Occurrence Of Guillain-Barré Syndrome Research Articles

Association Between Guillain-Barré Syndrome and COVID-19 Infection and Vaccination: A Population-Based Nested Case-Control Study.

Existing data regarding occurrence of Guillain-Barré syndrome (GBS) after coronavirus disease 2019 (COVID-19) infection and vaccination are inconclusive. We aimed to assess the association between GBS and both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 vaccine. We conducted a nested case-control study in a cohort of 3,193,951 patients aged 16 years or older, without a diagnosis of prior GBS, from the largest health care provider in Israel. Participants were followed from January 1, 2021, until June 30, 2022, for the occurrence of GBS. Ten randomly selected controls were matched to each case of GBS on age and sex. We assessed both SARS-CoV-2 infection and COVID-19 vaccine administration in the prior 6 weeks in cases and controls. Overall, 76 patients were diagnosed with GBS during follow-up and were matched to 760 controls. A positive test for SARS-CoV-2 was detected in 9 (11.8%) cases and 18 (2.4%) controls. An administration of COVID-19 vaccine was detected in 8 (10.5%) cases (all Pfizer-BioNTech [BNT162b2] vaccine) and 136 (17.9%) controls (134 Pfizer-BioNTech vaccine). Multivariable conditional logistic regression models showed that the odds ratio for GBS associated with SARS-CoV-2 infection and COVID-19 vaccine administration was 6.30 (95% CI 2.55-15.56) and 0.41 (95% CI 0.17-0.96), respectively. The results were similar when exposure to SARS-CoV-2 infection or COVID-19 vaccine administration was ascertained in the prior 4 and 8 weeks, although did not reach statistical significance for COVID-19 vaccine at 4 weeks. Our study suggests that SARS-CoV-2 infection is associated with increased risk of GBS, whereas Pfizer-BioNTech COVID-19 vaccine is associated with decreased risk of GBS.

COVID-19 as a trigger of Guillain-Barré syndrome: A review of the molecular mechanism.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic with serious complications. After coronavirus disease 2019 (COVID-19), several post-acute COVID-19 syndromes (PACSs) and long-COVID sequels were reported. PACSs involve many organs, including the nervous, gustatory, and immune systems. One of the PACSs after SARS-CoV-2 infection and vaccination is Guillain-Barré syndrome (GBS). The incidence rate of GBS after SARS-CoV-2 infection or vaccination is low. However, the high prevalence of COVID-19 and severe complications of GBS, for example, autonomic dysfunction and respiratory failure, highlight the importance of post-COVID-19 GBS. It is while patients with simultaneous COVID-19 and GBS seem to have higher admission rates to the intensive care unit, and demyelination is more aggressive in post-COVID-19 GBS patients. SARS-CoV-2 can trigger GBS via several pathways like direct neurotropism and neurovirulence, microvascular dysfunction and oxidative stress, immune system disruption, molecular mimicry, and autoantibody production. Although there are few molecular studies on the molecular and cellular mechanisms of GBS occurrence after SARS-CoV-2 infection and vaccination, we aimed to discuss the possible pathomechanism of post-COVID-19 GBS by gathering the most recent molecular evidence.

Study of clinical profile and outcome in children aged 1-12 years presenting with Guillain Barre syndrome

