Reporte de un caso de Síndrome de Guillain Barré post vacuna Coronavac: ¿rol causal o asociación temporal? / Guillain Barre syndrome associated with Coronavac vaccine: report of one case

We report a 50-year-old woman with a history of celiac disease, who presented with lumbar pain and progressive flaccid tetraparesis 48 hours after the inoculation of the first dose of CoronaVac inactivated SARS-CoV-2 vaccine. CSF was normal and electrodiagnostic studies showed an axonal motor polyneuropathy. No other triggers were identified, and other etiologies were ruled out. The presentation was compatible with the AMAN (Acute Motor Axonal Neuropathy) subtype of GBS, and intravenous immunoglobulin halted the progression of symptoms. Intensive neurorehabilitation was performed. The patient was discharged five weeks after admission, walking with poles and climbing stairs with minimal assistance. To date no cases of inactivated SARSCoV-2 vaccine related GBS have been reported. Thus, description of its clinical presentation is relevant. We discuss the current evidence relating GBS with vaccines, highlighting that vaccine associated GBS is a controversial entity and causality must be interpreted cautiously given the actual COVID-19 pandemic context.

Guillain-Barré syndrome in patients with SARS-CoV-2 infection. Report of three cases / Síndrome de Guillain-Barré en pacientes con infección por SARS-CoV-2. Reporte de tres casos

ABSTRACT Several cases of Guillain Barre Syndrome (GBS) associated with SARS-CoV-2 have been published, most being acute inflammatory demyelinating polyradiculoneuropathy. Between April and December 2020, 1,499 cases of SARS-CoV-2 infection were admitted to Hospital del Salvador, in Santiago, Chile, serving a population of 521,920 adults. In the same period, seven cases of GBS were admitted. Three females had a demyelinated type of GBS associated with SARS-CoV-2 infection. All three presented with progressive flaccid symmetrical areflexic weakness with inability to walk, one needed intubation and mechanical ventilation due to SARS-CoV2 infection. All had a favorable, rapid response to intravenous immunoglobulin. In two patients, the onset of GBS was almost concomitant with SARS-CoV-2 infection. A causal relationship between SARS-CoV-2 and GBS has been questioned since no increase of GBS has occurred during the pandemic. However, a rise in GBS associated with SARS-CoV-2 infection could be hidden due to a general decrease of GBS due to the decrease of all other infections. Lack of reporting due to the pandemic could be an added factor.

Se han publicado varios casos de síndrome de Guillain Barre (SGB) asociados con el SARS-CoV-2, la mayoría de los cuales son polirradiculoneuropatía desmielinizante inflamatoria aguda. Entre abril y diciembre de 2020, se ingresaron 1.499 casos de infección por SARS-CoV-2 en el Hospital del Salvador de Santiago de Chile, que atiende a una población de 521.920 adultos. Durante el mismo período se admitieron siete casos de SGB. Tres pacientes de sexo femenino con SGB tipo desmielinizante asociado a una infección por SARS-CoV-2. Las tres presentaron debilidad simétrica, flácida y arrefléctica progresiva, con incapacidad para caminar, una necesitó intubación y ventilación mecánica debido a la infección por SARS-CoV2. Todas tuvieron una respuesta rápida y favorable a la inmunoglobulina intravenosa. En dos pacientes, la aparición de SGB fue casi concomitante con la infección por SARS-CoV-2. Una relación causal entre el SARS-CoV-2 y SGB ha sido cuestionada ya que no se ha producido ningún aumento de SGB durante la pandemia. Sin embargo, un aumento de SGB asociado con la infección por SARS-CoV-2 podría ocultarse en una disminución general de SGB debido a la disminución de todas las demás infecciones asociadas a este. La sub-notificación debido a la dimensión de la pandemia podría ser también un factor.

