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Guillain–Barré Syndrome, Acute Disseminated Encephalomyelitis and Encephalitis Associated with Zika Virus Infection in Brazil: Detection of Viral RNA and Isolation of Virus during Late Infection

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  • 1 Department of Neurology-Hospital of Restoration, Recife, Pernambuco, Brazil;
  • | 2 Department of Medicine-Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil;
  • | 3 Department of Neurology-Hospital of Restoration, Recife, Pernambuco, Brazil;
  • | 4 Department of Pediatrics-Hospital of Restauração, Recife, Pernambuco, Brazil;
  • | 5 Aggeu Magalhães Institute, Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil

Zika virus (ZIKV) emerged in Brazil in 2015, which was followed by an increase of Guillain–Barre Syndrome (GBS) cases. We report the epidemiological, clinical, and laboratory findings of the first six neurological cases associated with ZIKV in Brazil seen in a reference neurology hospital in Pernambuco, Brazil. In all cases, ZIKV was detected in serum and/or cerebrospinal fluid (CSF) samples. In this case series, four cases were defined as GBS, one as acute disseminated encephalomyelitis (ADEM) and the other as encephalitis. ZIKV was detected in all cases by RT-PCR and virus isolation was successful in two patients. The time between ZIKV acute symptoms and the development of neurological manifestations varied from 3 to 13 days and ZIKV was detected between 15 and 34 days after the initial symptoms. Our results highlight the need to include ZIKV as a differential diagnosis for neurological syndromes in countries with circulation of this arbovirus. Because the viremia in these patients appears to persist longer, direct diagnostic techniques such as RT-PCR and viral isolation should be considered even if it is after the acute phase of viral infection.

Author Notes

Address correspondence to Carlos Alexandre Antunes de Brito, Department of Medicine-Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, Pernambuco 50670-901, Brazil. E-mail: cbritoc@gmail.com

Financial support: LJP is supported by grants from FACEPE and CNPq.

Authors’ addresses: Maria Lucia Brito Ferreira, Hospital da Restauração, Neurology, Recife, Pernambuco, Brazil, E-mail: lucabrito@uol.com.br. Carlos Alexandre Antunes de Brito, Universidade Federal de Pernambuco, Medicina Clínica, Recife, Pernambuco, Brazil, E-mail: cbritoc@gmail.com. Álvaro José Porto Moreira and Maria Íris de Morais Machado, Hospital da Restauração, Neurology, Recife, Pernambuco, Brazil, E-mails: alvarojpm@yahoo.com.br and irismorais@terra.com.br. Adélia Henrique Souza, Hospital da Restauração, Pediatrics, Recife, Pernambuco, Brazil, E-mail: adelianeuro@gmail.com. Marli Tenório Cordeiro, CPqAM-FIOCRUZ, LAVITE, Recife, Pernambuco, Brazil, E-mail: marli.tenorio@gmail.com. Ernesto Torres de Azevedo Marques Jr., University of Pittsburgh Medical Center Health System, Center for Vaccine Research, Pittsburgh, PA, and Centro de Pesquisa Aggeu Magalhaes, Virology, Recife, Pernambuco, Brazil, E-mail: marques@pitt.edu. Lindomar José Pena, Centro de Pesquisas Aggeu Magalhaes, Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, Brazil, E-mail: lindomar.pena@cpqam.fiocruz.br.