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1.
Nat Rev Neurol ; 15(11): 671-683, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31541214

RESUMO

Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diagnostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.


Assuntos
Gerenciamento Clínico , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/terapia , Variação Genética/genética , Síndrome de Guillain-Barré/epidemiologia , Humanos , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/terapia
2.
PLoS Negl Trop Dis ; 13(8): e0007622, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31449532

RESUMO

BACKGROUND: A severe neurological disorder, Guillain-Barré syndrome (GBS) is the leading cause of acute flaccid paralysis. Enhanced surveillance of GBS in Latin America and the Caribbean (LAC) following the 2015-2016 Zika virus (ZIKV) epidemic presents an opportunity to estimate, for the first time, the regional incidence of GBS. METHODS AND FINDINGS: For this systematic review and meta-analysis, we searched nine scientific databases and grey literature from January 1, 1980 to October 1, 2018. Sources with primary data on incident GBS cases in LAC within a well-defined population and timeframe, published in English, Spanish, Portuguese, or French, were included. We calculated the annual GBS incidence rates (IRs) and 95% confidence intervals (CIs) for each source based on published data. Following an assessment of heterogeneity, we used random-effects meta-analysis to calculate the pooled annual IR of GBS. The study is registered with PROSPERO, number CRD42018086659. Of the 6568 initial citation hits, 31 were eligible for inclusion. Background annual GBS IRs in Latin America ranged from 0.40 in Brazil to 2.12/100,000 in Chile. The pooled annual IR in the Caribbean was 1.64 (95% CI 1.29-2.12, I2<0.01, p = 0.44). During the ZIKV epidemic, GBS IRs ranged from 0.62 in Mexico to 9.35/100,000 in Martinique. GBS increased 2.6 (95% CI 2.3-2.9) times during ZIKV and 1.9 (95% CI 1.1-3.4) times during chikungunya outbreaks over background rates. A limitation of this review is that the studies included employed different methodologies to find and ascertain cases of GBS, which could contribute to IR heterogeneity. In addition, it is important to consider that data on GBS are lacking for many countries in the region. CONCLUSIONS: Background IRs of GBS appear to peak during arboviral disease outbreaks. The current review contributes to an understanding of the epidemiology of GBS in the LAC region, which can inform healthcare system planning and preparedness, particularly during arboviral epidemics. TRIAL REGISTRATION: Registered with PROSPERO: CRD42018086659.


Assuntos
Síndrome de Guillain-Barré/epidemiologia , Infecção por Zika virus/epidemiologia , Região do Caribe/epidemiologia , Febre de Chikungunya/epidemiologia , Bases de Dados Factuais , Epidemias , Feminino , Humanos , Incidência , América Latina/epidemiologia , Masculino , Martinica/epidemiologia , Zika virus
3.
J Assoc Physicians India ; 67(4): 56-59, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31309800

RESUMO

Objectives: To study clinical characteristics of various forms of Guillain-Barre syndrome in Indian adults. Material and Methods: The epidemiological, clinical, cerebrospinal fluid and electrophysiological data of 65 patients of Guillain-Barre syndrome (GBS) were reviewed in a retrospective study. Results: Analysis of age distribution disclosed a high incidence (36.92%) in young adults between 18 to 29 years of age. Seasonal preponderance in winter and summer was found. Preceding events were identified in 22 (33.84%) cases. Motor weakness, areflexia, and facial weakness were the most common clinical features. Cerebrospinal fluid albuminocytological dissociation was present in 80% of patients. Utilising clinical and electrophysiological data, these 65 patients with Guillain-Barre syndrome were subclassified as acute demyelinating polyradiculoneuropathy 17 (26.15%), axonal form 17 (26.15%), Fisher's syndrome 2 (3.07%)and ataxic variant 1(1.53). The remaining 28 (43.07%) patients were unclassified. 9(13.8%) patients had recurrent GBS. Only 5 (7.7%) patients required mechanical ventilation. Follow up available on 47 patients disclosed that all of them recovered satisfactorily. No patient was persistently disabled and no mortality occurred during hospitalization. Conclusions: GBS in Indian population from northwest India showed peculiar age, seasonal distribution and high frequency of both AIDP and axonal subtypes. Both, axonal and demyelinating subtypes shared common clinical features and had good prognosis.