Guía basada en la evidencia. Diagnóstico y manejo del síndrome de Guillain-Barré en diez pasos / Evidence based guidelines. Diagnosis and management of Guillain-Barré syndrome in ten steps

Resumen El síndrome de Guillain-Barré (SGB) es una enfermedad inmunológica del nervio periférico y las raíces nerviosas, poco frecuente, potencialmente mortal y que suele desencadenarse por infecciones. La incidencia del SGB puede aumentar durante el brote de enfermedades infecciosas, tal como se observó en las epidemias del virus Zika en la Polinesia Francesa en 2013 y en América Latina en 2015. El diagnóstico y el manejo clínico del SGB pueden ser complicados ya que su presentación y el curso de la enfermedad son heterogéneos, y actualmente no se cuenta con guías clínicas internacionales. Para respaldar a los médicos, especialmente en el contexto de un brote de una enfermedad infecciosa, hemos desarrollado una guía clínica aplicable en todo el mundo para el diagnóstico y el tratamiento del SGB. La guía se basa en literatura actualizada y el consenso de expertos, y tiene una estructura de diez pasos para facilitar su uso en la práctica clínica. Inicialmente, brindamos una introducción a los criterios de diagnóstico, variantes clínicas y diagnósticos diferenciales del SGB. Los diez pasos luego abordan el reconocimiento y el diagnóstico temprano del SGB, la admisión a la unidad de cuidados intensivos, indicación y selección de tratamiento, seguimiento y tratamiento de la progresión de la enfermedad, predicción del curso clínico, resultados y tratamiento de complicaciones y secuelas.

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 in 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 diag nostic 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.

Clinical-epidemiological characteristics associated with discharge outcomes and seasonality among surviving patients with Guillain-Barré syndrome in a national third-level hospital, Lima, Peru / Características clínico-epidemiológicas asociadas con los resultados al alta y la estacionalidad entre los pacientes sobrevivientes con síndrome de Guillain-Barré en un hospital nacional de tercer nivel, Lima, Peru

ABSTRACT Background: Guillain-Barré syndrome (GBS) is an autoimmune disease that affects the peripheral nervous system. Severe motor deficit (SMD), respiratory impairment, cranial nerve involvement and autonomic dysfunction are associated with a poor prognosis. Objective: To investigate the association between the clinical-epidemiological characteristics and the discharge results among Peruvian patients with GBS. Methods: We carried out a retrospective observational study on patients with GBS who survived until discharge. We used the Brighton Collaboration's criteria and considered Hughes Severity Scale (HSS) scores greater than two to be SMD. We defined the discharge results as an improvement if the HSS score decreased by at least one point from admission to hospital discharge and defined hospital stay as prolonged if > 14 days. Results: We analyzed 92 patients, among whom 70.7% were male. Quadriparesis (81.1%) and hyporeflexia (86.8%) were the most characteristic manifestations. We observed that more than half of the cases were in summer and winter. Gastrointestinal infections were associated with a higher proportion of prolonged stays. The proportion of improvement was lower among patients who had an SMD at hospital admission. We confirmed these results through fitting in multivariate models. Conclusions: The prolonged stay was related to previous gastrointestinal infection, while a less improvement in SMD individuals at admission. Prospective multicenter surveillance systems are needed for monitoring GBS cases in low-income settings like Peru.

RESUMEN Antecedentes: El síndrome de Guillain-Barré (SGB) es una enfermedad autoinmune que afecta al sistema nervioso periférico. Déficit motor severo (DMS), compromiso respiratorio, afectación de pares craneales y disfunción autonómica se asocian con un mal pronóstico. Objetivo: Investigar la asociación entre las características clínico-epidemiológicas y los resultados del alta en pacientes peruanos con SGB. Métodos: Realizamos un estudio observacional retrospectivo de pacientes con SGB supervivientes hasta el alta. Consideramos los criterios de colaboración de Brighton y una escala de severidad de Hughes (ESH) superior a dos como un DMS. Definimos los resultados del alta como una mejoría si el ESH disminuyó en al menos un punto desde el ingreso hasta el alta hospitalaria y una estadía prolongada si el tiempo de hospitalización fue > 14 días. Resultados: Analizamos 92 pacientes, de los cuales el 70,7% eran varones. La cuadriparesia (81,1%) y la hiporreflexia (86,8%) fueron las manifestaciones más características. Observamos más de la mitad de los casos en verano e invierno. Las infecciones gastrointestinales se asociaron con una mayor proporción de estadías prolongadas. La proporción de mejoría fue menor en los pacientes que tenían un DMS al ingreso hospitalario. Confirmamos estos resultados con modelos multivariados ajustados. Conclusiones: La estadía prolongada se relacionó con infección gastrointestinal previa, mientras que una mejoría menor en individuos con DMS al ingreso. Necesitamos sistemas de vigilancia multicéntricos prospectivos para monitorear los casos de SGB en un entorno de bajos ingresos como Perú.

