Antecedent #infections in #GBS: a single-center, prospective study (Ann Clin Transl Neurol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Ann Clin Transl Neurol. 2019 Nov 12. doi: 10.1002/acn3.50946. [Epub ahead of print]

Antecedent infections in Guillain-Barré syndrome: a single-center, prospective study.

Hao Y1, Wang W1, Jacobs BC2, Qiao B1, Chen M3, Liu D1, Feng X1, Wang Y1,4.

Author information: 1 Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China. 2 Department of Neurology and Immunology, Erasmus University Medical Centre, Rotterdam, The Netherlands. 3 Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China. 4 Central Laboratory, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China.

 

Abstract

OBJECTIVE:

To investigate the spectrum of antecedent infections in Chinese patients with Guillain-Barré syndrome (GBS) and analyze the infections-related clinical phenotypes locally.

METHODS:

A prospective case-control study of 150 patients diagnosed with GBS and age- and sex-matched neurological and healthy controls was performed to investigate recent infections of 14 pathogens serologically and collect the clinical data during a follow-up of 12 months.

RESULTS:

In total, 53% of patients with GBS had a positive serology for recent infection, including Campylobacter jejuni (27%), influenza A (17%) and B (16%), hepatitis A virus (5%), dengue virus (3%), cytomegalovirus (3%), Epstein-Barr virus (3%), Mycoplasma pneumoniae (2%), herpes simplex virus (2%), varicella-zoster virus (1%), and rubella virus (1%). Serology for infections of hepatitis E virus, Haemophilus influenzae, and Zika virus was negative. There was a higher frequency of C. jejuni, influenza A, influenza B, and hepatitis A virus infections in GBS patients than both the neurological and healthy controls. C. jejuni infection was more frequent in younger GBS patients and was associated with antibodies against GM1, GalNAc-GD1a, and GM1:galactocerebroside complex. Influenza B infection was associated with a pure motor form of GBS.

INTERPRETATION:

C. jejuni, influenza A, influenza B, and hepatitis A virus serve as the most common cause of antecedent infections in GBS locally. Influenza B-related GBS may represent a pure motor phenotype. Differences in the infectious spectrum worldwide may contribute to the geographical clinical heterogeneity of GBS.

© 2019 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals, Inc on behalf of American Neurological Association.

PMID: 31714025 DOI: 10.1002/acn3.50946

Keywords: GBS; Neurology; Hepatitis A; Seasonal Influenza.

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Second #IVIg course in #GBS with poor #prognosis: the non-randomised ISID study (J Neurol Neurosurg Psychiatry, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Neurol Neurosurg Psychiatry. 2019 Oct 5. pii: jnnp-2019-321496. doi: 10.1136/jnnp-2019-321496. [Epub ahead of print]

Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study.

Verboon C1, van den Berg B1, Cornblath DR2, Venema E1,3, Gorson KC4, Lunn MP5, Lingsma H3, Van den Bergh P6, Harbo T7, Bateman K8, Pereon Y9, Sindrup SH10, Kusunoki S11, Miller J12, Islam Z13, Hartung HP14, Chavada G15, Jacobs BC1,16, Hughes RAC17, van Doorn PA18; IGOS Consortium.

Author information: 1 Department of Neurology, Erasmus MC, Rotterdam, The Netherlands. 2 Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA. 3 Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. 4 Department of Neurology, St. Elizabeth’s Medical Center, Boston, Massachusetts, USA. 5 Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK. 6 Department of Neurology, University Clinic St. Luc, Leuven, Belgium. 7 Department of Neurology, Aarhus University Hospital, Aarhus, Denmark. 8 Department of Neurology, University of Cape Town, Cape Town, South Africa. 9 Department of Clinical Neurophysiology, Reference Centre for NMD, Nantes University Hospital, Nantes, France. 10 Department of Neurology, Odense University Hospital, Odense, Denmark. 11 Department of Neurology, Kindai University Faculty of Medicine, Osaka, Japan. 12 Department of Neurology, Royal Victoria Infirmary, Newcastle, UK. 13 Department of Laboratory Sciences and Services Division, The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. 14 Department of Neurology, Heinrich Heine University, Düsseldorf, Germany. 15 Department of Neurology, University of Glasgow, Glasgow, UK. 16 Department of Immunology, Erasmus MC, Rotterdam, The Netherlands. 17 MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK. 18 Department of Neurology, Erasmus MC, Rotterdam, The Netherlands p.a.vandoorn@erasmusmc.nl.

