Guillain-Barré Syndrome in Mexico: An Updated Review Amid the Coronavirus Disease 2019 ERA.

Guillain-Barré syndrome (GBS) is the most frequent cause of acute flaccid paralysis and if not diagnosed and treated timely, a significant cause of long-term disability. Incidence in Latin America ranges from 0.71 to 7.63 cases/100,000 person-years. Historically, GBS has been linked to infections (mainly gastrointestinal by Campylobacter jejuni) and vaccines (including those against severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]); however, a trigger cannot be detected in most cases. Regarding SARS-CoV-2, epidemiological studies have found no association with its development. Acute motor axonal neuropathy is the most common electrophysiological variant in Mexico and Asian countries. Intravenous immunoglobulin or plasma exchanges are still the treatment cornerstones. Mortality in Mexico can be as high as 12%. Avances in understanding the drivers of nerve injury in GBS that may provide the basis for developing targeted therapies have been made during the past decade; despite them, accurate criteria for selecting patients requiring acute treatment, prognostic biomarkers, and novel therapies are still needed. The newly-developed vaccines against SARS-CoV-2 have raised concerns regarding the potential risk for developing GBS. In the midst of coronavirus disease 2019 and vaccination campaigns against SARS-CoV-2, this review discusses the epidemiology, clinical presentation, management, and outcomes of GBS in Mexico.

Guillain-Barré syndrome and variants associated with SARS-CoV-2 infection in Mexico

Background: To date, Mexico has more than 1,280,000 confirmed cases and more than 116,000 deaths due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Limited information is available regarding Latin American patients with Guillain-Barré syndrome (GBS) and SARS-CoV-2. Objective: The objective is to describe the presentation, diagnosis, and outcome of patients with GBS associated with SARS-CoV-2 infection. Methods: We describe four cases of GBS associated with SARS-CoV-2 infection in Mexico. Results: Neurological symptoms initiated 2-17 days after the respiratory symptoms. The age group in or patients ranged from 26 to 41 years. Two patients presented with progressive, acute, and symmetric weakness and two with bilateral facial palsy. Patients with GBS diagnosis associated with SARS-CoV-2 infection have been reported to have a good outcome after IGIV or plasma exchange therapy. Conclusion: It is important to consider GBS as a potential manifestation of SARS-CoV-2 infection and recall that the diagnosis is based mainly on clinical evaluation. Laboratory and CSF analysis, as well as neurophysiologic studies, should be considered as a complement for diagnosis. (English) [ABSTRACT FROM AUTHOR] Antecedentes: A la fecha, México tiene más de 1,280,000 casos confirmados y más de 116,000 muertes por infección por SARS-CoV-2. Se dispone de información limitada sobre los pacientes latinoamericanos con síndrome de Guillain-Barré (GBS) y SARS-CoV-2. Objetivo: El objetivo es describir la presentación, el diagnóstico y la evolución de los pacientes con síndrome de Guillain-Barré asociado a la infección por SARS-CoV-2. Métodos: Describimos cuatro casos de SGB asociados a la infección por SARS-CoV-2 en México. Resultados: Los síntomas neurológicos se iniciaron 2-17 días después de los síntomas respiratorios. El grupo de edad de los pacientes osciló entre 26 y 41 años. Dos pacientes presentaron debilidad progresiva, aguda y simétrica y dos con parálisis facial bilateral. Se ha reportado que los pacientes con diagnóstico de GBS asociado con la infección por SARS-CoV-2 tienen un buen resultado después de la terapia de recambio plasmático o IGIV Conclusión: Es importante considerar el SGB como una posible manifestación de la infección por SARS-CoV-2 y recordar que el diagnóstico se basa principalmente en la evaluación clínica. Los análisis de laboratorio y de LCR, así como los estudios neurofisiológicos, deben considerarse como un complemento del diagnóstico. (Spanish) [ABSTRACT FROM AUTHOR] Copyright of Revista Mexicana de Neurociencia is the property of Academia Mexicana de Neurologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)