Assuntos
Síndrome de Guillain-Barré/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Humanos , Incidência , Índia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
4.
Neurology ; 93(1): e59-e76, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31175208

RESUMO

OBJECTIVE: To define the current treatment practice of Guillain-Barré syndrome (GBS). METHODS: The study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account. RESULTS: We excluded 88 (7%) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15%) were described separately because 83% were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92%) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97%), mild GBS (126/168, 75%), Miller Fisher syndrome (53/70, 76%), and other variants (33/40, 83%). Of 235 (32%) patients who did not improve after their initial treatment, 82 (35%) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5%) of 1,023 patients, of whom 36 (68%) were re-treated with IVIg or PE. CONCLUSIONS: In current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations.


Assuntos
Síndrome de Guillain-Barré/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Síndrome de Guillain-Barré/epidemiologia , Humanos , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
5.
World Neurosurg ; 128: 347-353, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31059858

RESUMO

BACKGROUND: Guillain-Barré syndrome (GBS) is an uncommon, yet life-threatening postoperative neuropathic complication that is easily neglected, and hence, timely treatment is not provided in the clinics. This review aims to summarize the clinical features of postoperative GBS, and thus, improve the understanding of postoperative GBS. METHODS: We reviewed the literature on postoperative GBS and assessed the demographic information, clinical manifestation, operation, time of onset of postoperative GBS, and prognosis. RESULTS: A total of 33 cases of postoperative GBS were included in this study. The average age of patients with postoperative GBS was 46.9 years, and there was a peak in occurrence of GBS between ages 50 and 70 years. Men seemed more likely to have postoperative GBS than did women, with a ratio of 2.67:1. Progressive muscular weakness, present in 31 of the cases, was the most common presentation. Patients with spinal surgery were at further increased risk for GBS, and 84.8% of the patients with GBS had a good prognosis after prompt treatment. CONCLUSIONS: Surgery is probably a potential risk factor for the occurrence of GBS. Early diagnosis and prompt treatment are imperative to reduce mortality.


Assuntos
Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/terapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/epidemiologia , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia
6.
Mymensingh Med J ; 28(2): 449-455, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31086165

RESUMO

Guillain-Barre syndrome (GBS) is related with significant morbidity and also mortality. Little is known about the long term outcome of GBS patients who survived. The objective of this study is to determine the lasting outcome and consequences of GBS patients. This is a cross-sectional study of patients who diagnosed GBS and managed at the Intensive Care Unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2004 to December 2017. All survived patients were invited for a structured interview, questionnaires, and full neurologic exam to record their current clinical condition focused on complaints and symptoms, neurological deficits, disabilities, behaviour, and quality of life. Thirty-eight patients participated, with a median age of 20 years (range 4-39 years) and a median interviewed time of 7 years (range 1-13 years). Residual complaints were reported by 24(63%) patients, including paresthesias (10.5%), unsteadiness of gait (37%), painful hands or feet (29%), and severe fatigue (13%). Questionnaires identified a wide range of behavioural problems. Most Patients showed good recovery of neurological deficits after GBS, but many have persisting long-term residual complaints and symptoms that may lead to psychosocial problems interfering with participation in daily life.


Assuntos
Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/psicologia , Qualidade de Vida/psicologia , Adolescente , Adulto , Bangladesh/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Fadiga/epidemiologia , Síndrome de Guillain-Barré/epidemiologia , Humanos , Unidades de Terapia Intensiva , Parestesia/epidemiologia , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
7.
Rev Peru Med Exp Salud Publica ; 36(1): 10-16, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31116321

RESUMO

OBJECTIVE: To describe the epidemiological behavior of Guillain-Barré syndrome (GBS) in Peru. MATERIALS AND METHODS: Descriptive study of secondary data on the Ministry of Health (MINSA) hospital discharges during the period 2012-2017; EsSalud and SuSalud hospital discharges between 2015 and 2017; and national mortality data between 2014-2016. The identification of GBS in the databases was carried out using the International Classification of Diseases, 10th version, by means of code G610. Incidence, fatality rate, and mortality were estimated by age, sex, and department group. RESULTS: A total of 955 cases of GBS were identified in the database of MINSA hospital discharges between 2012 and 2017, with a higher frequency in men, within the 20 to 59-year old population. The national incidence of GBS per 100,000 inhabitants was 0.62 (2015), 0.92 (2016), and 0.91 (2017), being higher in older adults and in men. The overall case fatality rate was 3.5%, and was highest in those over 60. The average length of hospitalization was 16 ± 22 days. In addition, Lima is the department that accounted for more than 40% of all GBS cases; and Cusco, Lima, Callao, Lambayeque, and Arequipa had the highest incidence. CONCLUSIONS: This study provides relevant information to better understand the epidemiological behavior of GBS in Peru, and thus ensure adequate patient care nationally.