 

Abstract

OBJECTIVE:

To compare disease course in patients with Guillain-Barré syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses.

METHODS:

From the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression.

RESULTS:

Of 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an ‘early’ second IVIg course (1-2 weeks after start of the first IVIg course) and 18 patients a ‘late’ second IVIg course (2-4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95%CI 0.16 to 3.04) for the early group and 0.66 (95%CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course.

CONCLUSIONS:

This observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS.

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

KEYWORDS: Guillain-Barré syndrome; poor prognosis; second IVIg course; treatment

PMID: 31586949 DOI: 10.1136/jnnp-2019-321496

Keywords: GBS; Immunoglobulins.

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Do #Vaccines Trigger #Neurological Diseases? Epidemiological Evaluation of Vaccination and Neurological Diseases Using Examples of #MS, #GBS and #Narcolepsy (CNS Drugs., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

CNS Drugs. 2019 Oct 1. doi: 10.1007/s40263-019-00670-y. [Epub ahead of print]

Do Vaccines Trigger Neurological Diseases? Epidemiological Evaluation of Vaccination and Neurological Diseases Using Examples of Multiple Sclerosis, Guillain-Barré Syndrome and Narcolepsy.

Stowe J1, Andrews N2, Miller E3.

Author information: 1 Immunisation and Countermeasures, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK. Julia.stowe@phe.gov.uk. 2 Statistics and Modelling Economics Unit, Public Health England, London, NW9 5EQ, UK. 3 Immunisation and Countermeasures, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.

 

Abstract

This article evaluates the epidemiological evidence for a relationship between vaccination and neurological disease, specifically multiple sclerosis, Guillain-Barré syndrome and narcolepsy. The statistical methods used to test vaccine safety hypotheses are described and the merits of different study designs evaluated; these include the cohort, case-control, case-coverage and the self-controlled case-series methods. For multiple sclerosis, the evidence does not support the hypothesized relationship with hepatitis B vaccine. For Guillain-Barré syndrome, the evidence suggests a small elevated risk after influenza vaccines, though considerably lower than after natural influenza infection, with no elevated risk after human papilloma virus vaccine. For narcolepsy, there is strong evidence of a causal association with one adjuvanted vaccine used in the 2009/10 influenza pandemic. Rapid investigation of vaccine safety concerns, however biologically implausible, is essential to maintain public and professional confidence in vaccination programmes.

PMID: 31576507 DOI: 10.1007/s40263-019-00670-y

Keywords: Drugs safety; Vaccines; GBS; Narcolepsy; Neurology.

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Adverse events following #adenovirus type 4 and type 7 #vaccine, live, oral in the Vaccine Adverse Event Reporting System (#VAERS), #USA, October 2011-July 2018 (Vaccine, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Vaccine. 2019 Sep 20. pii: S0264-410X(19)31188-0. doi: 10.1016/j.vaccine.2019.08.087. [Epub ahead of print]

Adverse events following adenovirus type 4 and type 7 vaccine, live, oral in the Vaccine Adverse Event Reporting System (VAERS), United States, October 2011-July 2018.

McNeil MM1, Paradowska-Stankiewicz I2, Miller ER2, Marquez PL2, Seshadri S3, Collins LC Jr3, Cano MV2.

Author information: 1 Immunization Safety Office, Division of Healthcare Quality Promotion (DHQP), National Center for Zoonotic and Emerging Infectious Diseases (NCZEID), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA. Electronic address: mmm2@cdc.gov. 2 Immunization Safety Office, Division of Healthcare Quality Promotion (DHQP), National Center for Zoonotic and Emerging Infectious Diseases (NCZEID), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA. 3 Immunization Healthcare Division, Public Health Division, Defense Health Agency, Falls Church, VA 22042, USA.

 

Abstract

BACKGROUND:

In March 2011, the U.S. Food and Drug Administration licensed adenovirus type 4 and type 7 vaccine, live, oral (Barr Labs, Inc.) (adenovirus vaccine) for use in military personnel 17 through 50 years of age. The vaccine was first universally administered to U.S. military recruits in October 2011. We investigated adverse event (AE) reports following the adenovirus vaccine submitted to the Vaccine Adverse Event Reporting System (VAERS).

