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.




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


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.


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.


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.


#Zika virus #infection: A correlation between #prenatal ultrasonographic and #postmortem #neuropathologic changes (Neuropathology, abstract)

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

Neuropathology. 2019 Nov 11. doi: 10.1111/neup.12603. [Epub ahead of print]

Zika virus infection: A correlation between prenatal ultrasonographic and postmortem neuropathologic changes.

Gutiérrez Sánchez LA1,2, Sandoval Martínez DK1,3, Díaz-Martínez LA1, Becerra Mojica CH1,2.

Author information: 1 School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia. 2 Department of Gynecology and Obstetrics, Hospital Universitario de Santander, Bucaramanga, Colombia. 3 Department of Pathology, Hospital Universitario de Santander, Bucaramanga, Colombia.



This study presents a correlation between prenatal ultrasonographic images and neuropathologic findings of postmortem tissue samples from five confirmed cases of perinatal Zika virus (ZIKV) infection belonging to the cohort of the ZEN Initiative in Bucaramanga, Colombia. Deaths occurred between June 2016 and March 2017. Mothers consulted with ZIKV infection clinical manifestations or fetal central nervous system (CNS) abnormalities or both. A detailed ultrasound scan and neurosonographic protocol was performed by maternal fetal specialists. Perinatal autopsies were performed following the Colombian National Health Institute’s ZIKV protocol. The autopsies were from two fetal deaths, and three early neonatal deaths. Gestational age was between 262/7 and 382/7 weeks. Two cases were classified as mild microcephaly. Few findings by ultrasound and pathology were found in case 1 because it was a late infection; the other cases presented findings corresponding to congenital Zika syndrome: craniofacial malformations, cerebellar hypoplasia, anomalies of the corpus callosum and ventriculomegaly, all confirmed in autopsy specimens. By ultrasonography, hyperechogenicities were seen in several brain structures, which correspond to cortical and periventricular calcifications, subependymal glial reactivity and perivascular rings. The ultrasound and pathological findings show a wide spectrum of CNS anomalies that confirm the neurotropic effect of the ZIKV, recognizing the neuroimaging findings of this disease (unilateral ventriculomegaly, alterations in the corpus callosum and cerebellum, and calcifications) are highly suggestive of ZIKV infection.

© 2019 Japanese Society of Neuropathology.

KEYWORDS: Zika virus infection; arthrogryposis; corpus callosum dysgenesis; lissencephaly; microcephaly

PMID: 31710135 DOI: 10.1111/neup.12603

Keywords: Zika Virus; Neuroimaging; Neuroinvasion; Pediatrics; Radiology.


Use of #MRI in the #diagnosis and #prognosis of acute necrotizing #encephalopathy in a #Chinese teenager: A case report (Medicine (Baltimore), abstract)

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

Medicine (Baltimore). 2019 Nov;98(44):e17797. doi: 10.1097/MD.0000000000017797.

Use of MRI in the diagnosis and prognosis of acute necrotizing encephalopathy in a Chinese teenager: A case report.

Li H1, Sun C2, Chi S2, Wang Y2, Wu L3, Qin X3.

Author information: 1 Department of Magnetic Resonance Imaging. 2 Department of Intensive Care Unit. 3 Department of Neurology, People’s Hospital of RiZhao, Rizhao, China.




Acute necrotizing encephalopathy (ANE) is a rapidly progressing disease associated with frequent neurologic sequelae and has poor prognosis. Currently, the diagnosis and treatment of ANE rely on neuroradiologic findings and offering supportive care. Here, we report the successful treatment of a teenager diagnosed with ANE using combination of high-dose methylprednisolone and oseltamivir.


The patient, a 15-year-old female, presented with impaired consciousness and seizures secondary to acute upper respiratory tract infection. A series of brain magnetic resonance images (MRIs) were obtained toward establishing a possible diagnosis.


Based on the history of presenting illness and subsequent brain MRI scans, the patient was diagnosed to be suffering from ANE.


Following the diagnosis, the patient was placed on therapy comprising of high-dose methylprednisolone and oseltamivir.


After treatment with methylprednisolone and oseltamivir for 15 days, the patient recovered nearly completely from ANE as confirmed by subsequent brain MRI scans. No complications or other emerging clinical symptoms were noted for the duration of follow-up that lasted 6 months.


Contrary to common reports, ANE can occur beyond pediatric populations and its treatment should not be restricted to supportive care. Our case suggests that the use of high-dose corticosteroids and oseltamivir leads to promising prognosis.

PMID: 31689857 DOI: 10.1097/MD.0000000000017797

Keywords: Neurology; Neuroimaging; Antivirals; Corticosteroids; Oseltamivir; Encephalopathy.


#Clinical, #laboratory and immune aspects of #zika virus-associated #encephalitis in #children (Int J Infect Dis., abstract)

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

Int J Infect Dis. 2019 Oct 30. pii: S1201-9712(19)30424-2. doi: 10.1016/j.ijid.2019.10.030. [Epub ahead of print]

Clinical, laboratory and immune aspects of zika virus-associated encephalitis in children.

