#Clinical Subpopulations in a Sample of North #American #Children Diagnosed With Acute Flaccid #Myelitis, 2012-2016 (JAMA Pediatr, abstract)

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

JAMA Pediatr. 2018 Nov 30. doi: 10.1001/jamapediatrics.2018.4890. [Epub ahead of print]

Clinical Subpopulations in a Sample of North American Children Diagnosed With Acute Flaccid Myelitis, 2012-2016.

Elrick MJ1, Gordon-Lipkin E2, Crawford TO1, Van Haren K3, Messacar K4, Thornton N5, Dee E5, Voskertchian A6, Nance JR1, Muñoz LS1, Gorman MP7, Benson LA7, Thomas DL8, Pardo CA1, Milstone AM5,6, Duggal P5.

Author information: 1 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland. 2 Kennedy Krieger Institute, Baltimore, Maryland. 3 Department of Neurology and Neurological Sciences, Stanford University, Stanford, California. 4 Department of Pediatrics, Children’s Hospital Colorado, the University of Colorado, Aurora. 5 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 6 Division of Infectious Disease, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland. 7 Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts. 8 Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.




Acute flaccid myelitis (AFM) is an emerging poliolike illness of children whose clinical spectrum and associated pathogens are only partially described. The case definition is intentionally encompassing for epidemiologic surveillance to capture all potential AFM cases. Defining a restrictive, homogenous subpopulation may aid our understanding of this emerging disease.


To evaluate the extent to which the US Centers for Disease Control and Prevention (CDC) case definition of AFM incorporates possible alternative diagnoses and to assess the plausibility of a case definition that enriches the biological homogeneity of AFM for inclusion in research studies.


Retrospective case analysis of children younger than 18 years diagnosed as having AFM between 2012 and 2016 using the CDC case definition. Group 1 included patients recruited from the United States and Canada based on the CDC case definition of AFM. Group 2 included patients referred to the Johns Hopkins Transverse Myelitis Center for evaluation of suspected AFM. Patients’ records and imaging data were critically reviewed by 3 neurologists to identify those cases with definable alternative diagnoses, and the remaining patients were categorized as having restrictively defined AFM (rAFM). Clinical characteristics were compared between patients with rAFM (cases) and those with alternative diagnoses, and a case description distinguishing these AFM groups was identified. Interrater reliability of this description was confirmed for a subset of cases by a fourth neurologist. Data were analyzed between May 2017 and November 2018.


Proportion of patients with possible alternative diagnosis.


Of the 45 patients who met the CDC AFM case definition and were included, the mean age was 6.1 years; 27 were boys (60%); and 37 were white (82%), 3 were Asian (7%), 1 was Hispanic (2%), and 4 were mixed race/ethnicity (9%). Of the included patients, 34 were classified as having rAFM, and 11 had alternate diagnoses (including transverse myelitis, other demyelinating syndromes, spinal cord stroke, Guillain-Barre syndrome, Chiari I myelopathy, and meningitis). Factors differing between groups were primarily asymmetry of weakness, lower motor neuron signs, preceding viral syndrome, symptoms evolving over hours to days, absence of sensory deficits, and magnetic resonance imaging findings. A case description was able to reliably define the rAFM group.


We present an approach for defining a homogeneous research population that may more accurately reflect the pathogenesis of the prototypical poliomyelitis-like subgroup of AFM. The definition of rAFM forms a blueprint for inclusion criteria in future research efforts, but more work is required for refinement and external validation.

PMID: 30500056 DOI: 10.1001/jamapediatrics.2018.4890

Keywords: Acute Flaccid Myelitis; USA.



Potential role of #dengue virus, #chikungunya virus and #Zika virus in #neurological diseases (Mem Inst Oswaldo Cruz, abstract)

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

Mem Inst Oswaldo Cruz. 2018 Oct 29;113(11):e170538. doi: 10.1590/0074-02760170538.

Potential role of dengue virus, chikungunya virus and Zika virus in neurological diseases.

Vieira MADCES1,2,3, Costa CHN4, Linhares ADC5, Borba AS2, Henriques DF6, Silva EVPD6, Tavares FN5, Batista FMA7, Guimarães HCL7, Martins LC6, Monteiro TAF3,5, Cruz ACR6, Azevedo RDSDS6, Vasconcelos PFDC6.