Background: Guillain-Barré syndrome (GBS) is a group of clinical syndromes involving acute polyneu­ropathy secondary to an immune-mediated process. The aim of the research is to study clinical profile and outcome in children aged 1-12 years presenting with GBS. Methods: It is a prospective plus retrospective observational study (5-year retrospective + 18 months prospective). All cases of GBS admitted from January 2020-july 2021 were enrolled for the study and retrospective cases were taken from case record from January 2015 onwards in a tertiary care centre. Results: Total 45 children were enrolled. The male: female ratio was 1.64:1. Mean age at presentation was 6.3 years, in a range of 1.5 -11.5 years of age. History of antecedent illness prior to the occurrence of GBS was present in 93.3% patients with upper respiratory tract infection being most common seen in 53.3% patients. Following variants of GBS were seen on NCV study performed in 34 patients, the most common was AIDP in 46.7% patients, followed by AMAN in 22.2% subjects and AMSAN in 6.7% patients. All children presented with lower limb weakness which progressed to involve upper limbs. Other associated features like bulbar cranial nerve involvement, respiratory muscle weakness, sensory symptoms and autonomic disturbance (arrythmia, hypotension, tachycardia, bradycardia) was observed in 30,12,7,16 patients respectively. Out of the total 45 patients, 12 patients required mechanical ventilation. Conclusions: Male predominance seen in GBS. AIDP the most common subtype of GBS. Respiratory distress and autonomic instability were associated with greater severity of Hughes disability score. Factors associated with poor outcome were sensory symptoms, autonomic instability, respiratory distress and bulbar cranial nerve involvement.

COVID-19, Vaccine, and Guillain-Barré Syndrome: Association or Causation.

Guillain–Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy, which causes acute flaccid paralysis. Most cases of GBS report either a gastrointestinal or respiratory tract infection in the 3–4 weeks preceding symptom onset. Molecular mimicry between the lipopolysaccharides of the infectious organism and the glycosphingolipids or similar nerve antigens in our body triggers the immune response.[1] Martic, et al. have presented an original study on the GBS followed by coronavirus disease 2019 (COVID-19) infection, vaccination, and other precipitating factors during the pandemic in Serbia and Montenegro.[2] They retrospectively recruited 109 GBS patients between January and April 2022 into the following three groups: COVID-19 infection-associated (19 cases), COVID-19 vaccination-associated (16 cases), and other causes (74 cases). Individuals positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on polymerase chain reaction (PCR) testing were classified as COVID-19-positive. A COVID-19 infection or vaccination was considered a trigger if it occurred between 3 days and 6 weeks before symptom onset. No differences were noted in the clinical presentation, electrophysiology, or outcome between the three groups of GBS patients. Demyelinating neuropathy was the most common electrophysiological subtype, the most common vaccine associated was Sinopharm (8/16 cases), and most events occurred after the first dose. Unlike the Zika virus pandemic, epidemiological studies have not demonstrated COVID-19 infection to be associated with GBS.[3,4] Experts have argued that an increase in GBS incidence might be masked by a decrease in GBS incidence due to other infectious triggers because of better hygiene, lockdown, and social distancing.[5] Studies from Japan and Brazil have reported a decreased incidence of infectious diseases during the lockdown because of these containment measures,[6,7] thereby indirectly reducing the occurrence of GBS. The “GBS consortium,” established in India with 26 centers,[5] found a reduction in the number of GBS cases during the COVID-19 pandemic compared with the same duration in the previous year in both adult[5] and pediatric groups.[8] Similar findings were reported by an epidemiological study conducted in the United Kingdom.[3] These studies[3,5] also reported no significant differences between GBS patients triggered by COVID-19 and those without the infection. Demyelinating GBS is the most common subtype worldwide and was unsurprisingly the most common in this study as well. Older age was associated with a worse prognosis. This was also expected as increasing age is associated with worse GBS outcomes. The relative rarity of COVID-19 vaccine-induced GBS was also in accordance with global data. The authors reported 16 cases of COVID-19 vaccine-induced GBS in the background of 54.1% coverage in adults in a population of 7,806,891 people.[2] The first dose of vaccines was the most common dose implicated, with Sinopharm use associated with most cases. AstraZeneca and Covaxin were the vaccines most commonly used in India, and very few vaccine-associated GBS cases have been reported.[9] A study from Kerala showed a mildly raised incidence of GBS associated with ChAdOx1-S/nCoV-19 vaccination.[10] A retrospective study conducted in the West and North Midlands of the United Kingdom between January and June 2021 reported only 12 cases of COVID-19 vaccine-induced GBS.[11] Most of these individuals had received AstraZeneca vaccines. They reported a higher likelihood of cranial nerve involvement in such GBS cases, similar to Martic, et al.[2] It should be added that this GBS occurrence post-vaccination does not necessarily prove causation. Temporal associations do not imply causality. Also, the COVID-19 vaccine benefits far outweigh the risk of such rare side effects. Finally, the authors mention that the patients were treated with intravenous immunoglobulin (IVIg) and plasma exchange in the standard way. In our experience during the pandemic, the proportion of GBS patients receiving IVIg was significantly higher than that of those receiving plasma exchange (PLEX).[5] The reasons were probably manifold: logistical (greater physician and nursing workforce were working in COVID-19 designated facilities) and difficulty in conducting plasma exchanges within COVID-19 facilities and patient choice (considering they were without accompanying family members in the hospital). The pandemic has shown the need for high-quality prospective longitudinal studies on Guillain–Barré syndrome in low- to middle-income countries. The International Guillain–Barré Syndrome Outcome Study (IGOS) and the recently established GBS consortium in India are good models for replicating in other parts of the world.