Assuntos
Síndrome de Guillain-Barré/epidemiologia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Adulto Jovem
8.
J Infect Public Health ; 12(5): 714-719, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30992227

RESUMO

BACKGROUND: Effective acute flaccid paralysis (AFP) surveillance is crucial in countries approaching the final phase of polio eradication. Thus this study was conducted to highlight the epidemiological pattern of AFP as a surveillance tool for polio in Egypt. METHODS: A record-based descriptive study was conducted to include all AFP cases (599) reported in the last 9 years starting from January 2009 to December 2017 in Dakahlia, North East of Delta, Egypt. RESULTS: The overall non-polio AFP rate in less than 15 years old children was 2.99/100,000 during the study period. The majority of cases (98%) were notified within 7 days from onset of the disease, and investigated within 48 h of reporting. The commonest diagnoses were encephalitis (21.3%), myositis (20.2%), neuropathies (19.2%) and Guillain-Barre syndrome (17.8%) with no recorded cases diagnosed as poliomyelitis. The mean annual vaccination coverage rate was 96.1 ± 1.6. CONCLUSIONS: AFP surveillance system in Dakahlia, Egypt was effective in meeting the WHO surveillance performance indicators ensuring polio-free status and absence of wild polio virus transmission over the last 9 years in this locality. High routine immunization coverage, maintenance and improvement of current levels of surveillance performance are required for optimum surveillance.


Assuntos
Paralisia/epidemiologia , Paralisia/virologia , Poliomielite/complicações , Poliomielite/epidemiologia , Adolescente , Criança , Pré-Escolar , Coleta de Dados , Egito/epidemiologia , Fezes/virologia , Feminino , Síndrome de Guillain-Barré/epidemiologia , Síndrome de Guillain-Barré/virologia , Humanos , Lactente , Masculino , Vacinas contra Poliovirus/administração & dosagem , Vigilância em Saúde Pública , Pesquisa Qualitativa , Estudos Retrospectivos , Cobertura Vacinal
9.
Acta Neurol Scand ; 139(6): 546-554, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30929269

RESUMO

OBJECTIVE: We report a prospective study analysing clinical characteristics, subtyping and prognosis in Guillain-Barré syndrome (GBS). METHOD: The study was based on consecutive GBS patients admitted between 2009 and 2017. Disability was serially assessed using the GBS disability scale. RESULTS: Fifty-six GBS patients were identified with an average age of 55 years (range, 5-86 years) and a male/female ratio of 2.1. The interval to nadir was <7 days in 59% of cases, and 7 to 28 days in the remainder; at nadir, 35.5% of patients were able to walk unaided, and 64.5% did not. Mechanical ventilation was needed in 20% of cases. There were two fatal cases. Clinical variants included paraparetic GBS seven cases, Miller Fisher syndrome one case, and acute sensory ataxic neuropathy (ASAN) one case. Serial electrophysiology showed a demyelinating pattern in 62.5% of cases, axonal in 28.5%, inexcitable in 1.8%, equivocal in 1.8%, and normal in 5.4%. Very early (1 to 4 days after onset) electrophysiology was done in 18 patients; equivocal or normal features in six of them evolved into an axonal pattern in four. Reversible conduction failure of sensitive nerves occurred in ASAN. Antiganglioside antibodies were only detected in axonal GBS. At 24-month follow-up, functional outcome did not differ between demyelinating and axonal GBS. Clinico-pathological correlation in an early fatal case is reported. CONCLUSIONS: This GBS study demonstrates comparable clinical features to previous investigations from well-defined populations. There was a relatively high prevalence of axonal GBS. We provide new pathophysiological insights on nerve conduction alterations.