Author information: 1 Secretaria de Estado da Saúde do Piauí, Instituto de Doenças Tropicais Natan Portella, Departamento de Neurologia, Teresina, PI, Brasil. 2 Fundação Municipal de Saúde de Teresina, Diretoria de Vigilância em Saúde, Teresina, PI, Brasil. 3 Instituto Evandro Chagas, Programa de Pós-Graduação em Virologia, Ananindeua, PA, Brasil. 4 Secretaria de Estado da Saúde do Piauí, Instituto de Doenças Tropicais Natan Portella, Departamento de Infectologia, Teresina, PI, Brasil. 5 Instituto Evandro Chagas, Seção de Virologia Geral, Ananindeua, PA, Brasil. 6 Instituto Evandro Chagas, Seção de Arbovirologia e Febres Hemorrágicas, Ananindeua, PA, Brasil. 7 Secretaria de Estado da Saúde do Piauí, Diretoria da Unidade de Vigilância e Assistência à Saúde, Teresina, PI, Brasil.



This study showed that laboratory markers of recent infection by dengue, Zika or chikungunya arboviruses were detected in the biological samples of approximately one-third of patients with encephalitis, myelitis, encephalomyelitis or Guillain-Barré syndrome, in a surveillance programme in Piauí state, Brazil, between 2015-2016. Fever and myalgia had been associated with these cases. Since in non-tropical countries most infections or parainfectious diseases associated with the nervous system are attributed to herpesviruses, enteroviruses, and Campylobacter jejuni, the present findings indicate that in tropical countries, arboviruses may now play a more important role and reinforce the need for their surveillance and systematic investigation in the tropics.

PMID: 30379197 DOI: 10.1590/0074-02760170538

Keywords: Arbovirus; Chikungunya Fever; Dengue Fever; Zika Virus; Encephalitis; GBS; Encephalomyelitis.


Concurrent #GBS, transverse #myelitis and #encephalitis post- #Zika: A case report and review of the pathogenic role of multiple arboviral immunity (J Neurol Sci., abstract)

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

J Neurol Sci. 2018 Sep 26;395:47-53. doi: 10.1016/j.jns.2018.09.028. [Epub ahead of print]

Concurrent Guillain-Barré syndrome, transverse myelitis and encephalitis post-Zika: A case report and review of the pathogenic role of multiple arboviral immunity.

Mancera-Páez O1, Román GC2, Pardo-Turriago R3, Rodríguez Y4, Anaya JM5.

Author information: 1 Universidad Nacional de Colombia, Hospital Universitario Nacional, Faculty of Medicine, Department of Neurology, Bogotá, Colombia.; David Cabello International Alzheimer Disease Scholarship Fund, Houston Methodist Hospital, Houston, TX, USA.. Electronic address: ogmancerap@unal.edu.co. 2 Department of Neurology, Methodist Neurological Institute and the Institute for Academic Medicine Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA; Weill Cornell Medical College, Department of Neurology, Cornell University, NY, New York, USA. Electronic address: GCRoman@HoustonMethodist.org. 3 Universidad Nacional de Colombia, Hospital Universitario Nacional, Faculty of Medicine, Department of Neurology, Bogotá, Colombia.. Electronic address: rpardot@unal.edu.co. 4 Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia. Electronic address: johanintel@hotmail.com. 5 Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia. Electronic address: juan.anaya@urosario.edu.co.



We review post-infectious and post-vaccination neurological syndromes involving peripheral and central nervous system (CNS) and report an illustrative case of simultaneous occurrence of Guillain-Barré syndrome (GBS), confirmed by nerve conduction velocities, plus MRI-demonstrated transverse myelitis (TM) and acute encephalitis [acute disseminated encephalomyelitis] (ADEM+GBS) affecting a 24-year-old woman from Cúcuta, Colombia, who developed acute Zika virus (ZIKV) infection confirmed by serum reverse transcriptase-polymerase chain reaction (RT-PCR) and convalescent ZIKV IgG antibodies. With intensive care treatment, respiratory support, steroids, and intravenous immunoglobulin (IVIg), patient survived with residual flaccid paraparesis. She had preexisting immunity against Chikungunya virus (CHIKV) and Dengue virus (DENV) acquired before the arrival of ZIKV in Colombia. From reports in the Caribbean, Central and South America we review 19 cases of ZIKV-associated TM, encephalitis and ADEM occurring after a mean latent period of 10.5 days (range 1-96) post-infection. Although GBS and ADEM are usually considered post-infectious and associated with development of antibodies against peripheral nerve and CNS epitopes, we postulate that our case of ADEM+GBS is para-infectious, induced by acute ZIKV neurotropism boosted by active immunity against other arboviruses. Animal models of ZIKV demonstrated strong viral neurotropism enhanced by passive immunity with antibodies against arboviruses such as West Nile virus, CHIKV, or DENV. These considerations are relevant to prevent potential ZIKV vaccine-induced reactions involving central and peripheral nervous system.

