Prevalence of Zika virus infection in patients with Guillain-Barre syndrome in Bangladesh

Abstract

Guillain–Barre syndrome (GBS) is an autoimmune disease where the immune system of the body attacks the peripheral nervous system causing demyelination of the axon. This is the leading cause of acute flaccid paralysis (AFP) in Bangladesh. Previous studies have established an association between Zika virus (ZV) infection and GBS in South America and Oceania. In Asia, recently, ZV is known to circulate widely, but the association with Guillain–Barre syndrome is unclear. This prospective study aimed to describe the clinical profile and the frequency of ZIKA virus infected pathophysiology of GBS in Bangladesh. Detailed information of the clinical presentation, electrophysiology, diagnosis, disease severity, and clinical course were obtained from 98 patients with GBS prospectively and followed up for 6 months using a standard questionnaire. In this study, ZV specific IgG and IgM antibody were detected by Elisa to distinguish GBS patients with prolonging and recent ZV infection respectively. Moreover, RT-PCR was performed to confirm if patients had recent ZV infection. Among the 98 patients 18 (18%) GBS patients had ZV infection for a long time. Among the 18 Zika IgG positive patients, 15 patients with GBS (83%) were male and 3 of them were female (17%). The majority of ZV IgG positive patients with GBS were adults with a mean age of 40 years, almost 67% (n=66) had reported with preceding event and more than 40% (n=8) had gastrointestinal diarrhea. Around 45% of the ZV-IgG positive patients with GBS develop axonal variants of GBS and 38% had demyelinating variants of GBS. 56% had cranial nerve involvement and only 6% had sensory deficits. The MRC score of weeks 13 and week 26 were compared to observe the rate of recovery between Zika positive and Zika negative patients, however, there was no significant difference (week 13, p-value=0.31326 and week 26, p-value=0.430478). In conclusion, we can say that ZV can be considered a causative agent of Guillain-Barre Syndrome and male population are more vulnerable. However, further studies are warranted to see why ZV infection is predominant in male GBS patients comparing to their female counterparts.