Síndrome de Guillain-Barré asociado a zika; análisis de la cohorte delegacional en la región Veracruz norte durante 2016-2017 / Guillain-Barré syndrome associated with Zika virus infection: Analysis of a cohort from the region of northern Veracruz in 2016-2017

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Incidencia de síndrome de Guillain-Barré durante la oleada de zika del 2016 en un hospital de segundo nivel / Incidence of Guillain-Barré syndrome at a secondary centre during the 2016 zika outbreak

INTRODUCCIÓN: El síndrome de Guillain-Barré es poco frecuente, sin embargo, durante la oleada de zika en América se vio un marcado incremento en la incidencia del síndrome, sin poder denotarse una relación causal directa en todos los casos. MÉTODOS: Se revisaron los casos de enfermedad febril exantemática y parálisis flácida aguda durante el periodo del 1 de agosto a 15 de diciembre del 2016, realizando caracterización clínica y bioquímica de cada caso para ser incluidos como síndrome de Guillain-Barré asociado a zika. RESULTADOS: Durante el periodo comentado, se encontró una cohorte de 8 pacientes, 6 hombres y 2 mujeres, grupo etario más afectado: 50-59 años. La mayor incidencia fue en el mes de septiembre, con 7 casos. Los síntomas más frecuentes fueron exantema y conjuntivitis, seguidos de fiebre. La presentación más común fue parálisis simétrica ascendente con 7 casos. La afectación de pares craneales más frecuente fue la del VII par craneal. Solo 2 pacientes presentaron disociación albumino-citológica. Todos presentaron PCR-RT negativa a zika. Todos recibieron inmunoglobulina por vía intravenosa y todos tuvieron buen pronóstico. Ninguno ameritó ventilación mecánica. No se registraron defunciones. La tasa de incidencia acumulada es del 3,9%, la incidencia de casos/mes fue de 0,04 casos/mes a 2 casos/mes. CONCLUSIONES: Existe un incremento en los casos de Guillain-Barré durante la oleada de zika, con un incremento en la incidencia y el número de casos/mes; sin embargo, no se pudo demostrar relación causal directa entre estas 2 entidades

INTRODUCTION: Although Guillain-Barré syndrome is rare, a marked increase in incidence was observed during the 2016 Zika outbreak in the Americas, with no direct causal relationship being apparent in all cases. METHODS: Cases of febrile exanthematous disease and acute flaccid paralysis were reviewed during the period from 1 August to 15 December, 2016; clinical and biochemical assessment was performed for each case to identify Zika-related Guillain-Barré syndrome. RESULTS: During the study period, we identified 8 patients (6 men and 2 women) with Zika-related Guillain-Barré syndrome, with the most affected age group being 50-59 years. The highest incidence was in the month of September, with 7 cases. The most frequent symptoms were rash and conjunctivitis, followed by fever. The most common presentation was symmetrical ascending paralysis, present in 7 cases. Cranial nerve VII was the most frequently involved nerve. Only 2 patients presented albuminocytologic dissociation. RT-PCR returned negative results for Zika virus in all patients. All patients received intravenous immunoglobulin and all had a good prognosis. None warranted mechanical ventilation. No deaths were recorded. The cumulative incidence rate was 3.9%, monthly incidence was between 0.04 and 2 cases/month. CONCLUSIONS: Cases of Guillain-Barré syndrome increased during the Zika outbreak, with an increase in incidence and number of cases per month; however, a direct causal relationship between the 2 conditions could not be demonstrated

Incidence of Guillain-Barré syndrome at a secondary centre during the 2016 zika outbreak. / Incidencia de síndrome de Guillain-Barré durante la oleada de zika del 2016 en un hospital de segundo nivel.