Epidemiological and clinical aspects of Guillain-Barré syndrome and its variants / Aspectos epidemiológicos e clínicos da síndrome de Guillain-Barré e suas variantes

Abstract Background: Guillain-Barré syndrome (GBS), an acute polyradiculoneuropathy that occurs because of an abnormal inflammatory response in the peripheral nervous system, is clinically characterized by acute flaccid paresis and areflexia with or without sensory symptoms. This syndrome can lead to disabling or even life-threatening sequelae. Objective: This study aimed to present the clinical and epidemiological aspects of GBS in patients admitted to a tertiary-level hospital in the Federal District between January 2013 and June 2019. Methods: In this observational, cross-sectional and retrospective study, medical records of patients diagnosed with acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy or acute axonal motor-sensitive neuropathy based on electromyographic findings were included, and clinical data were collected retrospectively. Results: A total of 100 patients (63 males and 37 females; ratio, 1.7:1) aged 2-86 years (mean, 36.4 years) were included. The mean annual incidence rate of GBS was 0.54 cases/100,000 inhabitants, with 52 and 49% of the cases occurring between October and March (rainy season) and between April and September (dry season), respectively. The proportions of patients showing each GBS variant were as follows: demyelinating forms, 57%; axonal forms, 39%; and undetermined, 4%. The mean duration of hospitalization was 8-15 days for most patients (38%). During hospitalization, 14% of the patients required mechanical ventilation and 20% experienced infectious complications. Conclusion: The findings indicate that there was an increase in the incidence of GBS during the rainy season. Moreover, we did not observe the typical bimodal distribution regarding age at onset.

RESUMO Introdução: Síndrome de Guillain-Barré (SGB), uma polirradiculoneuropatia aguda que ocorre devido a uma resposta inflamatória anormal no sistema nervoso periférico, é caracterizada clinicamente por paralisia flácida aguda e arreflexia, com ou sem sintomas sensitivos. Essa síndrome pode deixar sequelas incapacitantes ou até ameaçar a vida. Objetivo: Apresentar os aspectos clínicos e epidemiológicos da SGB em pacientes internados em um hospital terciário do Distrito Federal, no período de janeiro/2013 a junho/2019. Métodos: Estudo observacional, transversal e retrospectivo, no qual pacientes com diagnóstico de polirradiculoneuropatia desmielinizante inflamatória aguda, neuropatia axonal motora aguda ou neuropatia axonal sensitivo motora aguda a partir dos achados eletroneuromiográficos foram selecionados e seus dados clínicos coletados retrospectivamente em seus prontuários. Resultados: Um total de 100 pacientes (63 homens e 37 mulheres; proporção de 1,7:1), com idades entre 2-86 anos (média, 36,4 anos), foram incluídos. A taxa média anual de incidência de SGB foi de 0,54 casos/100.000 habitantes, com 52 e 49% dos casos ocorrendo entre outubro e março (período chuvoso) e entre abril e setembro (período seco), respectivamente. A proporção de pacientes que apresentaram cada variante de SGB foi a seguinte: formas desmielinizantes, 57%; formas axonais, 39%; e indeterminado, 4%. A duração média da hospitalização foi de 8‒15 dias para a maioria dos pacientes (38%). Durante a hospitalização, 14% dos pacientes necessitaram de ventilação mecânica e 20% apresentaram complicações infecciosas. Conclusão: Os resultados indicam aumento na incidência de GBS durante a estação chuvosa. Além disso, não observamos a distribuição bimodal típica em relação à idade de início.

Guillain-Barré syndrome: advances and future perspectives / Síndrome de Guillain-Barré: avanços e perspectivas futuras

The first case of Guillain-Barré syndrome was described in 1916. Since then, knowledge about the pathophysiology and immunogenesis of this acquired inflammatory polyradiculoneuropathy has been growing steadily, especially after the advent of nerve conduction studies and the discovery of pathogenic autoantibodies. In the present study, we conducted a review of the main information available in the literature to date about the syndrome, including its diagnosis and management.