Guillain-Barré syndrome following influenza vaccination: A 15-year nationwide population-based case-control study.

Influenza vaccination may increase the risk of developing Guillain-Barré syndrome (GBS) due to an elicited immune response, but the exact magnitude and duration of risk is unclear and hence the aim of this study. We conducted a retrospective nationwide population-based case-control study of prospectively collected data on all patients with first-time hospital-diagnosed GBS in Denmark between 2002 and 2016 and 10 age-, sex- and index date-matched population controls per case. The primary exposure was incident influenza vaccination 1 month prior to admission with GBS. We used medical registries to ascertain a complete hospital contact history of pre-existing morbidities. To examine duration of GBS risk, we repeated the analysis for five consecutive 1-month risk periods following vaccination. Of the 1295 GBS cases and 12,814 controls, 20 cases (1.5%) and 119 controls (0.9%) had received an influenza vaccination within the last month, yielding a comorbidity-adjusted odds ratio of 1.9 (95% confidence interval 1.1-3.2) for GBS. Stratified analyses by calendar time, gender and age showed similar results. The increased risk of GBS was largely confined to 1 month following influenza vaccination. The population-attributable fraction of GBS from influenza vaccination in Denmark was 0.4%. Influenza vaccination was associated with a slightly elevated risk of GBS occurrence within 1 month after vaccination. However, only 1.5% of GBS cases in Denmark are associated with recent influenza vaccination. Thus, the benefit of influenza vaccines in preventing influenza infections and associated morbidity and mortality needs to be weighed against the small absolute risk of GBS.

GUILLAIN-BARRE SYNDROME FOLLOWING CHADOX1 NCOV-19 COVID-19 VACCINATION AT AN ADR MONITORING CENTER IN A TERTIARY CARE HOSPITAL, KOZHIKODE: A CASE SERIES.

Guillain barre syndrome (GBS) is a rare but fatal autoimmune disease affecting the nervous system. The occurrence of GBS after COVID vaccination is rare and its exact cause is still unknown. Hence, here, we are trying to describe the pattern of GBS following the first dose of COVID-19 vaccination as a case series. The retrospective case series study was carried out by analyzing the serious AEFI (Adverse Events Following Immunization) case notification form reported by health-care professionals to ADR Monitoring Center during the period of March 2021–September 2021.The purpose of these case reports is to ensure proper surveillance methods to monitor the safety of COVID vaccination and to promote further researches which is required to determine the possible link between GBS and COVID-19 vaccination.

Comparison of electrodiagnostic findings in patients with post-COVID-19 and non-COVID-19 Guillain-Barre syndrome

Aim: The aim of this study is to compare the electrophysiological features of patients with Guillain-Barré syndrome (GBS) after Coronavirus disease–2019 (COVID-19) and the electrophysiological features of patients with non-COVID-19 GBS and to determine whether there is a difference between these two groups in terms of nerve dysfunction.
 Material and Method: The electromyography results of the patients followed up with the diagnosis of GBS between December 2019 and December 2021 in the Neurology Department of Atatürk University Faculty of Medicine were retrospectively analyzed. Patients with a history of COVID-19 in the 6-week period before the occurrence of GBS were considered as the post-COVID-19 GBS group. Patients who did not have a history of COVID-19 but developed GBS were considered the non-COVID-19 GBS group. Electrodiagnostic findings of the patients were compared between two groups.
 Results: Motor compound muscle action potential (CMAP) amplitude of the median nerve was detected as 1.94±1.43 mV in post-COVID-19 GBS group and 5.94±4.6 mV in non-COVID-19 GBS group (p

