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Revista da Sociedade Brasileira de Medicina Tropical

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Major Article • Rev. Soc. Bras. Med. Trop. 55 • 2022 • https://doi.org/10.1590/0037-8682-0306-2021 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

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.

Keywords:
Guillain Barré Syndrome; Arbovirus; Dengue; Clinical cohort; Diagnosis; Prognosis

Characteristic	Frequency	%
Median degree of disability at admission *	4
Grade 1	3	7.3
Grade 2	5	12.2
Grade 3	7	17.1
Grade 4	22	53.6
Grade 5	4	9.8
Involvement of cranial nerves	22	53.6
Oculomotor nerves	3	7.3
Facial nerves	14	34.1
Bulbar nerves	12	29.3
Other **	3	7.3
Autonomic dysfunction	15	36.6
Cardiac (arrhythmia, sustained tachycardia or bradycardia, and cardiac arrest)	2	4.9
Blood pressure (fluctuations, hypertension, and hypotension)	8	19.5
Gastroenteric	3	7.3
Bladder disfunction	7	17.1
Sensory deficit	22	53.6
Pain	19	46.3
Clinical variants
Classical	34	82.9
Form pharyngo-cervical-brachial	1	2.4
Miller Fisher syndrome	1	2.4
Miller Fisher-SGB overlap syndrome	3	7.3
SMF + pharyngo-cervical-brachial overlap syndrome	1	2.4
Bickerstaff’s encephalitis	1	2.4
Previous triggering events	34	82.9
Infection of the upper respiratory tract	16	39.0
Gastroenteritis	13	31.7
Vaccination	4	9.8
Other ***	7	17.1
Days between triggering event and onset of weakness
0-7	17	41.5
8-14	7	17.1
15-21	2	4.9
22-28	1	2.4
29-35	1	2.4
Previous episode of GBS	2	4.9
Examination of the CSF	40	97.6
Cellularity <5	38	92.7
Cellularity 5-50/µL	2	4.9
Cellularity >50/µL	0	0
Protein concentration >0.45 g/L	18	43.9
Median number of days between onset of symptoms and CSF examination	6
Electrophysiological classification
AMAN	9	23
AMSAN	8	20.5
AIDP	21	53.8
Indeterminate	1	2.5
Specific treatment
Human immunoglobulin	37	90.2
Plasmapheresis	0	0
No specific treatment	4	9.8
Median number of days between onset of strength loss and specific treatment	6
Use of mechanical ventilation	6	14.6
Admission to the intensive care unit	7	17.1
Lethality	1	2.4

Patient	Sex, Age	Diagnosis of the infectious event ¹	Previous events	Symptoms of preceding arbovirus infection	Neurological characteristics at admission ²	Study of nerve conduction	Cerebro spinal fluid	Treatment	Evolution at 52 weeks of follow-up
1	F 60 years	Dengue IgM + upon admission	Common cold Gastroenteritis	Skin rash Diarrhea	Disability scale 3 Presence of sensory deficit, pain, cranial nerve involvement, ataxia; Absence of autonomic dysfunction Classical GBS	AIDP³	Protein 0,12 g/L Cells: 0/µL	Human immunoglobulin IV	Absence of complications Disability scale 1
2	M 12 years	Dengue IgM + upon admission	None	None	Disability scale 2 Presence of pain Absence of sensory deficit, cranial nerve involvement, ataxia, autonomic dysfunction Classical GBS	AIDP	Not performed	Not performed	Absence of complications Disability scale 0
3	M 33 years	Dengue IgM + upon admission	Dengue	Mosquito bite Fever Skin rash Arthralgia	Disability scale 4 Presence of autonomic dysfunction (blood pressure and bladder dysfunction), cranial nerve involvement, ataxia; Absence of pain, sensory deficits Classical GBS	AIDP	Protein 0.43 g/L Cells: 3/µL	Human immunoglobulin IV	Absence of complications Disability scale 0
4	M 42 years	Dengue IgM + upon admission	None	None	Disability scale 5 Presence of pain, autonomic dysfunction (blood pressure); Absence of cranial nerve involvement Impossible to examine: ataxia, sensory deficits Classical GBS	Not performed	Protein 0.74 g/L Cells: 1/µL	Human immunoglobulin IV	Complications: intensive care unit admission and mechanical ventilation. Disability scale 3

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