Dirlikov E, et al. - Researchers attempted to detect specific clinical features of Guillain-Barré syndrome (GBS) associated with Zika virus (ZIKV) infection in this analysis of public health surveillance data from 123 patients with GBS with and without evidence of Zika virus infection identified through public health surveillance in Puerto Rico. They observed that Zika virus–associated GBS had higher morbidity during acute-phase neuropathy and displayed more frequent cranial neuropathy during acute neuropathy and 6 months afterwards. The results obtained from the study indicate GBS pathophysiologic mechanisms that might be more common after ZIKV infection.

Methods

• Using prospective and retrospective strategies, researchers identified patients with GBS who had neurologic illness onset in 2016 and were hospitalized at all 57 nonspecialized hospitals and 2 rehabilitation centers in Puerto Rico during the ZIKV epidemic in Puerto Rico.
• Using the Brighton Collaboration criteria, GBS diagnosis was confirmed by medical record review.
• By real-time reverse transcriptase–polymerase chain reaction, specimens (serum, urine, cerebrospinal fluid, and saliva) from patients with GBS were tested for evidence of ZIKV infection.
In addition, serum and cerebrospinal fluid were tested by IgM enzyme-linked immunosorbent assay.
• An aggregate of 123 confirmed GBS cases were identified, of which 107 had specimens submitted for testing in this analysis of public health surveillance data and there were 71 patients with and 36 patients without evidence of ZIKV infection.
• Follow-up telephone interviews with subjects were conducted 6 months after neurologic illness onset; 60 patients with and 27 patients without evidence of ZIKV infection took an interest.
• Main outcomes measured were acute and long-term clinical characteristics of GBS associated with ZIKV infection.

Results

• As per data, of 123 patients with confirmed GBS, the median age was 54 years (age range, 4-88 years), and 68 patients (55.3%) were male.
• It was noted that the following clinical features were more frequent among patients with GBS and evidence of ZIKV infection vs patients with GBS without evidence of ZIKV infection: facial weakness (44 [62.0%] vs 10 [27.8%]; P < .001), dysphagia (38 [53.5%] vs 9 [25.0%]; P=.005), shortness of breath (33 [46.5%] vs 9 [25.0%]; P=.03), facial paresthesia (13 [18.3%] vs 1 [2.8%]; P=.03), elevated levels of protein in cerebrospinal fluid (49 [94.2%] vs 23 [71.9%]; P=.008), admission to the intensive care unit (47 [66.2%] vs 16 [44.4%]; P=.03), and required mechanical ventilation (22 [31.0%] vs 4 [11.1%]; P=.02).
• Patients with GBS and evidence of ZIKV infection more frequently reported having excessive or inadequate tearing (30 [53.6%] vs 6 [26.1%]; P=.03), difficulty drinking from a cup (10 [17.9%] vs 0; P=.03), and self-reported substantial pain (15 [27.3%] vs 1 [4.3%]; P=.03) six months after neurologic illness onset.