Zika Virus Linked to Guillain-Barré Syndrome

Some people with Zika get sick again later wIth GBS.

Zika Virus
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If you're reading this article, then you probably already know that Zika virus, which is spread by mosquitoes, has been linked to a spate of microcephaly cases in Brazil. Many pregnant women who have been infected with Zika virus go on to have babies with smaller heads, or microcephalty, and profound brain damage.

We're now seeing people who are infected with Zika virus go on to develop Guillain-Barré syndrome (GBS), too.

GBS is a usually transient and uncommon neurological disease that mostly results in weakness of the arms and legs. Fortunately in most cases, GBS doesn't hold a candle to microcephaly, which is much more serious; nevertheless, GBS is serious and can very rarely result in death due to respiratory paralysis.

What Is GBS?

Guillain-Barré syndrome interferes with the peripheral nervous system and usually develops in a person about one to three weeks after a viral infection; GBS can also happen after innoculation (vaccination), surgery or bacterial infection, most notably Campylobacter jejuni enteritis (AKA food poisoning).

Although we have yet to elucidate the exact mechanism of GBS, we think that the pathology of this disease is immune-mediated, which explains why people who experience an insult to their immune systems, like previous infection, are at greater risk of developing this illness.

What Are the Symptoms of GBS?

Specifically, GBS is an acute or subacute progressive polyradiculopathy, which presents differently in different people.

This disease causes weakness that usually presents distally, or in the parts of your body farthest from your core like your legs. This weakness then ascends affecting the arms and then the face. The symptoms present symmetrically (think both legs or arms). This weakness makes it hard to walk and move.

Furthermore, GBS can cause sensory disturbances and interfere with how you feel things.

In addition to causing weakness and sensory deficits, GBS can also cause autonomic disturbances, which in rare circumstances are life threatening. These autonomic disturbances can affect heart rate, heart rhythm, sweating, breathing and even sphincter control. Rarely, respiratory problems caused by GBS can result in loss of life. Finally, GBS can interfere with your muscles of chewing and swallowing.

Overall, GBS is an uncomfortable, dismaying, serious and sometimes dangerous illness.

How Is GBS Diagnosed?

Typically, a physician will suspect GBS when a patient presents with weakness and sensory deficits following infection, surgery or so forth. Thus, medical history is particularly important when diagnosing GBS. On physical exam, in addition to sensory and motor disturbances, superficial and deep tendon reflexes are abnormal. As for diagnostic testing, nerve conduction studies as well as cerebrospinal fluid (CSF) analysis can be employed.

(Any changes in CSF protein concentration, usually indicative of viral infection, take a few weeks to show up.)

How Is GBS Treated?

People with GBS should seek medical help and treatment. Often, hospitalization is a good idea until the threat of respiratory compromise has passed.

Several treatment options for GBS exist including the following:

  • intravenous fluids and pressors (medications used to raise blood pressure) are used to treat hypotension, or dangerously low blood pressure
  • heparin, a blood thinner, can be give to decrease the chance of pulmonary embolism;
  • intravenous immunoglobulin
  • plasmapheresis
  • respiratory therapy

Of note, prednisone, or steroid treatment, may actually prolong recovery time and treatment with prednisone should be avoided.

For those with breathing problems stemming from GBS, stay on the ICU is warranted with mechanical ventilation for respiratory support.

GBS Prognosis

Fortunately, most people who come down with GBS make a full recovery. However, about 20 percent of people with GBS experience some form of residual disability. Additionally, about 3 percent of people with GBS go on to relapse at some point in the future.

On a final note, Zika virus can be appraised in parallax. From a humanistic perspective, the Zika virus is a threat that is now linked to the more serious suffering of birth defects and less serious suffering of GBS. From a scientific perspective, Zika virus is a fascinating infectious disease with stunning pathological reach which we're learning more about with each passing day.

Let's keep our fingers crossed that a vaccine for this virus is developed sooner rather than later.

Sources

Papadakis MA, McPhee SJ. Guillain-Barré Syndrome. In: Papadakis MA, McPhee SJ. eds. Quick Medical Diagnosis & Treatment 2016. New York, NY: McGraw-Hill; 2016. Accessed February 16, 2016.

 

 

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