Salgado DM1, Vega R2, Rodríguez JA2, Niño Á2, Rodríguez R2, Ortiz Á2, DeLaura I3, Bosch I4, Narváez CF5.

Author information: 1 Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Departamento de Pediatría, Hospital Universitario de Neiva, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia. Electronic address: 2 Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Departamento de Pediatría, Hospital Universitario de Neiva, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia. 3 Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Harvard College, Fulbright U.S. Program, Cambridge, MA 02138, USA. 4 E25Bio Inc. The Engine of MIT. 501 Massachusetts Ave. Cambridge, MA 02139, USA; Mount Sinai School of Medicine. Department of Medicine, 10029-6500, NY, USA. 5 Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia. Electronic address:




To evaluate the clinical, laboratory and immune characteristics of ZIKV-associated encephalitis in pediatric patients after the epidemic in Huila, southern Colombia.


A pediatric neuro-surveillance hospital study was conducted in a referral health center in southern Colombia, from October 2016 to October 2017. Cases of encephalitis were confirmed by nucleic acid amplification tests and serological methods in cerebrospinal fluid (CSF), plasma and/or urine. Levels of six cytokines were evaluated by flow cytometry. Patients underwent daily clinical and laboratory follow-ups.


Twenty children with probable encephalitis were included for further studies and 16 of them were confirmed. Four cases of S. pneumoniae, group B Streptococcus, S. epidermidis, and E. coli. bacterial meningoencephalitis and 12 cases of viral encephalitis were identified, six of them associated with ZIKV infection. Other viral encephalitis were caused by Herpes viruses (n = 3), enterovirus (n = 2) and one DENV-2 infection. ZIKV-associated encephalitis symptoms subsided faster compared to those of patients with encephalitis caused by other agents. CSF analysis revealed lymphocytic pleocytosis. Compared to healthy controls, children with ZIKV-associated encephalitis presented with modest plasma IL-10 but not IL-2, IL-4, IL-6, IFN-γ, or TNF-α. Cytokine expression was differentially regulated as dramatically elevated IL-6, IL-10 and IFN-γ levels were observed in CSF but not in paired plasma in one of the patients with ZIKV detectable in CSF.


This study provides evidence that ZIKV is responsible for pediatric encephalitis in endemic areas and the local presence of virus may induce cephalic but not systemic expression of cytokines.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Dengue virus; Neurologic surveillance; Pediatric; Viral encephalitis; Zika virus

PMID: 31678190 DOI: 10.1016/j.ijid.2019.10.030

Keywords: Zika Virus; Encephalitis; Pediatrics; Neurology.


#Clinical #findings in #congenital #infection by #Zika virus: a retrospective study in a reference hospital in Central-West #Brazil (BMC Pediatr., abstract)

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

BMC Pediatr. 2019 Oct 29;19(1):389. doi: 10.1186/s12887-019-1762-6.

Clinical findings in congenital infection by Zika virus: a retrospective study in a reference hospital in Central-West Brazil.

de Paula Guimarães C1, Macedo MS2, Barbosa MA3, Marques SM4, Costa PS4, de Oliveira ÊC4.

Author information: 1 Hospital das Clínicas da UFG/EBSERH, Goiânia, GO, Brazil. 2 Secretaria Municipal de Saúde, Goiânia, GO, Brazil. 3 Faculdade de Enfermagem da UFG, Goiânia, GO, Brazil. 4 Faculdade de Medicina da UFG, Goiânia, GO, Brazil.




An increased number of congenital Zika virus infections with neurological and musculoskeletal malformations have been diagnosed worldwide, however, there are still several gaps in the knowledge about this infection, its associated mechanism, timing of transmission, and description of throughout findings of signs and symptoms, which is described in this paper. The purpose of this study is to describe aspects of congenital Zika syndrome (CZS) beyond the central nervous system comprising detailed delineation of all the other clinical findings.


A retrospective research developed using electronic medical records. We analyzed the files of 69 children with an initial diagnosis of microcephaly by Zika vírus who were born in 2015, 2016 and 2017, treated during the period from 2016 to 2017.


The newborns presented several neurological and musculoskeletal malformations, eye damage, hearing impairment and other malformations.


The present study has significant impact for health care teams following lactents with Congenital Zika Syndrome.

KEYWORDS: Malformations; Microcephaly; Zika virus

PMID: 31660908 DOI: 10.1186/s12887-019-1762-6

Keywords: Zika Virus; Zika Congenital Syndrome; Pediatrics; Brazil.


#Cognitive #Development of #Infants Exposed to the #Zika Virus in #PuertoRico (JAMA Netw Open, abstract)

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

JAMA Netw Open. 2019 Oct 2;2(10):e1914061. doi: 10.1001/jamanetworkopen.2019.14061.

Cognitive Development of Infants Exposed to the Zika Virus in Puerto Rico.

Valdes V1, Zorrilla CD2, Gabard-Durnam L1, Muler-Mendez N2, Rahman ZI1, Rivera D2, Nelson CA 3rd1,3.

