Table 2.
Studies on Guillain-Barre Syndrome (GBS) in Association With Zika Virus (ZIKV) Infection
| Study Type, Site(s) (Year[s]) | Findings | CSF Analysis and NCS | ZIKV Infection Testing |
|---|---|---|---|
| Case-control | |||
| French Polynesia (2013) | 42 cases with GBS (median age, 55 y; 88% had prior viral syndrome; median period from prodrome to GBS, 6 days; 29% required mechanical ventilation) and 98 controls (group 1) with nonfebrile illness | CSF with increased protein concentration in 93% of patients and a median of 4 cells/mm3 [1–7]; all 37 patients with NCS exhibited findings consistent with AMAN | Anti-ZIKV IgM/IgG found in 41 cases (98%) and 54 controls (56%); OR, 59.7 (P < .0001) |
| Colombia (2016) | Cases: 29 GBS patients; median age of 42 years; median period from prodrome to GBS 7 days; 48% required mechanical ventilation; control: 74 patients with ZIKV infection and no neurological involvement; M. pneumoniae IgG and low socioeconomic status were associated with GBS after ZIKV infection | CSF with ACD in 10 patients; NCS consistent with AIDP in 16/27 patients and AMAN in 7/27 patients | Anti-ZIKV/DENV IgG in all cases cases; anti-ZIKV IgM in 1 case (median of 108 days after the prodrome) |
| Case series | |||
| Colombia (2016) | 68 patients with GBS; median age, 47 y; 97% had prior febrile illness; median period from prodrome to GBS, 7 days; 31% required mechanical ventilation and 3 died | CSF with ACD in 45 patients; 36/46 had NCS findings consistent with AIDP | ZIKV RT-PCR done for 17 patients (urine samples for 16, CSF samples for 3, and a serum sample for 1); anti-flavivirus IgM/IgG found in 18 |
| Colombia (2016) | 19 patients with GBS; mean age, 44 y; all had preceding mild febrile illness; median period from prodrome to GBS, 10 days; 79% required mechanical ventilation | CSF with ACD in 8 patients and NCS findings consistent with AMAN in 10 | ZIKV RT-PCR done for 1 patient |
| Puerto Rico (2016) | 34 patients with GBS; median age, 55 y; 94% had prior acute febrile illness; median period from prodrome to GBS, 5 days; 35% required mechanical ventilation and 1 died | CSF with ACD in 25 patients; 5/5 had NCS findings consistent with AIDP | ZIKV RT-PCR done for 10 patients; either anti-ZIKV or anti-flavivirus IgM antibodies found in 24 |
| Brazil (2016) | 29 patients with GBS; 83% had prior viral symptoms; median period from prodrome to GBS, 10 days; 10% required mechanical ventilation and 1 died; outcomes at 3 mo included chronic pain in 55% and Hughes GBS disability scale of 1 in most patients | No CSF analysis reported; 18/27 patients had NCS findings consistent with AIDP, 2/27 had AMAN, and 6 had AMSAN | ZIKV RT-PCR done for 1 patient; anti-ZIKV IgM found in serum/ CSF for 1 and anti-DENV IgM negativity for 26 |
| Multicentera (2016) | 8 patients with GBS and 2 with encephalitis admitted to the ICU; 7 had exanthema on admission and 6 required mechanical ventilation | CSF with pleocytosis in 4 patients (2 with increased protein levels); NCS findings consistent with AIDP in 1 and with AMAN in 1 | ZIKV RT-PCR done for 10 patients |
| Martinique (2016) | 2 patients with GBS | CSF with ACD; NCS findings consistent with AIDP | ZIKV RT-PCR |
| Suriname (2016) | 3 patients with GBS; 2 aged 40 y and 1 aged 60 y | CSF with ACD in 1 patient; NCS findings consistent with AIDP in 2 | ZIKV RT-PCR done for 1 patient; anti-ZIKV IgG found in 2 patients |
| Case report | |||
| Brazil (2014, 2016); French Polynesia (2013); Haiti (2016); Honduras (2016); New Zealand (2016); Spain (2016); the Netherlands (2016) | 8 patients with GBS; age range, 24–62 y; female sex more common (n = 5); 1 was pregnant, 4 had preceding febrile illness, 1 developed weakness after a trip to Tonga, 5 had cranial nerve involvement, 1 had Miller-Fisher syndrome variant, and 1 had respiratory failure | CSF with CAD in 5 patients; NCS findings consistent with AIDP in 4 | ZIKV RT-PCR done for 4 patients; anti-ZIKV IgM found in 4 patients |
Abbreviations: ACD, albuminocytological dissociation; AIDP, acute inflammatory demyelinating polyneuropathy; AMAN, acute motor axonal neuropathy; AMSAN, acute motor sensory axonal neuropathy; CSF, cerebrospinal fluid; IgG, immunoglobulin G; IgM, immunoglobulin M; NCS, nerve conduction studies; OR, odds ratio; RT-PCR, reverse-transcription polymerase chain reaction.
aSites were in Colombia, Venezuela, El Salvador, Guatemala, Puerto Rico, Ecuador, Peru, and Chile.