Assuntos
Síndrome de Guillain-Barré/epidemiologia , Síndrome de Guillain-Barré/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha/epidemiologia , Adulto Jovem
10.
J Neurol ; 266(7): 1655-1662, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30955122

RESUMO

The clinical features of Guillain-Barré syndrome (GBS) are highly variable, according to the type of antecedent infection. Although a major GBS phenotype, Fisher syndrome (FS), has been shown to be preceded by infections similar to those preceding GBS, whether or not the clinical features in FS also vary according to antecedent infection remains unclarified. Frequent antecedent infections among this study of 70 FS patients included Haemophilus influenzae [n = 15 (21%)], Campylobacter jejuni [n = 10 (14%)], and cytomegalovirus (CMV) [n = 6 (8.6%)]. Compared with other FS patients, H. influenzae-seropositive FS patients more frequently had a history of prior upper respiratory tract infection; double vision as the initial symptom; and, except for oculomotor disturbance, more rarely showed cranial nerve involvement. C. jejuni-related FS occurred predominantly in younger male patients and characteristically presented with blurred vision. According to GBS disability scale, CMV-related FS tended to be more severe, although every patient received immunotherapy. Serum anti-GQ1b IgG antibodies were detected in most cases, regardless of antecedent infection type. At the nadir of illness, the most frequent diagnosis in H. influenzae-related cases was "pure FS" without limb weakness or central nervous system involvement (71%), in C. jejuni-related cases "incomplete FS" such as acute ophthalmoparesis with or without ataxia (60%), and in CMV-related cases (50%) advanced conditions such as GBS overlap and Bickerstaff brainstem encephalitis. These findings indicate that the type of preceding infection determined the neurological features of FS. CMV-related FS appeared to be similar to H. influenzae- and C. jejuni-related FS regarding anti-GQ1b antibody-mediated pathogenesis, as opposed to CMV-related GBS.


Assuntos
Infecções por Campylobacter/diagnóstico , Infecções por Citomegalovirus/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Infecções por Haemophilus/diagnóstico , Síndrome de Miller Fisher/diagnóstico , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Infecções por Campylobacter/sangue , Infecções por Campylobacter/epidemiologia , Criança , Pré-Escolar , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/epidemiologia , Feminino , Síndrome de Guillain-Barré/sangue , Síndrome de Guillain-Barré/epidemiologia , Infecções por Haemophilus/sangue , Infecções por Haemophilus/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Miller Fisher/sangue , Síndrome de Miller Fisher/epidemiologia , Estudos Retrospectivos , Adulto Jovem
12.
Neurol Sci ; 40(5): 1015-1018, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30762168

RESUMO

BACKGROUND AND OBJECTIVE: In previous studies, data deriving from Google Trends showed promising correlation with disease incidence trends assessed with public health control systems. The aim of this work is to use search engine query data to investigate seasonal dynamics in Guillain-Barré syndrome (GBS) in the USA. METHODS: Average Google monthly search volumes for GBS from 2008 to 2017 were analysed for the USA overall and on regional base with generalized estimating equation models. Association with monthly historical temperature variations was tested. RESULTS: Monthly search volume for GBS displayed the greatest positive anomaly for October, clustering with September and November. Region-wide analysis confirmed this pattern and showed secondary spring (Feb/Apr) subpeaks in Pacific and Midwest. Association of GBS search volume with month-to-month temperature variations showed J-shaped relationship, with the highest peak occurring in months with greatest temperature falls, and subpeak in months with sharpest temperature rises. CONCLUSIONS: This study represents the first approach in investigating digital epidemiology of GBS and establishing possible links with traditional epidemiology. Cold season GBS peak has been observed by some traditional studies; hypothetical pathogenic relationship with infectious antecedents is supported from finding GBS peaks clustering with greatest temperature change. Further studies are needed to compare these findings to traditional public health approaches.


