da Silva IRF, et al. - The target of this trial was to gauge the rates of acute Zika virus (ZIKV) infection among patients hospitalized with Guillain-Barre syndrome (GBS), meningoencephalitis, or transverse myelitis. A rise was noted in the incidence of a diverse spectrum of serious neurologic syndromes due to ZIKV infection. The serologic and molecular testing through the blood and cerebrospinal fluid samples appeared to be a less expensive, alternative diagnostic strategy in developing countries, where plaque reduction neutralization testing was discovered to be impractical.

Methods

• The plot of this trial was a prospective, observational cohort study.
• It was carried out at a tertiary referral center for neurological diseases in Rio de Janeiro, Brazil, between December 5, 2015, and May 10, 2016.
• It enrolled consecutive hospitalized adults (>18 years of age) with new-onset acute parainfectious or neuroinflammatory disease.
• They were examined for a series of arbovirosis. A scrutiny was performed of the three-month functional outcome.
• Samples of serum and cerebrospinal fluid were inspected for ZIKV through the real-time reverse-transcriptase–polymerase chain reaction and an IgM antibody-capture enzyme-linked immunosorbent assay.
• Data was cumulated with regard to the clinical, radiographic (magnetic resonance imaging), electrophysiological, and 3-month functional outcome findings.
• The detection of neurologic complications secondary to ZIKV infection served as the primary outcome.

Results

• This study constituted 40 patients (15 women and 25 men; median age, 44 years [range, 22-72 years]), including 29 patients (73%) with GBS (90% Brighton level 1 certainty), 7 (18%) with encephalitis, 3 (8%) with transverse myelitis, and 1 (3%) with newly diagnosed chronic inflammatory demyelinating polyneuropathy.
• 35 patients (88%) presented with molecular and/or serologic evidence of recent ZIKV infection in the serum and/or cerebrospinal fluid.
• Amongst the patients positive for ZIKV infection, 27 suffered from GBS (18 demyelinating, 8 axonal, and 1 Miller Fisher syndrome), 5 had encephalitis (3 with concomitant acute neuromuscular disease), 2 had transverse myelitis, and 1 had chronic inflammatory demyelinating polyneuropathy.
• 9 patients positive for ZIKV infection (26%) needed admission to the intensive care unit and 5 (14%) required mechanical ventilation.
• The admissions for GBS increased from a mean of 1.0 per month to 5.6 per month, admissions for encephalitis increased from 0.4 per month to 1.4 per month, and admissions for transverse myelitis remained constant at 0.6 per month, compared with admission during the period from December 5, 2013, to May 10, 2014 (before the Brazilian outbreak of ZIKV).
• It was disclosed that 2 patients positive for ZIKV infection (6%) died (1 with GBS and 1 with encephalitis), 18 (51%) had chronic pain, and the median modified Rankin score among survivors was 2 (range, 0-5), at 3 months.