METHODS:

We searched the VAERS database for U.S. reports among persons who received adenovirus vaccine during October 2011 through July 2018 including participants in a military observational study. We reviewed all serious reports and accompanying medical records. We compared the proportion of serious reports in a proxy military recruit population and reviewed all reports of suspected allergic reactions following adenovirus vaccination.

RESULTS:

During the analytic period, VAERS received 100 reports following adenovirus vaccination; 39 (39%) were classified as serious and of these, 17 (44%) were from the observational study. One death was reported. Males accounted for 72% of reports. Median age of vaccinees was 19 years (range 17-32). The most frequently reported serious AEs were Guillain Barré syndrome (GBS) (n = 12) and anaphylaxis (n = 8); of these, two GBS and all the anaphylaxis reports were reported in the observational study. Reports documented concurrent receipt of multiple other vaccines (95%) and penicillin G (IM Pen G) or other antibiotics (50%).

CONCLUSIONS:

The reporting rate for serious AEs was higher than with other vaccines administered in the comparison military recruit population (39% vs 18%); however, we identified no unexpected or concerning pattern of adenovirus vaccine AEs. Co-administration of vaccines and IM Pen G was commonly reported in this military population. These exposures may have contributed to the GBS and anaphylaxis outcomes observed with the adenovirus vaccine. Future adenovirus vaccine safety studies in a population without these co-administrations would be helpful in clarifying the vaccine’s safety profile.

Published by Elsevier Ltd.

KEYWORDS: Adenovirus vaccine; Adverse event; Epidemiology; Hereditary Neuropathy with Liability to Pressure Palsy; Surveillance; Vaccine safety

PMID: 31548014 DOI: 10.1016/j.vaccine.2019.08.087

Keywords: Adenovirus; Vaccines; Drugs Safety; GSB; USA.

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Atypical #Lyme #Neuroborreliosis, #GBS or #Conversion #Disorder: Differential Diagnosis of Unusual Neurological Presentations (Case Rep Neurol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Case Rep Neurol. 2019 Apr 30;11(1):142-147. doi: 10.1159/000499901. eCollection 2019 Jan-Apr.

Atypical Lyme Neuroborreliosis, Guillain-Barré Syndrome or Conversion Disorder: Differential Diagnosis of Unusual Neurological Presentations.

Teodoro T1, Oliveira R2, Afonso P3.

Author information: 1 Department of Psychiatry, Lisbon Psychiatric Hospital Center, Lisbon, Portugal. 2 Department of Neurology, Hospital da Luz – Lisboa, Lisbon, Portugal. 3 Department of Psychiatry, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.

 

Abstract

Nervous system Lyme disease and Guillain-Barré syndrome are common neurological conditions that may present with unusual symptoms rendering differential diagnosis difficult. We report the case of a 62-year-old woman presenting with asymmetrical tetraparesis and hyporeflexia. Initially the presumed diagnosis of Guillain-Barré syndrome with a possible functional component was suspected and treatment with intravenous immunoglobulin was initiated. Due to partial response to therapy and further test results including positive serologies and cerebrospinal fluid antibodies for Borrelia, the diagnosis of neuroborreliosis was considered. Further exploring revealed the possibility of exposure to ticks although there was no report of typical skin lesions. Daily physical therapy and appropriate antibiotic treatment with parenteral ceftriaxone resulted in significant improvement of motor symptoms and functional status. The patient was discharged with marked functional improvement and indication for further physical rehabilitation.

KEYWORDS: Conversion disorder; Guillain-Barré syndrome; Lyme disease; Neuroborreliosis

PMID: 31543796 PMCID: PMC6739718 DOI: 10.1159/000499901

Keywords: Neuroborreliosis; Lyme’s Disease; GBS; Neurology.

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#Diagnosis and #management of #GBS in ten steps (Nat Rev Neurol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Nat Rev Neurol. 2019 Sep 20. doi: 10.1038/s41582-019-0250-9. [Epub ahead of print]

Diagnosis and management of Guillain-Barré syndrome in ten steps.

Leonhard SE1, Mandarakas MR1, Gondim FAA2, Bateman K3, Ferreira MLB4, Cornblath DR5, van Doorn PA1, Dourado ME6, Hughes RAC7, Islam B8, Kusunoki S9, Pardo CA5, Reisin R10, Sejvar JJ11, Shahrizaila N12, Soares C13, Umapathi T14, Wang Y15, Yiu EM16,17,18, Willison HJ19, Jacobs BC20,21.