Assuntos
Síndrome de Guillain-Barré/epidemiologia , Ferramenta de Busca , Estações do Ano , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Retrospectivos , Temperatura Ambiente , Estados Unidos
13.
FEMS Microbiol Lett ; 366(5)2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30759205

RESUMO

Zika virus (Zikv) infection implies a significant public health issue due to the different syndromes associated. It is related to several central nervous system problems, such as microcephaly and Guillain-Barre Syndrome. In this way, the first document about the relation of Guillain-Barre Syndrome and Zika indexed in Web of Science was published in 2014. Therefore, the primary goal of the present study is to analyze the leading scientific producers, the relative specialization of the countries and the collaboration network in the research area. A total of 384 manuscripts were identified. Two manuscripts were published in 2014 and 2015; the remaining documents are distributed during 2016 (136), 2017 (186) and 2018 (59) (until April). In conclusion, Zikv and Guillain-Barre Syndrome research has experienced a significant increase in the last years. This may be related to the topic is an important issue of public health concern in the countries affected by Zikv outbreaks. In that sense, Brazil, India and Colombia make a great effort, considering their economic and social resources, in research. However, this study implies a preliminary overview of the research on this topic, a more extended period is needed to define the lines of research and collaboration between countries and authors.


Assuntos
Bibliometria , Síndrome de Guillain-Barré/epidemiologia , Infecção por Zika virus/epidemiologia , Zika virus/isolamento & purificação , Brasil/epidemiologia , Colômbia/epidemiologia , Humanos , Índia/epidemiologia , Cooperação Internacional , Saúde Pública
14.
Neurol Sci ; 40(3): 603-609, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30617450

RESUMO

BACKGROUND: Guillain-Barré syndrome (GBS) is an acute/subacute autoimmune inflammatory polyradiculoneuropathy. Previous epidemiological studies carried out in the province of Ferrara, Italy, from 1981 to 2002 indicated that GBS incidence had tendency of increase in the period considered. OBJECTIVES: We aimed at updating the epidemiology of GBS in the years 2003-2017 and carrying on the work started in the 1980s. METHODS: We conducted an incidence study, by adopting a complete enumeration approach. Cases were identified from administrative, medical records, and database of the Ferrara Hospital and other provincial structures of the study area. Case ascertainment and definition are analogous to those adopted in previous surveys. RESULTS: In the period 1 January 2003 to 31 December 2017, 73 patients living in the province of Ferrara (mean population 353,142) were found to be new cases of GBS fulfilling the NINCDS criteria. Male/female ratio 1.15. The mean incidence rate was 1.38 per 100,000 (95% CI 1.08-1.74), 1.54 per 100,000 for men and 1.23 per 100,000 for women, a nonsignificant difference. During the period considered, the rates had slow increase or mild decrease, without nonsignificant difference. The highest rates were observed for the age groups 70-79 years for both sexes. A half of patients reported infectious events in the weeks before the onset of symptoms. CONCLUSION: In line with many epidemiological data, in the whole period 2003-2017, we observed a trend towards increase or decrease in incidence and periods of relative stability. Similar temporal heterogeneity with the comparison to our previous works was found.


Assuntos
Síndrome de Guillain-Barré/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto Jovem
16.
J Neurol ; 266(2): 440-449, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30536111

RESUMO

OBJECTIVES: To describe the epidemiology and clinical heterogeneity of Guillain-Barré syndrome (GBS) in Denmark and to compare a population-based cohort to prospectively included patients in the International GBS Outcome Study (IGOS). METHODS: The incidence rate (IR) of GBS in Denmark from September 2012 to December 2015, applying the National Institute of Neurological Disorders and Stroke (NINDS) diagnostic criteria, was estimated and the level of diagnostic certainty was described with the Brighton criteria. All cases registered with a diagnosis of GBS or other inflammatory neuropathies in the Danish National Hospital Registry were reviewed for diagnostic criteria and for information on treatment and clinical course. RESULTS: A total of 299 GBS cases were confirmed, corresponding to a crude IR of 1.59 (95% CI 1.42-1.78) per 100,000 per year. The Brighton criteria level 1-3 of diagnostic certainty was met in 279 (93%) of the patients. Thirty-five percent of the patients were mildly affected (GBS disability score < 3) and a correlation between high age and high disability score at nadir was found (Spearman's rank correlation coefficient 0.42, p < 0.0001). The group of 89 (30%) patients who were enrolled in IGOS had higher GBS disability score at nadir, were admitted 5 days earlier, reached nadir 4 days faster, and a larger proportion received treatment with IVIg (all p < 0.05). CONCLUSION: The epidemiology and full clinical spectrum of GBS are described in a population-based study. This includes a larger proportion of milder cases that are underrepresented in prospective cohorts such as IGOS.


