It has now been linked to Guillian-Barre synd. Got DEET?
Richard T. Ellison III, MD Reviewing Frontera JA and da Silva IRF., N Engl J Med 2016 Oct 5;
Epidemiologic and virologic evidence in Colombia links Zika infection to GBS cases with distinct clinical features.
Concern that the Zika virus could cause Guillain-Barré syndrome (GBS) first arose during the 2013–2014 outbreak in French Polynesia (NEJM JW Infect Dis Apr 2016 and Lancet2016; 387:1531). An increased incidence of GBS following the emergence of Zika virus disease (ZVD) has been reported in multiple countries in the Americas. Researchers now report a more comprehensive investigation of this apparent link.
Epidemiologic surveillance identified 2603 laboratory-confirmed and about 58,790 suspected ZVD cases in Colombia between October 2015 and March 2016, during which time the estimated incidence of GBS increased from 20 to 90 cases per month. Detailed studies on 68 patients with strong evidence of GBS showed that 66 had symptoms of ZVD within 4 weeks before GBS onset; median time between ZVD symptom onset and GBS onset was 7 days. Limb weakness was present in 97%, with an ascending pattern in 82%. Cranial nerve palsies were common; 50% had bilateral facial palsy. Nerve conduction studies performed in 46 patients showed an acute inflammatory demyelinating polyneuropathy pattern in 36 (78%). Among 42 tested for Zika by polymerase chain reaction analysis, 17 (40%) were positive, and in 32 of 37 with serologic testing, the results supported recent flavivirus infection. In the subset of GBS patients tested for Zika, 20 (48%) had a parainfectious onset of GBS and the others had a postinfectious onset.
Comment
This report strengthens the evidence that the Zika virus can cause GBS, although frequently not in the typical postinfectious temporal sequence seen with other pathogens associated with GBS. As the authors note, this temporal pattern may relate to characteristics of ZVD or, alternatively, given the presence of dengue virus in Colombia, to ZVD superimposed on a prior history of dengue virus infection.
Richard T. Ellison III, MD Reviewing Frontera JA and da Silva IRF., N Engl J Med 2016 Oct 5;
Epidemiologic and virologic evidence in Colombia links Zika infection to GBS cases with distinct clinical features.
Concern that the Zika virus could cause Guillain-Barré syndrome (GBS) first arose during the 2013–2014 outbreak in French Polynesia (NEJM JW Infect Dis Apr 2016 and Lancet2016; 387:1531). An increased incidence of GBS following the emergence of Zika virus disease (ZVD) has been reported in multiple countries in the Americas. Researchers now report a more comprehensive investigation of this apparent link.
Epidemiologic surveillance identified 2603 laboratory-confirmed and about 58,790 suspected ZVD cases in Colombia between October 2015 and March 2016, during which time the estimated incidence of GBS increased from 20 to 90 cases per month. Detailed studies on 68 patients with strong evidence of GBS showed that 66 had symptoms of ZVD within 4 weeks before GBS onset; median time between ZVD symptom onset and GBS onset was 7 days. Limb weakness was present in 97%, with an ascending pattern in 82%. Cranial nerve palsies were common; 50% had bilateral facial palsy. Nerve conduction studies performed in 46 patients showed an acute inflammatory demyelinating polyneuropathy pattern in 36 (78%). Among 42 tested for Zika by polymerase chain reaction analysis, 17 (40%) were positive, and in 32 of 37 with serologic testing, the results supported recent flavivirus infection. In the subset of GBS patients tested for Zika, 20 (48%) had a parainfectious onset of GBS and the others had a postinfectious onset.
Comment
This report strengthens the evidence that the Zika virus can cause GBS, although frequently not in the typical postinfectious temporal sequence seen with other pathogens associated with GBS. As the authors note, this temporal pattern may relate to characteristics of ZVD or, alternatively, given the presence of dengue virus in Colombia, to ZVD superimposed on a prior history of dengue virus infection.
- Parra B et al. Guillain–Barré Syndrome Associated with Zika Virus Infection in Colombia. N Engl J Med2016 Oct 5; [e-pub]. (http://dx.doi.org/10.1056/NEJMoa1605564)
- Frontera JA and da Silva IRF.Zika Getting on Your Nerves? The Association with the Guillain–Barré Syndrome. N Engl J Med 2016 Oct 5; [e-pub]. (http://dx.doi.org/10.1056/NEJMe1611840)
I don't have an anger problem, I have an idiot problem.
