Acute flaccid #myelitis caused by #EVD68: Case #definitions for use in #clinical practice (Eur J Paediatr Neurol., abstract)

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

Eur J Paediatr Neurol. 2019 Jan 11. pii: S1090-3798(18)30281-2. doi: 10.1016/j.ejpn.2019.01.001. [Epub ahead of print]

Acute flaccid myelitis caused by enterovirus D68: Case definitions for use in clinical practice.

Kramer R1, Lina B2, Shetty J3.

Author information: 1 European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control, Stockholm, Sweden; Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agent Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France. Electronic address: kramer-rolf@gmx.de. 2 Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agent Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France; Virpath, CIRI, Université de Lyon, INSERM U1111, CNRS 5308, ENS de Lyon, UCBL, Lyon, France. 3 Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK; Child Life and Health, University of Edinburgh, Edinburgh, UK.

 

Abstract

Acute flaccid myelitis (AFM) was increasingly detected in recent years, coinciding with upsurges of enterovirus D68 (EV-D68) infections. We reviewed the evidence for a causal relationship between both. Based on reported cases, we provide case definitions for AFM caused by EV-D68 infections to enable a standard procedure for affected patients. Current case definitions are focussing on epidemiological aspects but clinical case definitions are still missing. We propose the following case definitions to be used in clinical practice in order to mirror clinical realities and facilitate a common systematic approach in case management: A possible case is defined as a person presenting with either acute myelitis/paralysis or Guillain-Barré Syndrome (GBS), particularly during periods of EV-D68 circulation. A probable case is defined as a person presenting with symptoms of either acute myelitis/paralysis or GBS and at least one of the following criteria: i) MRI abnormality representing with T2 hyperintensity in spinal cord grey matter with or without hyperintensity at dorsal brain stem, ii) investigations showing an axonal neuropathy including reduced compound motor action potentials with normal conduction velocities and absence of conduction blocks compatible with anterior horn cell disease or iii) detection of enteroviruses in a respiratory specimen obtained from the lower respiratory tract during periods of EV-D68 circulation. A confirmed case is defined as a person presenting with acute flaccid myelitis/paralysis, MRI abnormality and detection of enterovirus-D68-specific nucleic acids in a respiratory specimen using a validated PCR assay targeting the VP1 gene with subsequent sequencing and typing.

Copyright © 2019 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

KEYWORDS: Acute flaccid myelitis; Clinical case definitions; Enterovirus D68; Enteroviruses; Paralysis

PMID: 30670331 DOI: 10.1016/j.ejpn.2019.01.001

Keywords: AFM; EV-D68; GBS.

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#Incidence study of #GBS in the province of #Ferrara, Northern #Italy, between 2003 and 2017. A 40-year follow-up (Neurol Sci., abstract)

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

Neurol Sci. 2019 Jan 7. doi: 10.1007/s10072-018-3688-4. [Epub ahead of print]

Incidence study of Guillain-Barré syndrome in the province of Ferrara, Northern Italy, between 2003 and 2017. A 40-year follow-up.

Granieri E1, Andreasi NG2, De Martin P2, Govoni V2, Castellazzi M2, Cesnik E2, Pugliatti M2, Casetta I2.

Author information: 1 Department of Biomedical and Specialty-Surgical Sciences, Section of Neurology, Psychology and Psychiatry, University of Ferrara, Via Aldo Moro 8, 44124, Cona, Ferrara, Italy. enrico.granieri@unife.it. 2 Department of Biomedical and Specialty-Surgical Sciences, Section of Neurology, Psychology and Psychiatry, University of Ferrara, Via Aldo Moro 8, 44124, Cona, Ferrara, Italy.

 

Abstract

BACKGROUND:

Guillain-Barré syndrome (GBS) is an acute/subacute autoimmune inflammatory polyradiculoneuropathy. Previous epidemiological studies carried out in the province of Ferrara, Italy, from 1981 to 2002 indicated that GBS incidence had tendency of increase in the period considered.

OBJECTIVES:

We aimed at updating the epidemiology of GBS in the years 2003-2017 and carrying on the work started in the 1980s.

METHODS:

We conducted an incidence study, by adopting a complete enumeration approach. Cases were identified from administrative, medical records, and database of the Ferrara Hospital and other provincial structures of the study area. Case ascertainment and definition are analogous to those adopted in previous surveys.