Assuntos
Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/epidemiologia , Síndrome de Guillain-Barré/fisiopatologia , Índice de Gravidade de Doença , Adulto , Idoso , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Pessoa de Meia-Idade
17.
Eur J Paediatr Neurol ; 23(1): 43-52, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30502045

RESUMO

Bickerstaff Brainstem Encephalitis (BBE) is a rare autoimmune encephalitis, characterized by acute ophthalmoplegia, ataxia and altered state of consciousness. Together with Guillan-Barrè Syndrome (GBS) and Miller-Fisher Syndrome, it forms a spectrum of post-infectious demyelinating diseases. Overlapping forms between BBE and GBS (BBE/GBS) are described in patients with lower limbs weakness and typical signs of BBE, suggesting a combined involvement of Central and Peripheral Nervous System (PNS), but only few reported cases are focused on pediatric population. We reviewed all cases of pediatric BBE in the literature, to determine if any patient showed features suggestive for BBE/GBS. Data analysis focused on the diagnostic tests performed (e.g. anti-GQ1b antibodies), neuroimaging and nerve conduction studies (NCS). Further attention was given to the therapeutic management and to patients' outcome. We additionally present two previously unreported pediatric cases. Our review retrieved 19 cases of BBE/GBS, only 2 of which were originally and correctly diagnosed by the authors. The prevalence was higher in male subjects (ratio 3:1) and median age at diagnosis was 8 years. Anti-GQ1b were positive in 46% of the patients, while NCS were altered in 64%. Only 25% of the patients that underwent brain MRI showed abnormal findings. The incidence of BBE/GBS has been underrated in the past, mostly due to an underestimation of the PNS involvement. We therefore suggest to investigate all patients with a clinical picture suggestive of BBE/GBS through electroencephalogram, NCS, brain and spine MRI in order to promptly achieve the correct diagnosis.


Assuntos
Encefalite/diagnóstico , Encefalite/epidemiologia , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/epidemiologia , Tronco Encefálico/patologia , Criança , Eletroencefalografia , Encefalite/patologia , Feminino , Síndrome de Guillain-Barré/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Neuroimagem , Exame Neurológico , Prevalência
18.
Transpl Infect Dis ; 21(1): e13021, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30403433

RESUMO

BACKGROUND: Guillain-Barré syndrome (GBS) is a common ascending polyneuropathy in adults. It is often associated with preceding viral or diarrhoeal illness with cytomegalovirus (CMV), Epstein-Barr virus (EBV), or Campylobacter jejuni. Solid organ transplant recipients are more susceptible to opportunistic infections with CMV than the general population as a result of immunosuppressive therapies to prevent graft rejection. However, reports of GBS are rare in this population. OBJECTIVE: To systematically review cases of GBS in renal transplant patients to evaluate causative pathogens or triggers, management and associated morbidity and mortality. METHODS AND RESULTS: We conducted a systematic search of the MEDLINE database uncovering 17 cases of GBS in renal transplant patients in the literature. The majority of cases were in males (81%) and patients who received deceased donor renal transplants (87%). The mean age was 44.7 years (SD 13). The time between transplant and onset of symptoms ranged from 2 days to 10 years (Mean = 720 days). GBS was commonly associated with antecedent viral (CMV 12; EBV 1) or diarrhoeal (2) illness while two cases were attributed to calcineurin inhibitor use. All patients recovered fully or partially after treatment with anti-viral or anti-bacterial agents, immunoglobulins, and/or plasma exchange. CONCLUSION: Cytomegalovirus is the most common trigger for GBS in the post-renal transplant setting. Other triggers include campylobacter jejuni and calcineurin inhibitors. GBS should be considered in transplant patients presenting with weakness or paralysis in order to institute timely management.