A UNIQUE CASE OF GUILLAIN-BARRÉ SYNDROME RELATED TO COVID-19 INFECTION

SESSION TITLE: Fellows Critical Care Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: SARS-CoV2 causes a systemic infection, but pulmonary involvement is the main problem linked to SARS-CoV-2 infection(1). Neurological manifestations are increasingly reported in patients affected by COVID-19, including cases of encephalitis, stroke, and Guillain-Barre syndrome (2). We report a unique case of Guillain-Barre syndrome (GBS) in an immunocompromised patient with COVID-19 related respiratory failure who was failing weaning trial repeatedly. CASE PRESENTATION: A 59year old male with the history of splenectomy , Renal transplantation for End stage renal disease came with the chief complaints of confusion for 2 days. On arrival, the patient’s vitals were significant for hypoxia requiring supplemental oxygen via non-rebreather. CT head showed no acute intracranial pathology. His Chest X-ray revealed bilateral chest infiltrates. COVID-19 PCR on nasopharyngeal swab tested positive. His inflammatory markers were elevated and the patient received Convalescent Plasma and Tocilizumab. The patient’s mental status improved over next 3 days and he became oriented to time, place and person. The patient, however, had to be intubated on day 6 for worsening hypoxic respiratory failure. After 12 days of intubation, the patient was placed on weaning trial. He was able to open eyes during sedation breaks, however, was unable to follow commands or move extremities spontaneously or to painful stimuli. Repeat Head CT showed no acute changes. Electromyography revealed demyelinating axonal polyneuropathy. Lumbar puncture studies came out to be significant for elevated protein and minimal cell count (albumin-cytological dissociation). The Meningioencephalitis panel of Cerebrospinal fluid was negative. The patient has just completed five days of treatment with intravenous immunoglobulins. Due to the inability to wean him off the ventilator, he eventually underwent Tracheostomy and Peg tube placement procedure. DISCUSSION: Our case draws attention to the occurrence of GBS in patients with COVID-19 who are immunocompromised and does not experience motor or sensory symptoms before or at the time of intubation. In our case, GBS was suspected when our patient failed weaning trials. The mechanism of GBS in patients with COVID-19 is still unclear. Both SARS and COVID-19 attach to the angiotensin-converting enzyme 2 receptor which is present in cell membranes of numerous human organs including lung, liver, kidney, and nervous system (3). Guillain-Barré syndrome (GBS) is an acute/subacute immune-mediated polyradiculoneuropathy and may occur as a result of molecular mimicry. SARS-CoV-2 is known to cause an excessive immune reaction with an increased level of cytokines leading to extensive tissue damage (2). CONCLUSIONS: This must be known by clinicians as GBS may lead to failure of weaning trials in patient with COVID-19 and needs to be differentiated from a possible ICU-acquired weakness after ICU treatments. Reference #1: Guan WJ, Ni ZY, Hu Y et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Feb 28. doi: 10.1056/NEJMoa2002032. Reference #2: Carod-Artal FJ. Neurological complications of coronavirus and COVID-19. Rev Neurol. 2020;70(9):311-322. doi:10.33588/rn.7009.2020179 Reference #3: Sahin AR, Erdogan A, Mutlu Agaoglu P, Dineri Y, Cakirci AY, Senel ME, et al. 2019 Novel Coronavirus (COVID-Outbreak: A Review of the Current Literature. EJMO 2020;4(1):1-7.14 DISCLOSURES: No relevant relationships by Oleg Epelbaum, source=Web Response No relevant relationships by Anant Jain, source=Web Response No relevant relationships by Hamid Yaqoob, source=Web Response