A síndrome de Guillain-Barré teve seu primeiro caso descrito em 1916. Desde então, o conhecimento sobre a fisiopatologia e imunogênese dessa polirradiculoneuropatia inflamatória adquirida vem crescendo continuamente, especialmente após o advento dos estudos de condução nervosa e a descoberta de auto-anticorpos patogênicos. No presente estudo, realizamos uma revisão das principais informações disponíveis na literatura até o presente momento sobre a síndrome, incluindo seu diagnóstico e manejo.

Aumento das internações por síndrome de Guillain-Barré no Brasil: estudo ecológico / Aumento de hospitalizaciones por síndrome de Guillain-Barré en Brasil: un estudio ecológico / Increase in Guillain-Barré syndrome hospitalizations in Brazil: an ecological study

Objetivo: descrever as características demográficas e a dinâmica espaço-temporal das internações por síndrome de Guillain-Barré (SGB) no Brasil, no período 2008-2017. Métodos: trata-se de um estudo ecológico com dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS); foram calculadas taxas de internações por SGB e construiu-se um diagrama de controle; na análise espacial, utilizou-se o intervalo de quebras naturais. Resultados: foram registradas 15.512 internações por SGB no período do estudo; entre 2008 e 2014, observou-se uma média de 1.344 internações por ano; em 2015, foram registradas 1.953 internações, representando um incremento de 45% em relação à média dos anos anteriores; internações por SGB estiveram presentes em nível epidêmico na região Nordeste, nos anos de 2015 e 2016. Conclusão: houve aumento das internações por SGB a partir de 2015, após a introdução do vírus chikungunya e a rápida propagação do vírus Zika no Brasil.

Objetivo: describir las características demográficas y la dinámica espacio-temporal de las hospitalizaciones por síndrome de Guillain-Barré (GBS) en Brasil, en el período 2008-2017. Métodos: este es un estudio ecológico con datos del Sistema de Información Hospitalaria del SUS (SIH/SUS); se calcularon las tasas de hospitalización por GBS y se construyó un diagrama de control; en el análisis espacial, se utilizó el rango de rupturas naturales. Resultados: se registraron 15.512 ingresos por GBS durante el período de estudio. Entre 2008-2014, se observó un promedio de 1.344 hospitalizaciones por año, en el año siguiente (2015), se registraron 1.953 hospitalizaciones, lo que representa un aumento del 45% en relación con el promedio de años anteriores; las hospitalizaciones por GBS estuvieron presentes a nivel epidémico en la Región Nordeste en los años 2015 y 2016. Conclusión: hubo un aumento en las hospitalizaciones por GBS a partir de 2015, después de la introducción del virus chikungunya y la rápida propagación del virus Zika en Brasil.

Objective: to describe the demographic characteristics and the spatio-temporal dynamics of Guillain-Barré syndrome (GBS) hospitalizations in Brazil between 2008 and 2017. Methods: this is an ecological study using data from the Hospital Information System of the Brazilian National Health System (SIH/SUS); GBS hospitalization rates were calculated and a control diagram was built; natural break ranges were used in the spatial analysis. Results: 15,512 GBS hospitalizations were recorded during the study period; between 2008-2014 there were 1,344 hospitalizations per year on average, in the following year (2015), 1,953 hospitalizations were registered, representing an increase of 45% in relation to the average of previous years; GBS hospitalizations reached an epidemic level in the Northeast region in 2015 and 2016. Conclusion: GBS hospitalizations increased with effect from 2015, following the introduction of chikungunya virus and the rapid spread of Zika virus in Brazil.

Prevalence of Guillain-Barré syndrome among Zika virus infected cases: a systematic review and meta-analysis

ABSTRACT Zika virus (ZIKV) is an emergent flavivirus transmitted mainly through Aedes spp. mosquitoes that is posing challenge to healthcare services in countries experiencing an outbreak. Usually ZIKV infection is mild, but in some cases it has been reported to progress into neurological diseases such as microcephaly in infants and Guillain-Barré syndrome (GBS) in adults. GBS is a debilitating autoimmune disorder that affects peripheral nerves. Since ZIKV caused massive outbreaks in South America in the past few years, we aimed to systematically review the literature and perform a meta-analysis to estimate the prevalence of GBS among ZIKV-infected individuals. We searched PubMed and Cochrane databases and selected three studies for a meta-analysis. We estimated the prevalence of ZIKV-associated GBS to be 1.23% (95% CI = 1.17-1.29%). Limitations include paucity of data regarding previous flavivirus infections and ZIKV-infection confirmation issues. Our estimate seems to be low, but cannot be ignored, since ZIKV outbreaks affects an overwhelming number of individuals and GBS is a life-threatening debilitating condition, especially in pregnant women. ZIKV infection cases must be closely followed to assure prompt care to reduce the impact of GBS associated-sequelae on the quality of life of those affected.