Assuntos
Infecções por Campylobacter/epidemiologia , Infecções por Citomegalovirus/epidemiologia , Diarreia/epidemiologia , Infecções por Vírus Epstein-Barr/epidemiologia , Síndrome de Guillain-Barré/epidemiologia , Transplante de Rim/efeitos adversos , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Inibidores de Calcineurina/efeitos adversos , Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/microbiologia , Campylobacter jejuni/isolamento & purificação , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/virologia , Diarreia/tratamento farmacológico , Diarreia/microbiologia , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Infecções por Vírus Epstein-Barr/virologia , Síndrome de Guillain-Barré/tratamento farmacológico , Síndrome de Guillain-Barré/etiologia , Herpesvirus Humano 4/isolamento & purificação , Humanos , Incidência , Resultado do Tratamento
19.
Trop Med Int Health ; 24(2): 132-142, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30444562

RESUMO

OBJECTIVE: The objective of this study was to describe the factors associated with the development of Guillain-Barré syndrome, both infectious and non-infectious, during and after the A(H1N1) influenza pandemic in 2009 and the recent Zika virus epidemic in the Americas. METHOD: Systematic review of literature on factors associated with the development of the Guillain-Barré syndrome published between 2007 and 2017 listed in EBSCO, MEDLINE and LILACS databases. The quality of the studies was evaluated using the Newcastle Ottawa Scale. RESULTS: Thirty-four articles met inclusion criteria and were selected for analysis. Their quality was considered good in relation to most of the items evaluated. Many aetiological agents had the results of association with Guillain-Barré syndrome, among them Campylobacter jejuni, influenza vaccine - both pandemic and seasonal vaccines, respiratory infection, gastrointestinal infection among others. The aetiological agents found are, in most part, the same reported prior to the study period. The association with surgeries, chikungunya virus (CHIKV), Zika virus and quadrivalent human papillomavirus vaccine stand out as new aetiological agents in the list of the various possible agents that trigger Guillain-Barré syndrome reported in the study period. There were no Brazilian studies identified during this period. CONCLUSIONS: The results of the review reaffirmed C. jejuni as the major trigger of GBS, whereas the association of influenza vaccines and GBS is less clear; Zika virus infection in association with GBS was found in only one study.


Assuntos
Infecções por Campylobacter/epidemiologia , Síndrome de Guillain-Barré/etiologia , Infecção por Zika virus/epidemiologia , Infecções por Campylobacter/complicações , Campylobacter jejuni , Síndrome de Guillain-Barré/epidemiologia , Humanos , Influenza Humana/epidemiologia , Infecção por Zika virus/complicações
20.
P R Health Sci J ; 37(Spec Issue): S85-S92, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30576584

RESUMO

OBJECTIVE: Guillain-Barré syndrome (GBS) is an uncommon autoimmune disorder that follows infection or vaccination, and increased incidence has been reported during Zika virus (ZIKV) transmission. During the 2016 ZIKV epidemic, the Puerto Rico Department of Health (PRDH) implemented the Enhanced GBS Surveillance System (EGBSSS). Here, we describe EGBSSS implementation and evaluate completeness, validity, and timeliness. METHODS: GBS cases were identified using passive surveillance and discharge diagnostic code for GBS. Completeness was evaluated by capture-recapture methods. Sensitivity and positive predictive value (PPV) for confirmed GBS cases were calculated for both case identification methods. Median time to completion of key time steps were compared by quarter (Q1-4) and hospital size. RESULTS: A total of 122 confirmed GBS cases with onset of neurologic illness in 2016 were identified. Capture-recapture methodology estimated that four confirmed GBS cases were missed by both identification methods. Identification of cases by diagnostic code had a higher sensitivity than passive surveillance (89% vs. 80%), but a lower PPV (60% vs. 72%). There was a significant decrease from Q1 to Q3 in median time from hospital admission to case reporting (11 days vs. 2 days, p = 0.032) and from Q2 to Q3 in median time from specimen receipt to arbovirus laboratory test reporting (35 days vs. 26 days, p = 0.004). CONCLUSION: EGBSSS provided complete, valid, and increasingly timely surveillance data, which guided public health action and supported healthcare providers during the ZIKV epidemic. This evaluation provides programmatic lessons for GBS surveillance and emergency response surveillance.


Assuntos
Síndrome de Guillain-Barré/epidemiologia , Vigilância da População/métodos , Saúde Pública , Infecção por Zika virus/epidemiologia , Epidemias , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/virologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Valor Preditivo dos Testes , Porto Rico/epidemiologia , Sensibilidade e Especificidade , Fatores de Tempo
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