PDF herunterladen
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(07): 607-611
DOI: 10.1590/0004-282X-ANP-2019-0464
Article

Cytomegalovirus infection in Guillain-Barré syndrome: a retrospective study in Brazil

Infecção por citomegalovirus na Síndrome de Guillain-Barré: um estudo retrospectivo no Brasil
Mario Emilio Teixeira Dourado  Junior
1   Universidade Federal do Rio Grande do Norte, Centro de Ciências da Saúde, Departamento de Medicina Integral, Natal RN, Brazil.
2   Universidade Federal do Rio Grande do Norte, Instituto de Medicina Tropical do Rio Grande do Norte, Natal RN, Brazil.
,
Bruno Fernandes de Sousa 
1   Universidade Federal do Rio Grande do Norte, Centro de Ciências da Saúde, Departamento de Medicina Integral, Natal RN, Brazil.
,
Nathaly M. Coelho da Costa 
3   Universidade Federal do Rio Grande do Norte, Centro de Biociências, Departamento de Bioquímica, Natal RN, Brazil.
,
Selma Maria Bezerra Jeronimo 
2   Universidade Federal do Rio Grande do Norte, Instituto de Medicina Tropical do Rio Grande do Norte, Natal RN, Brazil.
3   Universidade Federal do Rio Grande do Norte, Centro de Biociências, Departamento de Bioquímica, Natal RN, Brazil.
4   Intituto Nacional de Ciências e Tecnologia de Doenças Tropicais, Natal RN, Brazil.
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

ABSTRACT

Background: Guillain-Barré syndrome (GBS) is currently the most common cause of acute flaccid paralysis worldwide. Risk factors for GBS include previous viral or bacterial infections or vaccination. Recently, an outbreak of Zika virus led to an outbreak of GBS in Latin America, mostly in Brazil, concomitant to continuous circulation of dengue virus serotypes. However, there is no study about cytomegalovirus (CMV) infection as a risk for GBS in Brazil. Objectives: In this study, we report a series of cases of GBS with the aim of determining the prevalence of CMV and the characteristics associated with the infection. Methods: A cohort of 111 GBS cases diagnosed between 2011 and 2017 in Natal, northeastern Brazil, was studied. Presence of CMV IgM antibodies was determined by means of electrochemiluminescence. The analysis was performed considering CMV infection status and the clinical outcome. Results: We found seroprevalence of 15.3% (n = 17) for CMV. CMV patients were younger (26 vs. 40; p = 0.016), with no apparent gastrointestinal (p = 0.762) or upper respiratory infections (p = 0.779) or sensory loss (p = 0.03). They presented more often with a classic GBS sensorimotor variant (p = 0.02) and with a demyelinating pattern in electrophysiological studies (p < 0.001). Conclusion: In Brazil, the clinical-epidemiological profile of GBS associated with CMV infection is similar to that described in other countries. Better understanding of the relationship between infectious processes and GBS is a key component of the research agenda and assistance strategy for global health initiatives relating to peripheral neuropathic conditions.

RESUMO

Introdução: Aproximadamente 2/3 dos pacientes com a Síndrome de Guillain-Barré (SGB) apresentam alguma doença infecciosa precedente. Recentemente, uma epidemia de infecção por o vírus Zika resultou em surto de SGB na América Latina, principalmente no Brasil, concomitante à circulação contínua de sorotipos do vírus da Dengue. No entanto, não há estudo sobre a infecção por citomegalovírus (CMV) como fator de risco para SGB no Brasil. Objetivos: Neste estudo, relatamos uma série de casos de SGB com o intuito de determinar a prevalência de CMV e as características associadas à infecção. Métodos: Foi estudada uma coorte de 111 casos de SGB diagnosticados entre 2011 e 2017 na cidade de Natal, capital do estudo do Rio Grande do Norte, nordeste do Brasil. A presença de anticorpos IgM CMV foi determinada por eletroquimiluminescência. A análise foi realizada considerando o status de infecção por CMV e os achados clínicos. Resultados: Foi observada uma soroprevalência de 15,3% (n = 17) para o CMV. Os casos de CMV eram mais jovens (26 vs. 40, p = 0,016), sem história de infecção gastrointestinal (p = 0,762) ou respiratória superior (0,779) ou perda sensorial (p = 0,03). Apresentaram-se mais frequentemente como uma variante sensitiva-motora clássica da SGB (p = 0,02) e subtipo desmielinizante nos estudos eletrofisiológicos (p <0,001). Conclusão: No Brasil, o perfil clínico-epidemiológico do SGB associado à infecção por CMV é semelhante ao descrito em outros países. O melhor entendimento das relações entre processos infecciosos e SGB é um componente-chave de uma agenda de pesquisa e estratégia de assistência para iniciativas globais de saúde em neuropatia periférica.

Keywords:

Cytomegalovirus infections - Guillain-Barré syndrome - Epidemiology - Brazil

Palavras-chave:

Infecção por citomegalovírus - Síndrome de Guillain Barré - Epidemiologia - Brasil

Authors’ contributions:

METD and SMBJ were involved in the study concept and design and in acquisition of data; BFS, NMCC, METD and SMBJ analyzed and interpreted the data; METD wrote the first draft of the manuscript; BFS and METD performed the statistical analysis; All authors read and approved the manuscript.


Support:

This work was supported by CAPES (grant number 440893/2016-0) and CNPq (grant number 88881.130729/2016-01).