Principales características epidemiologicas y clínicas del síndrome de Guillain-Barre en hospital clínico Herminda Martin de Chillan desde el año 2010 al 2016 / Main epidemiological and clinical characteristics of Guillain-Barre syndrome in Herminda Martin de Chillan clinical hospital from 2010 to 2016

INTRODUCCIÓN: El SGB es una polirradiculopatía aguda, que a menudo se asocia a una infección anterior. Constituye una emergencia neurológica. La tríada clásica es paresia simétrica y ascendente, abolición o disminución de reflejos osteotendíneos y parestesias. Se sospecha clínicamente. El tratamiento es de soporte, intercambio de plasma e inmunoglobulina intravenosa. OBJETIVO: Describir las características epidemiológicas y clínicas de pacientes con diagnóstico de SGB del Hospital Clínico Herminda Martin de Chillán entre los años 2010 a 2015. MATERIAL Y MÉTODO: Estudio descriptivo retrospectivo de fichas clínicas de 22 pacientes. Criterios de inclusión fueron tener el diagnóstico de SGB informado en ficha clínica y haber sido atendido en el HCHM durante enero de 2010 y mayo del 2015. Criterio de exclusión es no contar físicamente con la ficha clínica del paciente. Las variables investigadas fueron edad, sexo, estacionalidad, antecedente de infección previa, días de hospitalización y manifestaciones clínicas. RESULTADOS: Predominio de SGB en hombres (63,6%), en individuos de 0-20 años (45,4%), en la época deotoño-invierno (59%) y un 54,5% presentó infección previa. Las manifestaciones clínicas más frecuentes fueron: parestesia (86,3%), paresia muscular (95.4%), arreflexia osteotendínea (86.3%) y dolor muscular (54.5%). 50% de los pacientes tuvo una estadía hospitalaria mayor a cuatro semanas. DISCUSIÓN: La mayoría de las características epidemiológicas y clínicas concuerdan con la literatura y estadísticas internacionales. No obstante, existen diferencias en edad de presentación y estacionalidad.

INTRODUCTION: GBS is an acute polyradiculopathy, which is often associated with a previous infection. It constitutes a neurological emergency. The classic triad is symmetric and ascending paresis, abolition or diminution of osteotendine reflexes and paresthesias. It is clinically suspected. The treatment is support, plasma exchange and intravenous immunoglobulin. The aim of this study is to describe the epidemiological and clinical characteristics of patients with a diagnosis of GBS at the Clinical Hospital Herminda Martin de Chillán between 2010 and 2015. MATERIAL AND METHODS: Retrospective descriptiv estudy of 22 patients` medical records. Inclusion criteria were to have the diagnosis of GBS reported in theclinical record and to have been seen at the HCHM duringJanuary 2010 and May 2016. Exclusion criterion is not to physically counton the patient'sclinical record. The investigated variables were age, sex, seasonality, history of previous infection, clinical manifestations and recovery time. RESULTS: Predominance of GBS in males (63,6%), in the 0-20 years range (45,4%), debuting in autumn-winter (59%) and previous infection in 54,5% of patients. The most frequent clinical manifestations were: paresthesia (86.3%), muscle paresis (95.4%), osteotendinous areflexia (86.3%) and muscle pain (54.5%). 50% of patients recovered in more than four weeks. DISCUSSION: Most of the epidemiology and clinical features are consistent with the literature and international statistics. However, there are differences in age of presentation and seasonality

Surto de síndrome de Guillain-Barré possivelmente relacionado à infecção prévia pelo vírus Zika, Região Metropolitana do Recife, Pernambuco, Brasil, 2015 / Brote de síndrome de Guillain-Barré potencialmente relacionado con la infección anterior por el virus Zika, en la Región Metropolitana de Recife, Pernambuco, Brasil, 2015 / Outbreak of Guillain-Barré syndrome possibly related to prior Zika virus infection, Metropolitan Region of Recife, Pernambuco, Brazil, 2015

