MedicalResearch.com Interview with:
Dr. Emilio Dirlikov, PhD
Office of Epidemiology and Research, Puerto Rico Department of Health
Epidemic Intelligence Service
Division of Scientific Education and Professional Development
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: After reporting local Zika transmission in December 2015, the Puerto Rico Department of Health (PRDH), US Centers for Disease Control and Prevention (CDC), and University of Puerto Rico began identifying cases of Guillain-Barré syndrome (GBS), testing specimens, and conducting follow-up telephone interviews after patients left the hospital.
Through these efforts, we were able to characterize acute clinical features and long-term disability of GBS associated with Zika infection by analyzing data from GBS patients with and without evidence of Zika infection.
This investigation increases scientific and medical understanding of Guillain-Barré syndrome following Zika infection, provides insight into the disease processes involved in GBS following Zika infection, and adds to growing evidence of a causal association between Zika and GBS.
MedicalResearch.com: What should readers take away from your report?
Response: In this article, we contribute to better understanding Zika-associated Guillain-Barré syndrome in a number of key domains.
In terms of GBS epidemiology, during the 2016 Zika epidemic in Puerto Rico, the number of GBS patients increased above anticipated normal levels. Most of those GBS patients had evidence of Zika infection.
During the acute clinical phase, compared to Guillain-Barré syndrome patients without evidence of Zika infection, GBS patients with Zika infection were more likely to have muscle weakness, numbness, or tingling in the face; difficulty swallowing; shortness of breath; and elevated protein in cerebrospinal fluid. They were also more likely to be admitted to intensive care and require mechanical breathing assistance (ventilation).
Six months after illness onset, GBS patients with Zika infection were more likely to have excessive or inadequate tearing, difficulty drinking, and pain.
Finally, laboratory findings suggest that blood specimens are more useful for detecting Zika infection than urine and cerebrospinal fluid. Furthermore, laboratory findings indicate that viral persistence among GBS patients with evidence of Zika infection was similar to people infected with Zika who did not develop neurologic complications.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The results of this analysis point to several directions for future research.
First, future research should investigate risk factors for developing GBS following Zika infection. In our investigation, the majority (80%) of GBS patients with evidence of Zika infection reported Zika-like symptoms, although the majority of people infected with Zika and do not develop complications have no symptoms. Understanding risk factors for developing GBS could help with prevention as well as early detection and treatment initiation of GBS patients.
Second, future research should analyze prognostic indicators to identify GBS patients with and without evidence of Zika that might be at particular risk of developing long-term disability, toward linking patients to appropriate care, such as physical therapy.
Third, future research could also examine the disease processes involved in GBS following Zika infection. On a clinical level, we found that although similar to GBS patients without evidence of Zika infection, those with evidence of Zika infection more frequently had acute and residual cranial neuropathy. This indicates that specific anti-Zika antibodies are involved in the GBS disease process, and future research should focus on identifying antigens that are specific to or over-expressed in the cranial nerves.
MedicalResearch.com: Is there anything else you would like to add?
Response: This analysis is the result of a strong collaboration between Puerto Rico Department of Health, CDC, and University of Puerto Rico, as well as health care providers and patients throughout the Island.
Through these combined efforts, we were able to collect a complete picture of GBS in Puerto Rico during the 2016 Zika epidemic, toward increasing our global scientific and medical understanding of Zika-associated GBS.
Disclosures: One of the coauthors, Dr. Luciano, received support from US National Institutes of Health (NIH). The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Dirlikov E, Major CG, Medina NA, et al. Clinical Features of Guillain-Barré Syndrome With vs Without Zika Virus Infection, Puerto Rico, 2016. JAMA Neurol. Published online May 21, 2018. doi:10.1001/jamaneurol.2018.1058
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