哥伦比亚寨卡病毒感染相关格林-巴利综合征。

Guillain-Barré Syndrome Associated with Zika Virus Infection in Colombia.

机构信息

From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore.

出版信息

N Engl J Med. 2016 Oct 20;375(16):1513-1523. doi: 10.1056/NEJMoa1605564. Epub 2016 Oct 5.

DOI:10.1056/NEJMoa1605564

PMID:27705091

Abstract

BACKGROUND

Zika virus (ZIKV) infection has been linked to the Guillain-Barré syndrome. From November 2015 through March 2016, clusters of cases of the Guillain-Barré syndrome were observed during the outbreak of ZIKV infection in Colombia. We characterized the clinical features of cases of Guillain-Barré syndrome in the context of this ZIKV infection outbreak and investigated their relationship with ZIKV infection.

METHODS

A total of 68 patients with the Guillain-Barré syndrome at six Colombian hospitals were evaluated clinically, and virologic studies were completed for 42 of the patients. We performed reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays for ZIKV in blood, cerebrospinal fluid, and urine, as well as antiflavivirus antibody assays.

RESULTS

A total of 66 patients (97%) had symptoms compatible with ZIKV infection before the onset of the Guillain-Barré syndrome. The median period between the onset of symptoms of ZIKV infection and symptoms of the Guillain-Barré syndrome was 7 days (interquartile range, 3 to 10). Among the 68 patients with the Guillain-Barré syndrome, 50% were found to have bilateral facial paralysis on examination. Among 46 patients in whom nerve-conduction studies and electromyography were performed, the results in 36 patients (78%) were consistent with the acute inflammatory demyelinating polyneuropathy subtype of the Guillain-Barré syndrome. Among the 42 patients who had samples tested for ZIKV by RT-PCR, the results were positive in 17 patients (40%). Most of the positive RT-PCR results were in urine samples (in 16 of the 17 patients with positive RT-PCR results), although 3 samples of cerebrospinal fluid were also positive. In 18 of 42 patients (43%) with the Guillain-Barré syndrome who underwent laboratory testing, the presence of ZIKV infection was supported by clinical and immunologic findings. In 20 of these 42 patients (48%), the Guillain-Barré syndrome had a parainfectious onset. All patients tested were negative for dengue virus infection as assessed by RT-PCR.

CONCLUSIONS

The evidence of ZIKV infection documented by RT-PCR among patients with the Guillain-Barré syndrome during the outbreak of ZIKV infection in Colombia lends support to the role of the infection in the development of the Guillain-Barré syndrome. (Funded by the Bart McLean Fund for Neuroimmunology Research and others.).

摘要

背景

寨卡病毒（ZIKV）感染已与吉兰-巴雷综合征相关联。从 2015 年 11 月至 2016 年 3 月，在哥伦比亚寨卡病毒感染爆发期间，观察到吉兰-巴雷综合征的病例群集。我们在此次 ZIKV 感染爆发的背景下对吉兰-巴雷综合征病例的临床特征进行了描述，并对其与 ZIKV 感染的关系进行了调查。

方法

在六家哥伦比亚医院共评估了 68 例吉兰-巴雷综合征患者，其中 42 例患者完成了病毒学研究。我们对血液、脑脊液和尿液进行了 ZIKV 的逆转录-聚合酶链反应（RT-PCR）检测，以及抗黄病毒抗体检测。

结果

共有 66 例（97%）患者在吉兰-巴雷综合征发病前出现符合寨卡病毒感染的症状。ZIKV 感染症状出现与吉兰-巴雷综合征症状出现之间的中位时间为 7 天（四分位间距，3 至 10）。在 68 例吉兰-巴雷综合征患者中，50%的患者检查时有双侧面瘫。在进行神经传导研究和肌电图检查的 46 例患者中，36 例（78%）的结果符合吉兰-巴雷综合征的急性炎症性脱髓鞘性多神经病型。在通过 RT-PCR 对 42 例患者进行寨卡病毒检测的患者中，17 例（40%）的结果为阳性。大多数阳性 RT-PCR 结果来自尿液样本（在 17 例阳性 RT-PCR 结果的患者中），尽管 3 例脑脊液样本也为阳性。在接受实验室检测的 42 例吉兰-巴雷综合征患者中，有 18 例（43%）的 ZIKV 感染有临床和免疫检测结果支持。在这 42 例患者中，有 20 例（48%）的吉兰-巴雷综合征为感染后发病。所有患者经 RT-PCR 检测均为登革热病毒感染阴性。