Objetivo: investigar a ocorrência da síndrome de Guillain-Barré (SGB) na Região Metropolitana do Recife, Brasil, 2015. Métodos: estudo descritivo com dados do Sistema de Informações Hospitalares, Sistema Nacional de Gestão da Assistência Farmacêutica e entrevistas; os casos de SGB foram classificados segundo os critérios de Brighton, e a infecção prévia, segundo critérios laboratoriais e clínicos. Resultados: em 2015, houve três vezes mais internações por SGB que em 2014; investigaram-se 44 casos confirmados ou prováveis de SGB, dos quais 18 apresentaram sintomas de infecção por Zika até 35 dias antes da ocorrência da SGB, principalmente exantema; houve um caso confirmado laboratorialmente para Zika e um óbito. Conclusão: os achados reforçam possível relação da SGB com infecção por Zika, por ausência de aumento da ocorrência da SGB em anos epidêmicos de dengue, ausência de registro de transmissão de chikungunya, presença de manifestações clínicas compatíveis com infecção por Zika e uma confirmação laboratorial.

Objetivo: investigar la ocurrencia de SGB en la Región Metropolitana de Recife, Brasil, 2015. Métodos: estudio descriptivo utilizando datos del Sistema de Información Hospitalaria, Sistema Nacional de Gestión de Atención Farmacéutica y entrevistas; los casos de SGB fueron clasificados de acuerdo con criterios de Brighton y la infección anterior segundo criterios laboratoriales y clínicos. Resultados: en 2015, hubo tres veces más internaciones por SGB que 2014; se investigaron 44 casos confirmados o probables de SGB, donde 18 tenían síntomas de infección por Zika hasta 35 días antes de la SGB, especialmente erupción; hubo una confirmación laboratorial de Zika y una muerte. Conclusión: los hallazgos refuerzan la posible relación de SGB con infección por Zika, frente la ausencia de aumento de la ocurrencia de SGB en años epidémicos de dengue, ausencia de registro de transmisión de chikungunya, presencia de manifestaciones clínicas compatibles con infección previa por Zika y una confirmación laboratorial.

Objetivo: to investigate the occurrence of GBS in the Metropolitan Region of Recife, PE, Brazil, 2015. Methods: this was a descriptive study using data from the Hospital Information System, National Pharmaceutical Services Management System and interviews; GBS cases were classified according to Brighton criteria and prior infection according to laboratory and clinical criteria. Results: in 2015, the number of GBS hospitalizations had a threefold increase in comparison to 2014. We investigated 44 confirmed or probable GBS cases, of which 18 had symptoms of Zika infection up to 35 days before the occurrence of GBS, mainly rash; one case was laboratory-confirmed for Zika virus infection and one death was registered. Conclusion: the findings reinforce a possible relationship between GBS and Zika infection, given the absence of increased GBS occurrence in previous dengue epidemic years, absence of chikungunya transmission records, presence of clinical manifestations compatible with infection and a laboratory confirmation.

The clinical presentation, epidemiology, and short-term outcome of Guillain-Barré syndrome in Tikuranbessa hospital: a 6-year retrospective study

Introduction: Gullian-Barré Syndrome (GBS) is an acute monophasic demyelinating polyradiculoneuropathy which is characterized by progressive weakness and areflexia. Different antecedent events are associated with GBS and one of those is an anti-rabies vaccine prepared from infected animal brain.Objective: The study goal was to determine epidemiological features of and to describe the clinical and short-term outcomes of Gullian-Barré syndrome.Materials and Methods: A cross sectional descriptive study with retrospective data collection was done on children admitted with a diagnosis of Gullian-Barré Syndrome from September 2006 to September 2012.Result: 112 children were identified. The male to female ratio was 1.6. All had motor weakness, only one patient (0.9%) had sensory loss, 34(30.3%) had cranial nerve involvement and 37 (32.9%) had dysautonomia. Respiratory involvement which necessitated ventilation was found in 14 (12.5%) of our cases. Antecedent events were recorded in 82 (73.2%) of children and among them; upper respiratory infection (URTI) was the most frequent (43.8%). Of the 15 patients with vaccination antecedents, 7 (6.35%) had received anti-Fermi type rabies vaccine. The GBS subtype distribution among the 31 patients who had electrodiagnostic studies performed was as follows: acute inflammatory demyelinating neuropathy (AIDP) 3 (10%), acute motor axonal neuropathy (AMAN) 24 (80%),acute motor-sensory axonal neuropathy (AMSAN) 1 (3.3%), and both axonal and demyelinating neuropathy 3 (10%). Complete recovery was noted in 31 (27.7%) patients and there were 9 (8%) deaths.Conclusion: Male preponderance and presence of antecedent illness was observed in the majority of subjects. Acute motor axonal neuropathy was the commonest subtype of Guillain-Barré. Prior anti-Fermi-type rabies vaccine may have been one predisposing factor