Author information: 1 Laboratories of Cognitive Neuroscience, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts. 2 Obstetrics and Gynecology, Maternal-Infant Studies Center, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico. 3 Harvard Graduate School of Education, Cambridge, Massachusetts.




Existing research has established a causal link between Zika virus (ZIKV) infection and severe birth defects or consequent health impairments; however, more subtle cognitive impairments have not been explored.


To determine whether infants of mothers with at least 1 positive ZIKV test show differences in cognitive scores at ages 3 to 6 months and ages 9 to 12 months.


This cross-sectional study recruited infants enrolled in existing ZIKV study cohorts associated with the Maternal-Infant Studies Center and the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico and from the broader San Juan metropolitan area. The study took place at the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico. Participants were recruited through convenience sampling if their mothers underwent ZIKV testing prenatally and were at the target ages during the study period. Infants who were born preterm (<36 weeks’ gestational age), with low birth weight (<2500 g), or with a known genetic disorder were excluded. Infants were tested from ages 3 to 6 months or ages 9 to 12 months from May 2018 to April 2019. Data analysis was performed from March to April 2019.


Zika virus status was measured prenatally and in the early postnatal period using real-time polymerase chain reaction or a ZIKV IgM antibody capture enzyme-linked immunosorbent assay.


The infants’ development was assessed using the Mullen Scales of Early Learning (translated to Spanish and adapted for Puerto Rico), and assessors were blinded to each infant’s ZIKV status.


A total of 65 study participants were included. The mean (SD) age of the infants at the time of cognitive testing was 8.98 (3.19) months. Most of the infants were white (55 [84.6%]) and Puerto Rican (64 [98.5%]); 38 of the infants were male (58.5%). General cognitive and domain-specific scores did not differ significantly between prenatally ZIKV-positive and ZIKV-negative infants except for receptive language score (mean difference = 5.52; t = 2.10; P = .04). Exposure to ZIKV (B = -5.69; β = -0.26 [95% CI -11.01 to -0.36]; P = .04) and a measure of Hurricane Maria exposure (time without water, B = -0.05; β = -0.27 [95% CI, -0.10 to -0.01]; P = .03) were both independently and significantly associated with receptive language scores after adjusting for key confounders.


Although infants exposed to ZIKV prenatally showed unaffected motor and visually mediated cognitive development, they did show deficits in receptive language scores. Receptive language skills were also associated with the degree of exposure to Hurricane Maria, with those who spent more time without water after the hurricane having lower receptive language scores.

PMID: 31651970 DOI: 10.1001/jamanetworkopen.2019.14061

Keywords: Zika Virus; Pediatrics; Psychiatry; Extreme Weather; Hurricanes; Society; Puerto Rico.


#Hospitalization, #Alzheimer’s and Related #Neuropathologies, and Cognitive Decline (Ann Neurol., abstract)

[Source: Annals of Neurology, full page: (LINK). Abstract, edited.]

Hospitalization, Alzheimer’s and Related Neuropathologies, and Cognitive Decline

Bryan D. James PhD,  Robert S. Wilson PhD,  Ana W. Capuano PhD,  Patricia A. Boyle PhD,  Raj C. Shah MD,  Melissa Lamar PhD,  E. Wesley Ely MD,  David A. Bennett MD,  Julie A. Schneider MD

First published: 15 October 2019 / DOI:

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/ana.25621.




To test the hypothesis that Alzheimer’s disease and related neuropathologies contribute to the association between hospitalization and cognitive decline in old age.


As part of a longitudinal clinical‐pathologic cohort study, 526 older persons (mean age at death=90.9, 71% female) without dementia at baseline completed annual cognitive testing and were autopsied at death. Hospitalization information was obtained from linked Medicare claims records. Neuropathologic examination assessed β‐amyloid burden, tau tangle density, neocortical Lewy bodies, hippocampal sclerosis, chronic gross and microscopic cerebral infarcts, and TDP‐43.


Over mean 5.1 years, a total of 1,383 hospitalizations occurred and the mean annual rate of hospitalization was 0.5 (SD=0.6; median=0.4). Higher rate of hospitalizations was not directly related to higher burden for any of the neuropathologic markers. Higher rate of hospitalization was associated with more rapid cognitive decline (estimate=‐0.042, SE=0.012, p<0.001), and after controlling for all 7 neuropathologic markers, the association was essentially the same (estimate=‐0.040, SE=0.013, p=0.002). In a multivariable model with three‐way interactions of neuropathologic markers with hospitalization rate and time, the association between hospitalization rate and faster cognitive was greater in persons with more tangle pathology (estimate for interaction= ‐0.007, SE=0.002, p=0.002) and in persons with neocortical Lewy bodies (estimate for interaction=‐0.117, SE=0.042, p=0.005).


Older persons with more hospitalizations experienced faster rates of cognitive decline, and this association was more pronounced in persons with more tau tangle density and with neocortical Lewy body pathologies.

This article is protected by copyright. All rights reserved.

Keywords: Alzheimer’s Disease; Neurology.