Guillain‐Barré syndrome during SARS‐CoV‐2 pandemic: A case report and review of recent literature

Acute demyelinating inflammatory polyneuropathy (AIDP) is the most common type of Guillain‐Barré syndrome (GBS) in Europe, following several viral and bacterial infections. Data on AIDP‐patients associated with SARS‐CoV‐2 (coronavirus‐2) infection are scarce. We describe the case of a 54‐years‐old Caucasian female patient with typical clinical and electrophysiological manifestations of AIDP, who was reported positive with PCR for SARS‐CoV‐2, 3 weeks prior to onset of the neurological symptoms. She did not experience a preceding fever or respiratory symptoms, but a transient loss of smell and taste. At the admission to our neurological department, a progressive proximally pronounced paraparesis, areflexia, and sensory loss with tingling of all extremities were found, which began 10 days before. The modified Erasmus Giullain‐Barré Syndrome outcome score (mEGOS) was 3/9 at admission and 1/12 at day 7 of hospitalization. The electrophysiological assessment proved a segmental demyelinating polyneuropathy and cerebrospinal fluid examination showed an albuminocytologic dissociation. The neurological symptoms improved significantly during treatment with immunoglobulins. Our case draws attention to the occurrence of GBS also in patients with COVID‐19 (coronavirus disease 2019), who did not experience respiratory or general symptoms. It emphasizes that SARS‐CoV‐2 induces immunological processes, regardless from the lack of prodromic symptoms. However, it is likely that there is a connection between the severity of the respiratory syndrome and further neurological consequences.

Vaccines and the risk of Guillain-Barré syndrome.

The role of vaccination in the development of Guillain-Barré syndrome (GBS) is controversial, although cases of GBS have been reported following a wide range of vaccines. A nested case-control study was conducted between January 2011 and December 2015 in three Chinese cities. Four controls were matched to a case by gender, age, address and index date. An independent expert committee validated the diagnoses of cases and controls according to the Brighton Collaboration GBS case definition. Data on vaccinations were obtained from computerized vaccination records. Causal relations were assessed by conditional logistic regression. 1056 cases of GBS and 4312 controls were included in the analyses. Among paediatric and adult population, adjusted ORs for GBS occurrence within 180days following vaccination were 0.94 (95% CI 0.54-1.62) and 1.09 (95% CI 0.88-1.32), respectively. No increased risk of GBS was detected for vaccination against hepatitis B, influenza, hepatitis A, varicella, rabies, polio(live), diphtheria, pertuss(acellular), tetanusis, measles, mumps, rubella, Japanese Encephalitis, and meningitis vaccines. Adjusted ORs for the recurrence of GBS after vaccination among paediatric and adult population were 0.85 (95% CI 0.07-9.50) and 1.18 (95% CI 0.49-2.65), respectively. In this large retrospective study, we did not find evidence of an increased risk of GBS and its recurrence among either paediatric (≤ 18years) or adult (> 18years) individuals within the 180days following vaccinations of any kind, including influenza vaccination.

Association of infection with flaviviruses with occurrence of Guillain-Barre syndrome (GBS)

Association of infection with flaviviruses with occurrence of Guillain-Barre syndrome (GBS)

Seasonal variations of childhood Guillain-Barre Syndrome in South west Iran

Background: It was found that the occurrence of Guillain-Barre Syndrome (GBS) varies in respect tothe month and season; this variation has not been adequately studied.Objective: To determine the month and seasonal variation of GBS in children in the Khuzestanprovince, south west Iran, during a 10-year period (2006-2015).Patients and methods: We extracted data retrospectively from acute flaccid paralysis committeefrom healthcare centers in all cities of the province, over a 10-year period (from January 1, 2006 toDecember 31, 2015). In this study all children under 15 years of age with Guillain-Barre syndromewere surveyed. In order to compare the frequency of GBS in different seasons and months we used theChi Square test.Results: From 187 cases of GBS, 101 (54%) were males, 86 (46%) females with sex ratio 1.17:1. Themean age of the children was 5.39 ± 4.02 years. The highest occurrence of GBS was observed inautumn (32.1%) followed by winter (27.3%). The highest number of cases (28; 15%) occurred inDecember and the lowest (8; 4.3%) in September. There was seasonal (P=0.006) and monthly(P=0.036) variation in occurrence of GBS throughout the year with more prevalence in autumn ,September and December.Conclusion: Our study showed that there is a significant monthly and seasonal variation in childrenwith GBS in Khuzestan province.