RESULTS:

In the period 1 January 2003 to 31 December 2017, 73 patients living in the province of Ferrara (mean population 353,142) were found to be new cases of GBS fulfilling the NINCDS criteria. Male/female ratio 1.15. The mean incidence rate was 1.38 per 100,000 (95% CI 1.08-1.74), 1.54 per 100,000 for men and 1.23 per 100,000 for women, a nonsignificant difference. During the period considered, the rates had slow increase or mild decrease, without nonsignificant difference. The highest rates were observed for the age groups 70-79 years for both sexes. A half of patients reported infectious events in the weeks before the onset of symptoms.

CONCLUSION:

In line with many epidemiological data, in the whole period 2003-2017, we observed a trend towards increase or decrease in incidence and periods of relative stability. Similar temporal heterogeneity with the comparison to our previous works was found.

KEYWORDS: Epidemiology; Ferrara; Guillain-Barré syndrome; Incidence; Italy

PMID: 30617450 DOI: 10.1007/s10072-018-3688-4

Keywords: GBS; Neurology; Italy.

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#Zika virus #infection as a cause of #congenital #brain abnormalities and #GBS: From systematic review to living systematic review (F1000Res., abstract)

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

F1000Res. 2018 Feb 15;7:196. doi: 10.12688/f1000research.13704.1. eCollection 2018.

Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: From systematic review to living systematic review.

Counotte MJ1, Egli-Gany D1, Riesen M1, Abraha M1, Porgo TV2, Wang J1, Low N1.

Author information: 1 Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. 2 Department of Social and Preventative Medicine, Université Laval, Québec, Canada.

 

Abstract

Background.

The Zika virus (ZIKV) outbreak in the Americas has caused international concern due to neurological sequelae linked to the infection, such as microcephaly and Guillain-Barré syndrome (GBS). The World Health Organization stated that there is “sufficient evidence to conclude that Zika virus is a cause of congenital abnormalities and is a trigger of GBS”. This conclusion was based on a systematic review of the evidence published until 30.05.2016. Since then, the body of evidence has grown substantially, leading to this update of that systematic review with new evidence published from 30.05.2016 – 18.01.2017, update 1.

Methods.

We review evidence on the causal link between ZIKV infection and adverse congenital outcomes and the causal link between ZIKV infection and GBS or immune-mediated thrombocytopaenia purpura. We also describe the transition of the review into a living systematic review, a review that is continually updated.

Results.

Between 30.05.2016 and 18.01.2017, we identified 2413 publications, of which 101 publications were included. The evidence added in this update confirms the conclusion of a causal association between ZIKV and adverse congenital outcomes. New findings expand the evidence base in the dimensions of biological plausibility, strength of association, animal experiments and specificity. For GBS, the body of evidence has grown during the search period for update 1, but only for dimensions that were already populated in the previous version. There is still a limited understanding of the biological pathways that potentially cause the occurrence of autoimmune disease following ZIKV infection.

Conclusions.

This systematic review confirms previous conclusions that ZIKV is a cause of congenital abnormalities, including microcephaly, and is a trigger of GBS. The transition to living systematic review techniques and methodology provides a proof of concept for the use of these methods to synthesise evidence about an emerging pathogen such as ZIKV.

KEYWORDS: Guillain-barre syndrome; Zika virus; causality; congenital abnormalities; living systematic review; microcephlay

PMID: 30631437 PMCID: PMC6290976 DOI: 10.12688/f1000research.13704.1

Keywords: Zika Virus; Zika Congenital Infection; GBS.

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The #Zika Virus: An Association to #GBS in the #USA – A Case Report (P R Health Sci J., abstract)

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

P R Health Sci J. 2018 Dec;37(Special Issue):S93-S95.

The Zika Virus: An Association to Guillain-Barré Syndrome in the United States – A Case Report.

Rivera-Concepción JR1, Betancourt JP1, Cerra J2, Reyes E1.

Author information: 1 Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR. 2 Department of Medicine, Veterans Affairs Caribbean Healthcare System, University of Puerto Rico Medical Sciences Campus, San Juan, PR.

 

Abstract

Case of a 37 year-old Puerto Rican male with no past medical history who was admitted to the hospital after developing paresthesia in the upper and lower extremities with associated skin rash, weakness, and dysautonomia. After rigorous analysis of the clinical patterns, neurologic manifestations, laboratory workups, CSF analysis, and nerve conduction studies we conclude the existence of a strong relationship between the Zika virus and the Guillain-Barré syndrome. The patient recovered promptly and his response to treatment was excellent.

