Guillain-Barré and Zika virus are related.
This comes from evidence of Zika found in Colombian patients with Guillain-Barré syndrome and supports the theory that the two are related and could occur parainfectiously. All 68 patients who participated in the study were evaluated clinically for Guillain-Barré and underwent neurological evaluation as well. Of the 68 subjects, 42 underwent laboratory testing to find Zika in their blood, cerebrospinal fluid or urine, via reverse-transcriptase polymerase chain reaction (RT-PCR) testing.
"Results indicated that 66 (97%) of subjects had symptoms consistent with a Zika virus infection prior to the onset of Guillain-Barré syndrome. The median number of days between onset of Zika-like symptoms and the onset of Guillain-Barré syndrome was found to be 7 days (interquartile range, 3-10 days). Seventeen (40%) of the 42 patients who underwent laboratory testing tested positive for Zika virus RNA in their sample, with 16 of those 17 positive tests coming from urine samples. Additionally, 18 of the 42 laboratory-tested subjects had “clinical and immunologic findings [that] supported” a Zika virus infection."
It was found that the onset of Guillain-Barré syndrome can parallel the onset of the Zika virus. The authors noted the "RT-PCR testing of urine is a valuable diagnostic tool for the identification of [Zika virus] infection in patients with Guillain-Barré syndrome,”
How much do you know about Guillain-Barré syndrome? Take this short quiz to find out.
1. Which of the following statements regarding physical symptoms of Guillain-Barré syndrome (GBS) is TRUE?
2. True or False. Among laboratory testing methods for diagnosis of GBS, cerebrospinal fluid (CSF) analysis is more useful than electrophysiologic studies.
3. Which of the following laboratory test findings is LEAST suggestive of GBS diagnosis?
4. True or False. In progression of GBS, motor function will typically improve before acute autonomic failure resolves.
5. Which of the following statements is/are TRUE regarding differential diagnosis of GBS?
According to an article published in Mayo Clinic Proceedings, sever back pain and limb paralysis with a "tight band" feeling are common presenting signs and the paresthesias. Legs are more typically involved than arms, which creates the illusion of an ascending paralysis. Facial and oropharyngeal muscles are affected in 50% of the cases, and weakness of these muscle groups may be the initial manifestation. Because CSF can include a normal cell count and normal protein level in weak patients early in presentation, its usefulness is questionable. Lumbar puncture may be more appropriate in unclear clinical cases. Electrophysiologic studies are far more useful for diagnosis. Specific tests for proximal nerve involvement seen early in the disease course include recording of F-waves and abnormalities like dispersion or dropout in F-wave signal. Prolonged F-wave may be the only confirmatory finding if the patient is tested early. Also in patients with Guillain-Barré syndrome, more that 10 white blood cells per high-power field may be seen but, is more common in associated disorders such as Lyme disease, sarcoidosis and AIDS. Patients with diaphragmatic weakness have a decrease in the vital capacity when supine, but the decrease must be more than 25% from baseline to be called abnormal. Acute autonomic failure in GBS usually resolves in the plateau phase of the disorder and before improvement in motor function, but orthostatic hypotension may persist during the recovery phase,” according to a review article published in Mayo Clinic Proceedings. According to information cited in the review article published in Mayo Clinic Proceedings, “Guillain-Barré syndrome can be a first manifestation of chronic inflammatory demyelinating polyneuropathy, which typically worsens over 2 months” and “[i]n severe GBS, a neurointensivist will have to differentiate veritable dysautonomia from early sepsis, pulmonary embolus, aspiration pneumonia, opioid overuse, and other guises including urethra obstruction.” However, “[v]ery few disorders mimic GBS because their symptoms do not ascend, are not rapid, and are not postinfectious.”
Answer Key:
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Chitnis, D. (2016, October 6). Further evidence links Zika, Guillain-Barré syndrome. Retrieved July 13, 2017, from http://www.mdedge.com/clinicalneurologynews/article/115123/emerging-infections/further-evidence-links-zika-guillain-barre?utm_source=News_CNN_sf-guillain-barre-syndrome_071117&utm_medium=email&utm_content=Special Edition%3A Guillain-Barr%C3%A9 Syndrome
Wijdicks EFM, Klein CJ. Guillain-Barré syndrome. Mayo Clin Proc. 2017;92(3):467-479.