KEYWORDS: Acute disseminated encephalomyelitis; Colombia; Guillain-Barré syndrome; Post-infectious encephalitis; Transverse myelitis; Zika virus

PMID: 30292020 DOI: 10.1016/j.jns.2018.09.028

Keywords: Acute Disseminated Encephalomyelitis; Transverse Myelitis; GBS; Zika Virus.


#Antibodies to #Zika virus, #Campylobacter jejuni and #gangliosides in #GBS: A prospective single-center study from southern #India (Neurol India, abstract)

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

Neurol India. 2018 Sep-Oct;66(5):1324-1331. doi: 10.4103/0028-3886.241402.

Antibodies to Zika virus, Campylobacter jejuni and gangliosides in Guillain-Barre syndrome: A prospective single-center study from southern India.

Baskar D1, Amalnath D1, Mandal J2, Dhodapkar R2, Vanathi K2.

Author information: 1 Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. 2 Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.




The objective of this article was to study the presence of antibodies against Zika virus (ZIKV), Campylobacter jejuni, and gangliosides in patients with Guillain-Barre syndrome (GBS).


Ninety consecutive patients (age more than 12 years) with GBS admitted to a tertiary care center in southern India were included in this study. Data on clinical manifestations, nerve conduction studies, and response to therapy were collected. The following tests were done in stored serum samples – anti-ZIKV (IgM) antibodies, anti-C. jejuni (IgG) antibodies, and anti-ganglioside antibodies (IgG). Those samples which were positive to anti-Zika antibodies were tested for conventional polymerase chain reaction for ZIKV and IgM antibodies against dengue, and Japanese encephalitis virus.


Of the 90 patients, 3 died and 8 had persistent weakness. Acute inflammatory demyelinating polyradiculoneuropathy was the most common type of GBS (56.7%). Anti-ganglioside antibodies were present in 62.2% patients with GT1b being the most common. Anti-C. jejuni antibodies were present in 46.6%. Anti-Zika antibodies (IgM) were present in 14 patients (15.5%). Four of these patients also had anti-dengue antibody (IgM) positivity.


This is one of the largest studies on GBS from India and the first one to report on the presence of Zika virus antibodies from this geographical area. Our study had a high prevalence of anti-C. jejuni and anti-ganglioside antibodies. Evidence of recent ZIKV infection, as evidenced by anti-IgM antibodies, was present in 14 patients, with 4 of them being tested positive for anti-dengue IgM antibody. Whether this represents cross-reaction with dengue or prior/co-infection with dengue virus could not be addressed in this study.

KEYWORDS: Anti-ganglioside antibodies; Campylobacter jejuni; Guillain–Barre syndrome; India; Zika virus

PMID: 30232998 DOI: 10.4103/0028-3886.241402

Keywords: GBS; India; Zika Virus; Campylobacter jejuni.


#Longterm #clinical #outcomes of #Zika-associated #GBS (Emerg Microbes Infect., excerpt)

[Source: Emerging Microbes and Infections, full page: (LINK). Excerpt, edited.]

Correspondence | OPEN | Published: 22 August 2018

Long-term clinical outcomes of Zika-associated Guillain-Barré syndrome

Aileen Y. Chang, Rebecca Lynch, […] Gary L. Simon

Emerging Microbes & Infections, volume 7, Article number: 148 (2018)


Zika virus infection has been associated with the development of a spectrum of neurologic disease including Guillain–Barré syndrome (GBS)1. GBS is an autoimmune disorder of the peripheral nervous system often triggered by a preceding infection. The mechanism of Zika-associated GBS (Z-GBS) and the long-term clinical course is unknown. The purpose of this study was to describe the 2-year clinical course of Z-GBS in order to provide further insights into disease pathogenesis and prognosis.


Keywords: Zika Virus; GBS.


Small volume #plasma #exchange for #GBS in resource-limited settings: a phase II safety and feasibility study (BMJ Open., abstract)

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

BMJ Open. 2018 Aug 17;8(8):e022862. doi: 10.1136/bmjopen-2018-022862.

Small volume plasma exchange for Guillain-Barré syndrome in resource-limited settings: a phase II safety and feasibility study.

Islam B1,2, Islam Z2, Rahman S3, Endtz HP1, Vos MC1, van der Jagt M4, van Doorn PA5, Jacobs BC6, Mohammad QD7.

Author information: 1 Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands. 2 Laboratory Sciences and Services Division (LSSD), The International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh. 3 Department of Intensive Care Medicine, Uttara Adhunik Medical College & Hospital, Dhaka, Bangladesh. 4 Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands. 5 Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands. 6 Departments of Neurology and Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands. 7 Department of Neurology, National Institute of Neurosciences (NINS) and Hospital, Dhaka, Bangladesh, National Institute of Neuroscience (NINS), Dhaka, Bangladesh.