Publikationsverlauf

Eingereicht: 02. April 2020

Angenommen: 28. September 2020

Artikel online veröffentlicht:
01. Juni 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • REFERENCES

  • 1 Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016 Aug 13;388(10045):717-27. https://doi.org/10.1016/s0140-6736(16)00339-1
  • 2 Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019 Nov;15(11):671-83. https://doi.org/10.1038/s41582-019-0250-9
  • 3 Dourado ME, Duarte RC, Ferreira, LC, Queiroz JW, Illa I, Perez-Perez G, Guerrant RL, Jeronimo SM. Anti-ganglioside antibodies and clinical outcome of patients with Guillain-Barre syndrome in northeast Brazil. Acta Neurol Scand. 2003 Aug;108(2):102-8. https://doi.org/10.1034/j.1600-0404.2003.00103.x
  • 4 Dourado Júnior MET, Fernandes UT, Ramos ES, Vital ALF, Urbano JCC, Queiroz JW, Jeronimo SMB. Egos has reduced capacity to predicts GBS prognosis in Northeast Brazil. Acta Neurol Scand. 2018 Nov;138(5):459-62. https://doi.org/10.1111/ane.12995
  • 5 Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barre syndrome. Ann Neurol. 1990;27(Suppl):S21-4. https://doi.org/10.1002/ana.410270707
  • 6 Ho TW, Mishu B, Li CY, Gao CY, Cornblath DR, Griffin JW, et al. Guillain-Barré syndrome in northern China Relationship to Campylobacter jejuni infection and anti- glycolipid antibodies. Brain. 1995;118:597-605. https://doi.org/10.1093/brain/118.3.597
  • 7 Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, Toyka KV, et al. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Ann Neurol. 1998 Nov;44(5):780-8. https://doi.org/10.1002/ana.410440512
  • 8 Uncini A, Susuki K, Yuki N. Nodo-paranodopathy: beyond the demyelinating and axonal classification in anti-ganglioside antibody-mediated neuropathies. Clin Neurophysiol. 2013 Oct;124(10):1928-34. https://doi.org/10.1016/j.clinph.2013.03.025
  • 9 Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM. Controlled trial prednisolone in acute polyneuropathy. Lancet. 1978 Oct 7;2(8093):750-3. https://doi.org/10.1016/s0140-6736(78)92644-2
  • 10 Klemola E, Weckman N, Haltia K. The Guillain-Barre´ syndrome associated with acquired cytomegalovirus infection. Acta Med Scand. 1967 May;181(5):603-7. https://doi.org/10.1111/j.0954-6820.1967.tb07283.x
  • 11 Dowling PC, Cook SD. Role of infection in Guillain-Barre syndrome: laboratory confirmation of herpesviruses in 41 cases. Ann Neurol. 1981;9(Suppl):44-55. https://doi.org/10.1002/ana.410090709
  • 12 Winer JB, Hughes RAC, Anderson MJ, Jones DM, Kangro H, Watkins RFP. A prospective study of acute idiopathic neuropathy. II. Antecedent events. J Neurol Neurosurg Psychiatry. 1988 May; 51(5):613-8. https://doi.org/10.1136/jnnp.51.5.613
  • 13 Jacobs BC, Rothbarth PH, van der Meché FG, Herbrink P, Schmitz PI, de Klerk MA, et al. The spectrum of antecedent infections in Guillain-Barre ó syndrome: a case-control study. Neurology. 1998 Oct;51(4):1110-5. https://doi.org/10.1212/wnl.51.4.1110
  • 14 Yuki N. Infectious origins of, and molecular mimicry in, Guillain-Barre ó and Fisher syndromes. Lancet Infect Dis. 2001 Aug;1(1):29-37. https://doi.org/10.1016/s1473-3099(01)00019-6
  • 15 Visser LH, van der Meche FGA, Meulstee J, Rothbarth P, Jacobs BC, Schmitz PIM, et al. Cytomegalovirus infection and Guillain-Barre syndrome: the clinical, electrophysiologic and prognostic features. Neurology. 1996 Sept;47(3):668-73. https://doi.org/10.1212/wnl.47.3.668
  • 16 Orlikowski D, Porcher R, Sivadon-Tardy V, Quincampoix JC, Raphaël JC, Durand MC, et al. Guillain-Barre´ syndrome following primary cytomegalovirus infection: a prospective cohort-study. CID 2011. Clin Infect Dis. 2011 Apr;52(7):837-44. https://doi.org/10.1093/cid/cir074
  • 17 Joventino KMS. Monitoramento da infecção por citomegalovírus em pacientes submetidos a transplante renal [Mestrado]. [Natal (RN)]: Universidade Federal do Rio Grande do Norte, Centro de Biociência; 2017. 62p.
  • 18 Yuki N, Kuwabara S. Axonal Guillain-Barré syndrome: carbohydrate mimicry and pathophysiology. J Peripher Nerv Syst. 2007 Dec;12(4):238-49. https://doi.org/10.1111/j.1529-8027.2007.00153.x
  • 19 Jacobs BC, van Doorn PA, Groeneveld JH, Tio-Gillen AP, van der Meche FG. Cytomegalovirus infections and anti-GM2 antibodies in Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 1997 Jun;62(6):641-3. https://doi.org/10.1136/jnnp.62.6.641
  • 20 Sawai S, Satoh M, Mori M, Misawa S, Sogawa K, Kazami T, et al. Moesin is a possible target molecule for cytomegalovirus-related Guillain-Barré syndrome. Neurology. 2014 Jul 8;83(2):113-7. https://doi.org/10.1212/wnl.20190464201904640566