Frequency of exposure to arboviruses and characterization of Guillain Barré syndrome in a clinical cohort of patients treated at a tertiary referral center in Brasília, Federal District.

BACKGROUND: Guillian Barré syndrome (GBS) is an acute autoimmune polyradiculoneuropathy often associated with previous exposure to infectious agents. METHODS: A clinical cohort of 41 patients with GBS admitted to the Base Hospital Institute of the Federal District between May 2017 and April 2019 was followed up for 1 year. Serological tests for arbovirus detection and amplification of nucleic acids using polymerase chain reaction for zika virus (ZIKV), dengue virus (DENV), and chikungunya virus (CHIKV) were performed. RESULTS: The cohort consisted of 61% men with a median age of 40 years, and 83% had GBS-triggering events. A total of 54% had Grade 4 disability, 17% had Grade 3, 12% had Grade 2, 10% had Grade 5, and 7% had Grade 1. The classic form occurred in 83% of patients. Nerve conduction evaluations revealed acute demyelinating inflammatory polyneuropathy (51%), acute motor axonal neuropathy (17%), acute sensory-motor neuropathy (15%), and indeterminate forms (17%). Four patients were seropositive for DENV. There was no laboratory detection of ZIKV or CHIKV infection. Ninety percent of patients received human immunoglobulin. Intensive care unit admission occurred in 17.1% of the patients, and mechanical ventilation was used in 14.6%. One patient died of Bickerstaff's encephalitis. Most patients showed an improvement in disability at 10 weeks of follow-up. CONCLUSIONS: GBS in the Federal District showed a variable clinical spectrum, and it was possible to detect recent exposure to DENV.

Sensitivity of Guillain-Barre Syndrome Surveillance in the Brazilian Federal District, using the Capture-Recapture Method.

INTRODUCTION: Guillain-Barre Syndrome (GBS) is an acute immune-mediated polyneuropathy that compromises the peripheral and cranial nerves. It is characterized by rapid-onset paresthesia accompanied by progressive weakness in the lower extremities followed by symmetric ascending paralysis. METHODOLOGY: assessment of sensitivity to detect GBS between March 2017 and May 2019 in a public referral hospital, using the capture-recapture method based on the Chapman estimator and comparing three GBS data sources: the hospital-based sentinel surveillance system (VSBH), Human Immunoglobulin Dispensing Records System (RDIH), and Hospital Information System (SIH). RESULTS: A total of 259 possible cases were identified (captured). Of these, 58 were confirmed and most resided in the Federal District. The VSBH showed the greatest sensitivity in case identification. The temporal distribution of cases showed periods with no cases identified, and more were registered during the rainy season from October to May, when high temperatures also occur. CONCLUSIONS: Increased circulation of arboviruses and gastrointestinal infections during the rainy season may explain the greater concentration of GBS cases. It is important to note that one-third of the cases identified in the different data sources do not converge, demonstrating that no single surveillance system is 100% effective. The severity and possible increase in cases related to GBS demonstrates the need for an improved surveillance system capable of monitoring and following-up cases involving neurological syndromes, regardless of the event preceding infection.

A case report on rapid clinical recovery and satisfactory outcome of a toddler with probable Guillain-Barré Syndrome / Relato de um caso com rápida evolução e desfecho satisfatório em criança com provável Síndrome de Guillain-Barré

INTRODUCTION: Guillain-Barré Syndrome (GBS) is the most frequent cause of acute and sub-acute flaccid paralysis after polio eradication. Although rare, it is recognized as the leading cause of flaccid paralysis among the admissions to pediatric intensive care for acute neuromuscular diseasesOBJECTIVE: To report the case of a 14-month-old male patient with a probable diagnosis of GBS with acute, myelinated motor sensitive neuropathy, with probable secondary axonal involvement, with rapid clinical recoveryCASE REPORT: A male patient admitted in a reference hospital in the Federal District, Brazil, residing in the Integrated Development Region of the Federal District and Surroundings. The child was 14 months old and 8.6 kg, with an updated vaccination status and neuropsychomotor development appropriate for his age, with a condition of paresis in the lower limbs, without cognitive changes. After 14 hours of admission, due to the worsening of his clinical situation and the albumino-cytological dissociation identified by the analysis of cerebrospinal fluid, it was started immunotherapy with intravenous human immunoglobulin, 0.7g/kg/day for three days. Twenty four hours after start of treatment, the child showed a clinical improvement of his general condition. The patient was discharged after five days of hospitalization. After 76 days of discharge, there was a significant improvement in neuropsychomotor development, despite a slight delay in its developmentCONCLUSION: Due to the rarity of Guillain-Barré Syndrome among young children, it is important that health professionals remain sensitive to capture and treat unusual cases in a timely manner. We also recommend that the identified cases be monitored carefully, in order to check if the Guillain-Barré Syndrome, and its variants, can explain developmental disorders a posteriori

INTRODUÇÃO: A Síndrome de Guillain-Barré (SGB) é a causa mais frequente de paralisia flácida aguda e subaguda desde a erradicação da poliomielite. Embora rara, é reconhecida como a principal causa de paralisia flácida entre pessoas internadas em terapia intensiva pediátrica por doenças neuromusculares agudasOBJETIVO: Relatar um caso de paciente do sexo masculino, com 14 meses de idade, com diagnóstico provável de Síndrome de Guillain-Barré com neuropatia sensitivo motora, aguda, mielínica, com provável comprometimento axonal secundário, com rápida evolução e melhora DESCRIÇÃO DO CASO: Foi admitido em hospital público materno-infantil de referência para o Distrito Federal um paciente masculino, residente na Região Integrada de Desenvolvimento do Distrito Federal e Entorno. A criança tinha 14 meses de idade e 8,6kg, situação vacinal atualizada e desenvolvimento neurospicomotor adequado para a idade, com quadro de paresia em membros inferiores, sem alterações cognitivas. Após 14 horas da admissão, diante do agravamento do quadro clínico e da dissociação albomino-citológica identificada pela análise de líquido cefalo-raquidiano foi iniciada imunoterapia (imunoglobulina humana endovenosa, 0,7g/kg/dia por três dias). Após 24 horas do início do tratamento, a criança apresentou melhora em seu estado geral. O paciente teve alta hospitalar após cinco dias de internação. Após 76 dias da alta, foi constatada melhora significativa no desenvolvimento neuropsicomotor, apesar de leve atraso em seu desenvolvimento até o momento. CONCLUSÃO: Diante da raridade de casos em crianças, é importante que os profissionais de saúde se mantenham sensíveis a captar e tratar os casos de maneira oportuna. Recomendamos ainda que os casos identificados sejam acompanhados cuidadosamente, afim de verificar se a SGB, e suas variantes, podem explicar transtornos de desenvolvimento à posteriori