Síndrome de Guillain-Barré e outras manifestações neurológicas possivelmente relacionadas à infecção pelo vírus Zika em municípios da Bahia, 2015 / Síndrome de Guillain-Barré y otras manifestaciones neurológicas posiblemente relacionadas a la infección por virus Zika en municipios de Bahía, 2015 / Guillain-Barré syndrome and other neurological manifestations possibly related to Zika virus infection in municipalities from Bahia, Brazil, 2015

Objetivo: descrever os casos notificados de síndrome de Guillain-Barré (SGB) e outras manifestações neurológicas com histórico de infecção por dengue, chikungunya ou Zika, na Região Metropolitana de Salvador e no município de Feira de Santana, Brasil. Métodos: estudo descritivo com dados de investigação conduzida pela vigilância epidemiológica, de março a agosto de 2015; para confirmar as manifestações neurológicas, considerou-se o registro de diagnóstico médico, e para infecção prévia, utilizaram-se critérios clínicos e laboratoriais. Resultados: dos 138 casos suspeitos investigados, 57 relataram quadro infeccioso até 31 dias antes dos sintomas neurológicos - 30 prováveis de infecção por Zika, 13 por dengue, 8 por chikungunya e 6 inconclusivos -; SGB foi a condição neurológica mais frequente (n=46); houve predomínio do sexo masculino (n=32), e a mediana de idade foi de 44 anos. Conclusão: a maioria dos casos relatou quadro clínico compatível com doença aguda pelo vírus Zika, que precedeu a ocorrência dos sintomas neurológicos.

Objetivo: investigar los casos notificados de síndrome de Guillain-Barré (SGB) y otras manifestaciones neurológicas con antecedentes de infección por dengue, chikungunya o Zika en la Región Metropolitana de Salvador y Feira de Santana, Brasil. Métodos: estudio descriptivo con datos de la investigación realizada por la vigilancia epidemiológica, de marzo a agosto de 2015. ; para confirmar una manifestación neurológica se consideró el registro de diagnóstico médico y para infección previa, criterios clínicos y de laboratorio. Resultados: de los 138 casos sospechosos investigados, 57 presentaron un cuadro infeccioso, hasta 31 días antes de presentar síntomas neurológicos. - 30 probablemente con infección por zika, 13 dengue, 8 chikungunya y 6 no concluyentes -; de éstos, SGB fue la condición neurológica más frecuente (n=46), hubo un predominio del sexo masculino (n=32) y la mediana de edad fue 44 (rango: 2-83) años. Conclusión: la mayoría de los casos relató un cuadro clínico compatible con enfermedad aguda por virus Zika, que precedió la aparición de síntomas neurológicos.

Objective: to describe the reported cases of Guillain-Barré Syndrome (GBS) and other neurological manifestations with a history of dengue, chikungunya or Zika virus infections, in the Metropolitan Region of Salvador and in the municipality of Feira de Santana, Brazil. Methods: this is a descriptive study with data of an investigation conducted by the epidemiological surveillance from March to August 2015; to confirm the neurological manifestations, medical diagnosis records were considered, and to prior infection, clinical and laboratory criteria were used. Results: 138 individuals were investigated, 57 reported infectious process up to 31 days before neurological symptoms - 30 possibly due to Zika, 13 to dengue, 8 to chikungunya and 6 were inconclusive -; GBS was the most frequent neurological condition (n=46), with predominance of male sex (n=32) and the median age was 44. Conclusion: most cases reported a clinical picture consistent with acute Zika virus disease, which preceded the occurrence of neurological symptoms.