Author information: 1 Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands. 2 Hospital Universitário Walter Cantidio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil. 3 Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. 4 Department of Neurology, Hospital da Restauração, Recife, Pernambuco, Brazil. 5 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 6 Department of Integrative Medicine, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, Brazil. 7 UCL Queen Square Institute of Neurology, University College London, London, UK. 8 International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh. 9 Kindai University Faculty of Medicine, Osaka, Japan. 10 Hospital Británico, Buenos Aires, Argentina. 11 Centers for Disease Control and Prevention, Atlanta, GA, USA. 12 Department of Neurology, University of Malaya, Kuala Lumpur, Malaysia. 13 Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil. 14 National Neuroscience Institute, Singapore, Singapore. 15 Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China. 16 Department of Neurology, The Royal Children’s Hospital Melbourne, Melbourne, VIC, Australia. 17 Neurosciences Research, Murdoch Children’s Research Institute, Melbourne, VIC, Australia. 18 Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia. 19 College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK. 20 Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands. b.jacobs@erasmusmc.nl. 21 Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands. b.jacobs@erasmusmc.nl.

 

Abstract

Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diagnostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.

PMID: 31541214 DOI: 10.1038/s41582-019-0250-9

Keywords: GBS; Immunopathology; Infectious Diseases; Zika Virus.

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Anti- #ganglioside #antibodies in patients with #Zika virus #infection-associated #GBS in #Brazil (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Anti-ganglioside antibodies in patients with Zika virus infection-associated Guillain-Barré Syndrome in Brazil

Juan Rivera-Correa, Isadora Cristina de Siqueira, Sabrina Mota, Mateus Santana do Rosário, Pedro Antônio Pereira de Jesus, Luiz Carlos Junior Alcantara, Joel D. Ernst, Ana Rodriguez

Published: September 17, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007695 / This is an uncorrected proof.

 

Abstract

Zika virus infection is associated with the development of Guillain-Barré syndrome (GBS), a neurological autoimmune disorder caused by immune recognition of gangliosides and other components at nerve membranes. Using a high-throughput ELISA, we have analyzed the anti-glycolipid antibody profile, including gangliosides, of plasma samples from patients with Zika infections associated or not with GBS in Salvador, Brazil. We have observed that Zika patients that develop GBS present higher levels of anti-ganglioside antibodies when compared to Zika patients without GBS. We also observed that a broad repertoire of gangliosides was targeted by both IgM and IgG anti-self antibodies in these patients. Since Zika virus infects neurons, which contain membrane gangliosides, antigen presentation of these infected cells may trigger the observed autoimmune anti-ganglioside antibodies suggesting direct infection-induced autoantibodies as a cause leading to GBS development. Collectively, our results establish a link between anti-ganglioside antibodies and Zika-associated GBS in patients.

 

Author summary

Zika virus infection can trigger the development of Guillain Barré syndrome (GBS), a neurological autoimmune disorder mediated by antibodies recognizing gangliosides in nerve membranes. Mechanisms such as molecular mimicry have been identified as a cause for GBS development in certain infections, such as Campylobacter jejuni, but the broad self reactivity observed during GBS suggests a role for alternative mechanisms. Our finding that Zika patients with GBS present higher levels of anti-ganglioside antibodies compared to uncomplicated Zika patients in Brazil points to these auto-antibodies as a trigger for GBS in these patients. These findings further support infection-induced autoantibodies as a factor contributing to GBS development, adding novel mechanisms for GBS development beyond molecular mimicry.

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Citation: Rivera-Correa J, de Siqueira IC, Mota S, do Rosário MS, Pereira de Jesus PA, Alcantara LCJ, et al. (2019) Anti-ganglioside antibodies in patients with Zika virus infection-associated Guillain-Barré Syndrome in Brazil. PLoS Negl Trop Dis 13(9): e0007695. https://doi.org/10.1371/journal.pntd.0007695

Editor: Rebecca C. Christofferson, Louisiana State University, UNITED STATES

Received: March 18, 2019; Accepted: August 7, 2019; Published: September 17, 2019

Copyright: © 2019 Rivera-Correa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files

Funding: AR and JRC received funding for this project from New York University School of Medicine Internal Funds. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Zika Virus; Immunopathology; GBS; Neurology; Brazil.

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