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Guillain-Barré Syndrome Associated With Zika Virus Infection in Martinique in 2016: A Prospective Study

Benoit Rozé 1, 2 Fatiha Najioullah 3 Jean-Louis Fergé 2 Frédérique Dorléans 4 Kossivi Apetse 5 José-Luis Barnay 6 Elise Daudens-Vaysse 4 Yannick Brouste 7 Raymond Césaire 3 Laurence Fagour 3 Ruddy Valentino 2 Martine Ledrans 4 Hossein Mehdaoui 2 Sylvie Abel 1 Isabelle Leparc-Goffart 8 Aissatou Signate 9, 10 André Cabié 11, 3, 12, *
* Corresponding author
1 Service de Maladies Infectieuses et Tropicales [Fort-de-France, Martinique]
2 Unité de soins intensifs [CHU Martinique]
3 EA 4537 - Laboratoire de Virologie-Immunologie [Fort de France, Martinique]
4 Agence Nationale de la Santé Publique - Unité Régionale Antilles Guyane [Saint-Maurice]
5 Département d'Electrophysiologie [Fort de France, Martinique]
6 Unité de Réhabilitation [Fort de France, Martinique]
7 Service d'Urgence [Fort de France, Martinique]
8 IRBA - Institut de Recherche Biomédicale des Armées [Antenne Marseille]
9 ESS - Environnement, Santé, Sociétés
10 Service de neurologie [Fort-de-France, Martinique]
11 Service de Maladies Infectieuses et Tropicales [Fort-de-France, Martinique]
12 CIC - Antilles Guyane - Centre d'Investigation Clinique Antilles-Guyane
Abstract : Background: Guillain-Barré syndrome (GBS) has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies, mostly on the basis of serological tests, with the problematic cross-reacting antibodies of the Flavivirus genus. Some GBS cases do not exhibit a high level of diagnostic certainty. This prospective study aimed to describe the clinical profiles and the frequency of GBS associated with ZIKV during the ZIKV outbreak in Martinique in 2016. Methods: We recorded prospective data from GBS meeting levels 1 or 2 of diagnostic certainty for the Brighton Collaboration, with proof of recent ZIKV infection and negative screening for etiologies of GBS. Results: Of the sample of 34 patients with suspected GBS during the outbreak, 30 had a proven presence of GBS, and 23 had a recent ZIKV infection. The estimated GBS incidence rate ratio (2016 vs 2006-2015) was 4.52 (95% confidence interval, 2.80-7.64; P = .0001). Recent ZIKV infection was confirmed by urine reverse-transcription polymerase chain reaction (RT-PCR) analysis in 17 cases and by serology in 6 cases. Patients, 65% of whom were male, had a median age of 61 years (interquartile range, 56-71 years) and experienced severe GBS. Electrophysiological tests were consistent with the primary demyelinating form of the disease. Conclusions: ZIKV infection is usually benign, when symptomatic, but in countries at risk of ZIKV epidemics, adequate intensive care bed capacity is required for management of severe GBS cases. Arbovirus RNA detection by RT-PCR should be part of the management of GBS cases.
Keywords : Zika virus infection Martinique Guillain-Barré syndrome outbreaks vector-borne infections.
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Submitted on : Thursday, November 21, 2019 - 6:15:30 PM
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Benoit Rozé, Fatiha Najioullah, Jean-Louis Fergé, Frédérique Dorléans, Kossivi Apetse, et al.. Guillain-Barré Syndrome Associated With Zika Virus Infection in Martinique in 2016: A Prospective Study. Clinical Infectious Diseases, Oxford University Press (OUP), 2017, 65 (9), pp.1462-1468. ⟨10.1093/cid/cix588⟩. ⟨inserm-02375019⟩

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