Zika cases: Epi Week 22, 2017

This table contains numerical data sourced from surveillance of cases related to Zika Virus disease and Guillain-Barré Syndrome (GBS). Entries began in the year 2015, Month 8, Epidemiological Week 32 and ended in 2017, Month 5, Epidemiological Week 22. They were made under the following headings: Zika Disease Confirmed case; Zika disease Suspected case; Cases of GBS; Cases of GBS lab­ confirmed for ZIKV; Other Neurological Syndromes; Other Neurological Syndromes lab­ confirmed for ZIKV; Suspected Cases of Congenital Syndrome Associated with ZIKV; Probable Cases of Congenital Syndrome Associated with ZIKV; and Confirmed Cases of Congenital Syndrome Associated with ZIKV. A total for each of the categories listed was displayed.

Guillain-Barré syndrome associated with the Zika virus outbreak in Brazil / Síndrome de Guillain-Barré associada ao surto de infecção por vírus Zika no Brasil

ABSTRACT Zika virus (ZIKV) is now considered an emerging flavivirosis, with a first large outbreak registered in the Yap Islands in 2007. In 2013, a new outbreak was reported in the French Polynesia, with associated cases of neurological complications including Guillain-Barré syndrome (GBS). The incidence of GBS has increased in Brazil since 2015, what is speculated to be secondary to the ZIKV infection outbreak. The gold-standard test for detection of acute ZIKV infection is the polymerase-chain reaction technique, an essay largely unavailable in Brazil. The diagnosis of GBS is feasible even in resource-limited areas using the criteria proposed by the GBS Classification Group, which is based solely on clinical grounds. Further understanding on the relationship of ZIKV with neurological complications is a research urgency.

RESUMO O vírus Zika (VZIK) é agora considerado uma flavivirose emergente, com um primeiro grande surto registrado nas ilhas Yap, em 2007. Em 2013, novo surto foi registado na Polinésia francesa, com complicações neurológicas, incluindo a síndrome de Guillain-Barré (SGB). A incidência de SGB experimentou um aumento durante o ano de 2015, o que se especula ser secundário ao surto de infecção pelo ZIKV. A técnica em reação em cadeia de polimerase é considerado o teste padrão-ouro, mas é pouco disponível no Brasil. O diagnóstico da SGB é possível mesmo em áreas com recursos limitados usando os critérios propostos pelo GBS Classification Group, os quais são baseados exclusivamente em achados clínicos. Um maior entendimento da relação entre a infecção pelo ZIKV e complicações neurológicas é uma urgência de pesquisa.

Monitoramento das emergências em saúde pública: Sindrome exantemática em gestante, microcefalias / Monitoring of public health emergencies: Exanthematic syndrome in pregnant women, microcephaly

Até o dia 15/12/2015 foram notificados 698 casos de Síndrome Exantemática em Gestante distribuídos entre 41 municípios nas nove regiões do Estado.

Monitoramento das emergências em saúde pública: Sindrome exantemática em gestante, microcefalias / Monitoring of public health emergencies: Exanthematic syndrome in pregnant women, microcephaly

Até o dia 22/12/2015 foram notificados 974 casos de Síndrome Exantemática em Gestante distribuídos entre 48 municípios nas nove regiões do Estado.

Monitoramento das emergências em saúde pública: Sindrome exantemática em gestante, microcefalias / Monitoring of public health emergencies: Exanthematic syndrome in pregnant women, microcephaly

Até o dia 29/12/2015 foram notificados 1.323 casos de Síndrome Exantemática em Gestante distribuídos entre 50 municípios nas nove regiões do Estado. Do total de notificações recebidas 34% não possuem informações laboratoriais.

[Epidemiology of acute flaccid paralysis in Kermanshah province, 2004-2009]

The aim of this study was to determine epidemiologic features of acute flaccid paralysis [AFP] during 2004-2009 in Kermanshah province. This cross-sectional descriptive study was done based on data records from Kermanshah health care center. In total 89 patients, 0- 14 years old were enrolled study, which 36 of them were male and 53 were female. 50.6% of subjects were diagnosed as Guillain-barre, 6.7% transverse synovitis and 5.6% as arthritis. No any cases of poliomyelitis were diagnosed. The prevalence of reported of AFP during 2004-2009 in Kermanshah province was more than expected rate of 1 per 100000 according to WHO