• 1.

    Hills SL, Russell K, Hennessey M, Williams C, Oster AM, Fischer M, Mead P, 2016. Transmission of Zika virus through sexual contact with travelers to areas of ongoing transmission - continental United States, 2016. MMWR Morb Mortal Wkly Rep 65: 215216.

    • Search Google Scholar
    • Export Citation
  • 2.

    Venturi G et al. 2016. An autochthonous case of Zika due to possible sexual transmission, Florence, Italy, 2014. Euro Surveill 21: 30148.

  • 3.

    Musso D, Nilles EJ, Cao-Lormeau VM, 2014. Rapid spread of emerging Zika virus in the Pacific area. Clin Microbiol Infect 20: O595O596.

  • 4.

    Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM, 2016. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 47: 67.

    • Search Google Scholar
    • Export Citation
  • 5.

    Brasil P et al. 2016. Zika virus outbreak in Rio de Janeiro, Brazil: clinical characterization, epidemiological and virological aspects. PLoS Negl Trop Dis 10: e0004636.

    • Search Google Scholar
    • Export Citation
  • 6.

    Petersen LR, Jamieson DJ, Powers AM, Honein MA, 2016. Zika virus. N Engl J Med 374: 15521563.

  • 7.

    Ioos S, Mallet HP, Leparc Goffart I, Gauthier V, Cardoso T, Herida M, 2014. Current Zika virus epidemiology and recent epidemics. Med Mal Infect 44: 302307.

    • Search Google Scholar
    • Export Citation
  • 8.

    Oehler E, Watrin L, Larre P, Leparc-Goffart I, Lastere S, Valour F, Baudouin L, Mallet H, Musso D, Ghawche F, 2014. Zika virus infection complicated by Guillain-Barre syndrome–case report, French Polynesia, December 2013. Euro Surveill 19: pii: 20720.

    • Search Google Scholar
    • Export Citation
  • 9.

    Cao-Lormeau VM et al. 2016. Guillain-Barre Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet 387: 15311539.

    • Search Google Scholar
    • Export Citation
  • 10.

    Pan American Health Organization, 2015. 1 December 2015: Neurological Syndrome, Congenital Malformations, and Zika Virus Infection. Implications for Public Health in the Americas - Epidemiological Alert. Available at: http://www.paho.org/hq/index.php?option=com_content&view=article&id=11484%3A1-december-2015-neurological-syndrome-zika-virus-infection-americas-epidemiological-alert&catid=2103%3Arecent-epidemiological-alerts-updates&Itemid=40266&lang=en.

  • 11.

    Mecharles S, Herrmann C, Poullain P, Tran TH, Deschamps N, Mathon G, Landais A, Breurec S, Lannuzel A, 2016. Acute myelitis due to Zika virus infection. Lancet 387: 1481.

    • Search Google Scholar
    • Export Citation
  • 12.

    Carteaux G et al. 2016. Zika virus associated with meningoencephalitis. N Engl J Med 374: 15951596.

  • 13.

    Faye O, Dupressoir A, Weidmann M, Ndiaye M, Alpha Sall A, 2008. One-step RT-PCR for detection of Zika virus. J Clin Virol 43: 96101.

  • 14.

    Lanciotti RS, Calisher CH, Gubler DJ, Chang GJ, Vorndam AV, 1992. Rapid detection and typing of dengue viruses from clinical samples by using reverse transcriptase-polymerase chain reaction. J Clin Microbiol 30: 545551.

    • Search Google Scholar
    • Export Citation
  • 15.

    Marli T et al. 2016. Zika virus IgM-specific based diagnostic is highly correlated with detection of neutralising antibodies in neonates with congenital disease. J Infect Dis 214: 18971904.

    • Search Google Scholar
    • Export Citation
  • 16.

    Control. ECfDPa, 2014. Rapid Risk Assessment: Zika virus infection outbreak, French Polynesia. Available at: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/Zika-virus-French-Polynesia-rapid-risk-assessment.pdf.

  • 17.

    Smith DW, Mackenzie J, 2016. Zika virus and Guillain-Barre syndrome: another viral cause to add to the list. Lancet. 387: 14861488.

  • 18.

    Organization. P-PAH, 2016. Zika - Epidemiological update, 1–6.

  • 19.

    Parra B et al. 2016. Guillain-Barre syndrome associated with Zika virus infection in Colombia. N Engl J Med 375: 15131523.

  • 20.

    Balm MN, Lee CK, Lee HK, Chiu L, Koay ES, Tang JW, 2012. A diagnostic polymerase chain reaction assay for Zika virus. J Med Virol 84: 15011505.

  • 21.

    Mansuy JM, Dutertre M, Mengelle C, Fourcade C, Marchou B, Delobel P, Izopet J, Martin-Blondel G, 2016. Zika virus: high infectious viral load in semen, a new sexually transmitted pathogen? Lancet Infect Dis 16: 405.

    • Search Google Scholar
    • Export Citation
  • 22.

    Atkinson B, Hearn P, Afrough B, Lumley S, Carter D, Aarons EJ, Simpson AJ, Brooks TJ, Hewson R, 2016. Detection of Zika virus in semen. Emerg Infect Dis 22: 940.

  • 23.

    Gourinat AC, O’Connor O, Calvez E, Goarant C, Dupont-Rouzeyrol M, 2015. Detection of Zika virus in urine. Emerg Infect Dis 21: 8486.

  • 24.

    Brazilian Ministry of Health, 2015. Protocolo de Atenção à Saúde e Resposta à Ocorrência de Microcefalia Relacionada à Infecção pelo Vìrus Zika. Available at: http://combateaedes.saude.gov.br/images/sala-de-situacao/04-04_protocolo-SAS.pdf.

 
 
 
 

 

 
 

 

 

 

 

 

 

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

View More View Less
  • 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.

Save