Medical Research Unit for Neurological Diseases, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Division of Epidemiological Surveillance of Communicable Diseases, Epidemiologic Surveillance Coordination, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
PLoS Negl Trop Dis. 2020 Dec 17;14(12):e0008032. doi: 10.1371/journal.pntd.0008032. eCollection 2020 Dec.
Background Zika, dengue and chikungunya viruses (ZIKV, CHIKV and DENV) are temporally associated with neurological diseases, such as Guillain-Barré syndrome (GBS). Because these three arboviruses coexist in Mexico, the frequency and severity of GBS could theoretically increase. This study aims to determine the association between these arboviruses and GBS in a Mexican population and to establish the clinical characteristics of the patients, including the severity of the infection. A case-control study was conducted (2016/07/01-2018/06/30) in Instituto Mexicano del Seguro Social (Mexican Social Security Institute) hospitals, using serum and urine samples that were collected to determine exposure to ZIKV, DENV, CHIKV by RT-qPCR and serology (IgM). For the categorical variables analysis, Pearson's χ2 or Fisher exact tests were used, and the Mann-Whitney U test for continuous variables. To determine the association of GBS and viral infection diagnosis through laboratory and symptomatology before admission, we calculated the odds ratio (OR) and 95% confidence intervals (95%CI) using a 2x2 contingency table. A p-value ≤ 0.05 was considered as significant. Ninety-seven GBS cases and 184 controls were included. The association of GBS with ZIKV acute infection (OR, 8.04; 95% CI, 0.89-73.01, p = 0.047), as well as laboratory evidence of ZIKV infection (OR, 16.45; 95% CI, 2.03-133.56; p = 0.001) or Flavivirus (ZIKV and DENV) infection (OR, 6.35; 95% CI, 1.99-20.28; p = 0.001) was observed. Cases of GBS associated with ZIKV demonstrated a greater impairment of functional status and a higher percentage of mechanical ventilation. According to laboratory results, an association between ZIKV or ZIKV and DENV infection in patients with GBS was found. Cases of GBS associated with ZIKV exhibited a more severe clinical picture. Cases with co-infection were not found.
寨卡病毒、登革热病毒和基孔肯雅热病毒（ZIKV、CHIKV 和 DENV）与神经疾病（如格林-巴利综合征，GBS）在时间上有关联。由于这三种虫媒病毒在墨西哥共存，GBS 的频率和严重程度理论上可能会增加。本研究旨在确定墨西哥人群中这些虫媒病毒与 GBS 之间的关联，并确定患者的临床特征，包括感染的严重程度。采用病例对照研究（2016 年 7 月 1 日至 2018 年 6 月 30 日），在墨西哥社会保障研究所（Mexican Social Security Institute）医院进行，使用血清和尿液样本，通过 RT-qPCR 和血清学（IgM）检测 ZIKV、DENV 和 CHIKV 的暴露情况。对于分类变量分析，使用 Pearson's χ2 或 Fisher 确切检验，对于连续变量使用 Mann-Whitney U 检验。为了确定通过实验室和入院前症状诊断与 GBS 相关的病毒感染，我们通过 2x2 列联表计算比值比（OR）和 95%置信区间（95%CI）。p 值≤0.05 被认为具有统计学意义。共纳入 97 例 GBS 病例和 184 例对照。GBS 与 ZIKV 急性感染相关（OR，8.04；95%CI，0.89-73.01，p = 0.047），以及 ZIKV 感染的实验室证据（OR，16.45；95%CI，2.03-133.56；p = 0.001）或黄病毒（ZIKV 和 DENV）感染（OR，6.35；95%CI，1.99-20.28；p = 0.001）。与 ZIKV 相关的 GBS 病例表现出更大的功能状态损害和更高比例的机械通气。根据实验室结果，发现 ZIKV 或 ZIKV 和 DENV 感染的 GBS 患者之间存在关联。与 ZIKV 相关的 GBS 病例表现出更严重的临床症状。未发现合并感染的病例。
