudia, Y. Y. ; Ojeda, E. C. ; Rodríguez, Y. ; Monsalve, D. M. ; Ramírez-Santana, C. ; Vega, D. A. ; Paipilla, D. ; Torres, L. ; Molano-González, N. ; Osorio, J. E. ; Anaya, J. M. / Clinical and nerve conduction features in Guillain−Barré syndrome associated with Zika virus infection in Cúcuta, Colombia. In: European Journal of Neurology. 2018 ; Vol. 25, No. 4. pp. 644-650.
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title = "Clinical and nerve conduction features in Guillain−Barr{\'e} syndrome associated with Zika virus infection in C{\'u}cuta, Colombia",
abstract = "Background and purpose: Zika virus (ZIKV) infection has been associated with an increased incidence of Guillain−Barr{\'e} syndrome (GBS) but the relative frequency of acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and axonal GBS subtypes is controversial. Methods: Twenty GBS patients diagnosed according to the Brighton criteria during the ZIKV outbreak in C{\'u}cuta, Colombia, were evaluated clinically and electrophysiologically. The electrodiagnosis of GBS subtypes was made according to a recently described criteria set that demonstrated a high diagnostic accuracy on the basis of a single test. The electrophysiological features of 34 Italian AIDP patients were used as control. Results: All patients had symptoms compatible with ZIKV infection before the onset of GBS and ZIKV infection was laboratory confirmed through a plaque reduction neutralization test (PRNT90) in 100{\%} of patients. The median time from onset of ZIKV infection symptoms to GBS was 5 days (interquartile range 1–6 days). Cranial nerve palsy was present in 85{\%} of patients (facial palsy in 75{\%}, bulbar nerve involvement in 60{\%}), autonomic dysfunction in 85{\%}, and 50{\%} of patients required invasive mechanical ventilation. AIDP was diagnosed in 70{\%} of patients. 40{\%} of nerves of AIDP patients showed a prevalent distal demyelinating involvement but this pattern was not different from the Italian AIDP patients without ZIKV infection. Conclusions: Guillain−Barr{\'e} syndrome associated with ZIKV infection in C{\'u}cuta is characterized by a high frequency of cranial nerve involvement, autonomic dysfunction and requirement of mechanical ventilation indicating an aggressive and severe course. AIDP is the most frequent electrophysiological subtype. Demyelination is prevalent distally but this pattern is not specific for ZIKV infection.",
author = "Antonio Uncini and Gonz{\'a}lez-Bravo, {D. C.} and Acosta-Ampudia, {Y. Y.} and Ojeda, {E. C.} and Y. Rodr{\'i}guez and Monsalve, {D. M.} and C. Ram{\'i}rez-Santana and Vega, {D. A.} and D. Paipilla and L. Torres and N. Molano-Gonz{\'a}lez and Osorio, {J. E.} and Anaya, {J. M.}",
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Clinical and nerve conduction features in Guillain−Barré syndrome associated with Zika virus infection in Cúcuta, Colombia. / Uncini, Antonio; González-Bravo, D. C.; Acosta-Ampudia, Y. Y.; Ojeda, E. C.; Rodríguez, Y.; Monsalve, D. M.; Ramírez-Santana, C.; Vega, D. A.; Paipilla, D.; Torres, L.; Molano-González, N.; Osorio, J. E.; Anaya, J. M.

In: European Journal of Neurology, Vol. 25, No. 4, 01.04.2018, p. 644-650.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical and nerve conduction features in Guillain−Barré syndrome associated with Zika virus infection in Cúcuta, Colombia

AU - Uncini, Antonio

AU - González-Bravo, D. C.

AU - Acosta-Ampudia, Y. Y.

AU - Ojeda, E. C.

AU - Rodríguez, Y.

AU - Monsalve, D. M.

AU - Ramírez-Santana, C.

AU - Vega, D. A.

AU - Paipilla, D.

AU - Torres, L.

AU - Molano-González, N.

AU - Osorio, J. E.

AU - Anaya, J. M.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background and purpose: Zika virus (ZIKV) infection has been associated with an increased incidence of Guillain−Barré syndrome (GBS) but the relative frequency of acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and axonal GBS subtypes is controversial. Methods: Twenty GBS patients diagnosed according to the Brighton criteria during the ZIKV outbreak in Cúcuta, Colombia, were evaluated clinically and electrophysiologically. The electrodiagnosis of GBS subtypes was made according to a recently described criteria set that demonstrated a high diagnostic accuracy on the basis of a single test. The electrophysiological features of 34 Italian AIDP patients were used as control. Results: All patients had symptoms compatible with ZIKV infection before the onset of GBS and ZIKV infection was laboratory confirmed through a plaque reduction neutralization test (PRNT90) in 100% of patients. The median time from onset of ZIKV infection symptoms to GBS was 5 days (interquartile range 1–6 days). Cranial nerve palsy was present in 85% of patients (facial palsy in 75%, bulbar nerve involvement in 60%), autonomic dysfunction in 85%, and 50% of patients required invasive mechanical ventilation. AIDP was diagnosed in 70% of patients. 40% of nerves of AIDP patients showed a prevalent distal demyelinating involvement but this pattern was not different from the Italian AIDP patients without ZIKV infection. Conclusions: Guillain−Barré syndrome associated with ZIKV infection in Cúcuta is characterized by a high frequency of cranial nerve involvement, autonomic dysfunction and requirement of mechanical ventilation indicating an aggressive and severe course. AIDP is the most frequent electrophysiological subtype. Demyelination is prevalent distally but this pattern is not specific for ZIKV infection.

AB - Background and purpose: Zika virus (ZIKV) infection has been associated with an increased incidence of Guillain−Barré syndrome (GBS) but the relative frequency of acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and axonal GBS subtypes is controversial. Methods: Twenty GBS patients diagnosed according to the Brighton criteria during the ZIKV outbreak in Cúcuta, Colombia, were evaluated clinically and electrophysiologically. The electrodiagnosis of GBS subtypes was made according to a recently described criteria set that demonstrated a high diagnostic accuracy on the basis of a single test. The electrophysiological features of 34 Italian AIDP patients were used as control. Results: All patients had symptoms compatible with ZIKV infection before the onset of GBS and ZIKV infection was laboratory confirmed through a plaque reduction neutralization test (PRNT90) in 100% of patients. The median time from onset of ZIKV infection symptoms to GBS was 5 days (interquartile range 1–6 days). Cranial nerve palsy was present in 85% of patients (facial palsy in 75%, bulbar nerve involvement in 60%), autonomic dysfunction in 85%, and 50% of patients required invasive mechanical ventilation. AIDP was diagnosed in 70% of patients. 40% of nerves of AIDP patients showed a prevalent distal demyelinating involvement but this pattern was not different from the Italian AIDP patients without ZIKV infection. Conclusions: Guillain−Barré syndrome associated with ZIKV infection in Cúcuta is characterized by a high frequency of cranial nerve involvement, autonomic dysfunction and requirement of mechanical ventilation indicating an aggressive and severe course. AIDP is the most frequent electrophysiological subtype. Demyelination is prevalent distally but this pattern is not specific for ZIKV infection.

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U2 - 10.1111/ene.13552

DO - 10.1111/ene.13552

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JO - European Journal of Neurology

JF - European Journal of Neurology

SN - 1351-5101

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