To assess the safety and feasibility of small volume plasma exchange (SVPE) for patients with Guillain-Barré syndrome (GBS).


Non-randomised, single-arm, interventional trial.


National Institute of Neurosciences and Hospital, Dhaka, Bangladesh.


Twenty adult (>18 years) patients with GBS presented within 2 weeks of onset of weakness who were unable to walk unaided for more than 10 m.


SVPE involves blood cell sedimentation in a blood bag and removal of supernatant plasma after blood cells are retransfused. This procedure was repeated three to six times a day, for eight consecutive days. Fresh frozen plasma (FFP) and normal saline were used as replacement fluid.


Serious adverse events (SAEs) were defined as severe sepsis and deep venous thrombosis related to the central venous catheter (CVC) used during SVPE. SVPE was considered safe if less than 5/20 patients experienced an SAE, and feasible if 8 L plasma could be removed within 8 days in at least 15/20 patients.


Median patient age 33 years (IQR 23-46; range 18-55); 13 (65%) were male. Median Medical Research Council (MRC) sum score was 20 (IQR 0-29; range 0-36); three (15%) patients required mechanical ventilation. One patient developed SAE (severe sepsis, possibly related to CVC). The median plasma volume exchanged was 140 mL/kg (range 110-175) and removal of 8 L plasma was possible in 15 (75%) patients. Patients received a median 1 g/kg IgG via FFP although a substantial proportion of IgG was probably removed again by the SVPE sessions. GBS disability score improved by at least one grade in 14 (70%) patients 4 weeks after SVPE started. No patients died.


SVPE seems a safe and feasible alternative treatment to standard plasma exchange (PE) or intravenous immunoglobulin (IVIg) for GBS; further studies of clinical efficacy in low-income and middle-income countries are warranted.


© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

KEYWORDS: Guillain-Barré syndrome; feasibility; safety; small volume plasma exchange

PMID: 30121613 DOI: 10.1136/bmjopen-2018-022862

Keywords: GBS; Small Volume Plasma Exchange; Neurology.


The 2016 #Singapore #ZIKV #outbreak did not cause a surge in #GBS (J Peripher Ner Syst., abstract)

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

J Peripher Nerv Syst. 2018 Aug 2. doi: 10.1111/jns.12284. [Epub ahead of print]

The 2016 Singapore ZIKV outbreak did not cause a surge in Guillain-Barré syndrome.

Umapathi T1, Kam YW2, Ohnmar O1, Ng BCJ1, Ng Y3, Premikha M1, Leo YS4,5, Ng LFP2,6.

Author information: 1 National Neuroscience Institute, Singapore. 2 Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore. 3 Epidemiology and Disease Control Division, Ministry of Health, Singapore. 4 Communicable Disease Centre, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore. 5 Saw Swee Hock School of Public Health, National University of Singapore, Singapore. 6 Institute of Infection and Global Health, University of Liverpool, United Kingdom.



Although individuals with Zika virus (ZIKV) antibodies were reported in Malaya in mid-1950s, entomological and human surveillance in Singapore did not identify autochthonous transmission until the outbreak of August-November, 2016. Four hundred and fifty five cases from 15 separate clusters were identified. We asked if this ZIKV outbreak increased the incidence of Guillain-Barré syndrome (GBS) and aimed to characterize these cases. Eleven GBS cases, consecutively enrolled into our prospective GBS database from onset to 4 weeks after outbreak, and 6 controls, comprising 3 GBS patients enrolled before outbreak and 3 non-GBS patients, were examined for evidence of recent ZIKV infection. We performed serum, urine ZIKV RT-PCR, ZIKV serology and virus neutralization assays, accounting for cross reaction and co-infection with dengue (DENV). We found 5 GBS cases with only serological evidence of recent ZIKV infection (including one ZIKV-DENV co-infection). A temporal relationship with ZIKV outbreak was unlikely as 2 cases were GBS controls enrolled 3 months before outbreak. None reported symptoms of ZIKV infection. In addition, compared to last 10 years the national number of GBS hospitalizations did not increase during and immediately after outbreak. We conclude the 2016 Singapore ZIKV outbreak did not cause a change in GBS epidemiology.

This article is protected by copyright. All rights reserved.

KEYWORDS: Dengue virus; Guillain-Barré Syndrome; Zika virus

PMID: 30070025 DOI: 10.1111/jns.12284

Keywords: Zika Virus; GBS; Singapore.