KEYWORDS: Guillain-Barré; ZIKA; Zika and Guillain-Barré

PMID: 30576585

Keywords: Zika Virus; GBS; Puerto Rico; USA.

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Implementation and #Evaluation of #GBS #Surveillance in #PuertoRico during the 2016 #Zika Virus #Epidemic (P R Health Sci J., abstract)

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

P R Health Sci J. 2018 Dec;37(Special Issue):S85-S92.

Implementation and Evaluation of Guillain-Barré Syndrome Surveillance in Puerto Rico during the 2016 Zika Virus Epidemic.

Major CG1, Dirlikov E2, Medina NA3, Lugo-Robles R4, Matos D3, Muñoz-Jordán J3, Colón-Sánchez C3, García-Negrón M5, Olivero-Segarra M5, Malavé-González G5, Thomas DL6, Luciano CA7, Waterman SH8, Sejvar J3, Sharp TM8, Rivera-García B4.

Author information: 1 Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC); Office for State, Tribal, Local, and Territorial Support, US CDC. 2 Office of Epidemiology and Research, Puerto Rico Department of Health (PRDH); Epidemic Intelligence Service, Division of Scientific Education and Professional Development, US CDC. 3 Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC). 4 Office of Epidemiology and Research, Puerto Rico Department of Health (PRDH). 5 Public Health Laboratory, PRDH. 6 Division of State and Local Readiness, Office of Public Health Preparedness and Response, US CDC; United States Public Health Service, Commissioned Corps. 7 Neurology Section, University of Puerto Rico Medical Sciences Campus, San Juan, PR. 8 Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC); United States Public Health Service, Commissioned Corps.

 

Abstract

OBJECTIVE:

Guillain-Barré syndrome (GBS) is an uncommon autoimmune disorder that follows infection or vaccination, and increased incidence has been reported during Zika virus (ZIKV) transmission. During the 2016 ZIKV epidemic, the Puerto Rico Department of Health (PRDH) implemented the Enhanced GBS Surveillance System (EGBSSS). Here, we describe EGBSSS implementation and evaluate completeness, validity, and timeliness.

METHODS:

GBS cases were identified using passive surveillance and discharge diagnostic code for GBS. Completeness was evaluated by capture-recapture methods. Sensitivity and positive predictive value (PPV) for confirmed GBS cases were calculated for both case identification methods. Median time to completion of key time steps were compared by quarter (Q1-4) and hospital size.

RESULTS:

A total of 122 confirmed GBS cases with onset of neurologic illness in 2016 were identified. Capture-recapture methodology estimated that four confirmed GBS cases were missed by both identification methods. Identification of cases by diagnostic code had a higher sensitivity than passive surveillance (89% vs. 80%), but a lower PPV (60% vs. 72%). There was a significant decrease from Q1 to Q3 in median time from hospital admission to case reporting (11 days vs. 2 days, p = 0.032) and from Q2 to Q3 in median time from specimen receipt to arbovirus laboratory test reporting (35 days vs. 26 days, p = 0.004).

CONCLUSION:

EGBSSS provided complete, valid, and increasingly timely surveillance data, which guided public health action and supported healthcare providers during the ZIKV epidemic. This evaluation provides programmatic lessons for GBS surveillance and emergency response surveillance.

KEYWORDS: Guillain-Barré syndrome; Puerto Rico; Surveillance; Zika virus

PMID: 30576584

Keywords: Zika Virus; GBS; Puerto Rico; USA.

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Muscle #weakness associated with #H7N9 #infection: report of two cases (BMC Infect Dis., abstract)

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

BMC Infect Dis. 2018 Dec 20;18(1):685. doi: 10.1186/s12879-018-3592-9.

Muscle weakness associated with H7N9 infection: report of two cases.

Jin CN1, Tang LL2.

Author information: 1 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. 2 Department of Infectious Disease, The State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China. 1196040@zju.edu.cn.

 

Abstract

BACKGROUND:

The emerging avian influenza A (H7N9) virus, a subtype of influenza viruses, was first discovered in March 2013 in China. Infected patients frequently present with pneumonia and acute respiratory disorder syndrome with high rates of intensive care unit admission and death. Neurological complications, such as Guillain-Barré syndrome(GBS), and intensive care unit-acquired weakness, including critical illness polyneuropathy and myopathy, have only rarely been reported previously.