INTRODUCTION: Although Guillain-Barré syndrome is rare, a marked increase in incidence was observed during the 2016 Zika outbreak in the Americas, with no direct causal relationship being apparent in all cases. METHODS: Cases of febrile exanthematous disease and acute flaccid paralysis were reviewed during the period from 1 August to 15 December, 2016; clinical and biochemical assessment was performed for each case to identify Zika-related Guillain-Barré syndrome. RESULTS: During the study period, we identified 8 patients (6 men and 2 women) with Zika-related Guillain-Barré syndrome, with the most affected age group being 50-59 years. The highest incidence was in the month of September, with 7 cases. The most frequent symptoms were rash and conjunctivitis, followed by fever. The most common presentation was symmetrical ascending paralysis, present in 7 cases. Cranial nerve VII was the most frequently involved nerve. Only 2 patients presented albuminocytologic dissociation. RT-PCR returned negative results for Zika virus in all patients. All patients received intravenous immunoglobulin and all had a good prognosis. None warranted mechanical ventilation. No deaths were recorded. The cumulative incidence rate was 3.9%, monthly incidence was between 0.04 and 2 cases/month. CONCLUSIONS: Cases of Guillain-Barré syndrome increased during the Zika outbreak, with an increase in incidence and number of cases per month; however, a direct causal relationship between the 2 conditions could not be demonstrated.

[Guillain-Barre syndrome in times of arbovirosis. Reply]. / Sindrome de Guillain-Barre en tiempos de arbovirosis. Replica.

TITLE: Sindrome de Guillain-Barre en tiempos de arbovirosis. Replica.

[The most frequent causative agents of Guillain-Barre syndrome in a Mexican general hospital]. / Agentes causales mas frecuentes del sindrome de Guillain-Barre en un hospital de Veracruz, Mexico.

INTRODUCTION: After Zika virus outbreak and the increase in the incidence of Guillain-Barre syndrome (GBS), the causal relationship has been studied, however a full etiological correlation has not been found. PATIENTS AND METHODS: From January 1 to December 31, 2017, patients with GBS were included. In addition to the basic serologies, enterovirus, herpes, Campylobacter, hepatitis B and C, TORCH, HIV, Brucella and Salmonella were requested. RESULTS: Cohort of seven male patients. Five patients analyzed cerebrospinal fluid reporting normal; all of them underwent brain scan, reporting normal. Neuroconduction was performed, resulting in acute inflammatory demyelinating polyneuropathy in four cases and acute motor axonal neuropathy in one case. All received intravenous immunoglobulins, five cases had a good prognosis and two deaths. No positive cases were reported to Zika virus. A positive case was reported to dengue and another to chikungunya. Five positive cases were reported to Campylobacter. One case positive to enterovirus. Dengue + Campylobacter coinfections were reported in one case and chikungunya + Campylobacter in another case. CONCLUSIONS: The present cohort shows that it was not possible to establish a causal relationship between GBS and Zika virus, but other viral and bacterial causal agents were identified, such as dengue, chikungunya and enterovirus, with the identification of Campylobacter cases even more remarkable.

TITLE: Agentes causales mas frecuentes del sindrome de Guillain-Barre en un hospital de Veracruz, Mexico.Introduccion. Con posterioridad a la oleada del virus del Zika y el incremento en la incidencia de sindrome de Guillain-Barre (SGB), se ha estudiado la relacion causal, pero no se ha encontrado una plena correlacion etiologica. Pacientes y metodos. Del 1 de enero al 31 de diciembre de 2017, se incluyeron pacientes con SGB. Ademas de las serologias basicas, se solicitaron determinaciones de enterovirus, virus del herpes, Campylobacter, hepatitis B y C, TORCH, virus de la inmunodeficiencia humana, Brucella y Salmonella. Resultados. Cohorte de siete pacientes de sexo masculino. A cinco pacientes se les analizo el liquido cefalorraquideo, que era normal. A todos se les realizo una tomografia encefalica, tambien normal, y se realizo neuroconduccion, que mostro polineuropatia inflamatoria desmielinizante aguda en cuatro casos y neuropatia motora axonal aguda en uno. Todos recibieron inmunoglobulinas intravenosas; tuvieron buen pronostico cinco casos y hubo dos defunciones. No se informo de casos positivos al virus del Zika. Hubo un caso positivo al dengue, uno al chikungunya, cinco a Campylobacter y uno a enterovirus. Se informo de coinfecciones de dengue + Campylobacter en un caso y de chikungunya + Campylobacter en otro. Conclusiones. La presente cohorte demuestra que no fue posible establecer una relacion causal entre el SGB y el virus del Zika, pero se identificaron otros agentes causales viricos y bacterianos, como dengue, chikungunya y enterovirus, y fue aun mas destacable la identificacion de los casos de Campylobacter.