CASE PRESENTATION:

In this study, we report on two Chinese patients with H7N9 severe pneumonia presenting neurological complications. These two patients had non-immune diseases prior to the onset of virus infection. A 56-year-old female patient (case 1) and a 78-year-old female patient (case 2) were admitted because of fever, cough, chest tightness and shortness of breath. These patients were confirmed to have H7N9 infection soon after admission followed by the development of acute respiratory distress syndrome and various severe bacterial and fungal infections. The case 1 patient was found to have muscle weakness in all extremities after withdrawing the mechanical ventilator, and the case 2 patient was found when withdrawing extracorporeal membrane oxygenation, both of these conditions prolonged ventilator-weaning time. Furthermore, the case 1 patient carried the H7N9 virus for a prolonged period, reaching 28 days, and both of them stayed in the hospital for more than two months. A clinical diagnosis of intensive care unit-acquired weakness could be confirmed. However, based on results from electrophysiological testing and needle electromyography of these 2 patients, it is difficult to differentiate critical illness polyneuropathy from GBS, since no lumbar puncture or muscle and nerve biopsy were conducted during hospitalization. Following a long-term comprehensive treatment, the patients’ neurological condition improved gradually.

CONCLUSIONS:

Although there is great improvement in saving severe patients’ lives from fatal respiratory and blood infections, it is necessary to pay sufficient attention and to use more methods to differentiate GBS from intensive care unit-acquired weakness. This unusual neurological complication could result in additional complications including ventilator associated pneumonia, prolonged hospital stay and then would further increase the death rate, and huge costs.

KEYWORDS: Case report; Guillain–Barré syndrome; H7N9; ICU-acquired weakness; Muscle weakness

PMID: 30572825 DOI: 10.1186/s12879-018-3592-9

Keywords: Avian Influenza; H7N9; ARDS; Polyneuropathy; GBS; Human; China.

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#Safety #assessment of seasonal trivalent #influenza #vaccine produced by Instituto #Butantan from 2013 to 2017 (Rev Inst Med Trop Sao Paulo, abstract)

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

Rev Inst Med Trop Sao Paulo. 2018 Dec 20;61:e4. doi: 10.1590/S1678-9946201961004.

Safety assessment of seasonal trivalent influenza vaccine produced by Instituto Butantan from 2013 to 2017.

Gattás VL1, Braga PE1, Koike ME1, Lucchesi MBB1, Oliveira MMM1, Piorelli RO1, Queiroz V1, Precioso AR1,2.

Author information: 1 Instituto Butantan, Divisão de Ensaios Clínicos e Farmacovigilância, São Paulo, São Paulo, Brazil. 2 Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, São Paulo, São Paulo, Brazil.

 

Abstract

Vaccination has been a successful strategy in influenza prevention. However, despite the safety and efficacy of the vaccines, they can cause adverse events following immunization (AEFI). Moreover, due to the vaccination success, most of vaccine-preventable diseases (VPD) have become rare, and public attention has been shifted from VPD to the AEFI associated with vaccination. This manuscript describes the safety of Instituto Butantan (IB) seasonal trivalent influenza vaccine (TIV) from 2013 to 2017. AEFI data were received by the Department of Pharmacovigilance of IB (PV-IB), from January the 1st 2013 to December the 31st 2017, and were recorded in an electronic database (OpenClinica©). PV-IB received 1,415 Individual Case Safety Reports (ICSR) associated with the TIV; 1,253 ICSR with at least one AEFI were analyzed and 4,140 AEFI were identified. The other 162 (11.4%) cases did not present any symptom. Among the total of AEFI, 405 (9.8%) were classified as serious. AEFI with the highest incidence rates per 100,000 doses of TIV were: “local pain” (0.28), “local erythema” (0.23), “local warmth” (0.22), “local swelling” (0.20) and “fever” (0.19). PV-IB received 175 (4.2%) occurrences of SAE of special interest, of which 75 (1.8%) anaphylaxis/anaphylactic reactions, 56 (1.4%) neurological syndromes (including seven Guillain-Barré Syndrome) and 44 (1.1%) convulsion/febrile convulsion. The results of this manuscript suggested that Instituto Butantan trivalent influenza vaccine (IB-TIV) is safe, as most of the reported AEFI were classified as non-serious. AEFI described for the IB-TIV are in agreement with the ones described in the literature for similar vaccines.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03057483.

PMID: 30570077 DOI: 10.1590/S1678-9946201961004

Keywords: Seasonal Influenza; Drugs Safety; GBS; Brazil; Vaccines.

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