Seasonal variations of childhood Guillain-Barre Syndrome in South west Iran

Background: It was found that the occurrence of Guillain-Barre Syndrome (GBS) varies in respect tothe month and season; this variation has not been adequately studied.Objective: To determine the month and seasonal variation of GBS in children in the Khuzestanprovince, south west Iran, during a 10-year period (2006-2015).Patients and methods: We extracted data retrospectively from acute flaccid paralysis committeefrom healthcare centers in all cities of the province, over a 10-year period (from January 1, 2006 toDecember 31, 2015). In this study all children under 15 years of age with Guillain-Barre syndromewere surveyed. In order to compare the frequency of GBS in different seasons and months we used theChi Square test.Results: From 187 cases of GBS, 101 (54%) were males, 86 (46%) females with sex ratio 1.17:1. Themean age of the children was 5.39 ± 4.02 years. The highest occurrence of GBS was observed inautumn (32.1%) followed by winter (27.3%). The highest number of cases (28; 15%) occurred inDecember and the lowest (8; 4.3%) in September. There was seasonal (P=0.006) and monthly(P=0.036) variation in occurrence of GBS throughout the year with more prevalence in autumn ,September and December.Conclusion: Our study showed that there is a significant monthly and seasonal variation in childrenwith GBS in Khuzestan province.

The clinical significance of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in Guillain–Barré syndrome

ABSTRACTPurpose/Aim of the study: Guillain Barré syndrome (GBS) is a severe peripheral nervous disease that leads to muscle weakness and areflexia. We now commonly accept a synthesis that inflammation and immunity play key role in GBS pathogenesis. Many studies pointed out that neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are novel promising markers of inflammation or immunity. Our study aimed to evaluate whether the NLR and the MLR were associated to GBS or not.Materials and Methods: We measured blood cell count in 334 individuals including 117 GBS and 217 healthy controls.Results: Our findings demonstrated that the GBS patients had higher levels of NLR and MLR than the healthy controls. The severe group also had higher levels of NLR and MLR compared to the mild group. We took the method of receiver-operating characteristic curve to find out the cut-off value of NLR for GBS occurrence and severity; it was 2.295 and 3.05, respectively. The cut-off values of MLR for GBS incidence and severity were the same, it was 0.235.Conclusion: In the setting of GBS, the NLR and MLR were significantly increased and they may be pathophysiologically and clinically relevant in GBS. The NLR and MLR would be new biomarkers of medical application.

Epidemiology of Guillain-Barré syndrome in Finland 2004-2014.

At total mean incidence of 0.84–1.1/100,000 the occurrence of Guillain‐Barré syndrome (GBS) is reported to be low in Finland compared to other Caucasian populations. However, a recent study from Southwestern Finland reported an incidence of 1.82/100,000 which is comparable to other Caucasian populations. We analyzed discharge data covering the years 2004 through 2014 on all neurological admissions in all Finnish university and central hospitals with a primary diagnosis of GBS. A total of 989 admissions due to GBS (917 individuals) were identified. The standardized (European population) annual incidence rate was 1.70/100,000 person‐years (95% confidence interval 1.60–1.81). GBS incidence had an increasing trend with age. The likelihood of GBS was higher among girls and adolescent women than boys and men of same age (male:female incidence rate ratio [IRR] 0.56), while in the older age groups (>19 years) the occurrence of GBS was higher among males than females (male:female IRR 1.59). The incidence of GBS remained stable during the study period. There was no seasonal variation in GBS admission frequencies (p = 0.28). No significant effect of the 2009–2010 H1N1 influenza or vaccination against it for GBS occurrence was observed. We suggest that GBS is as common, and has similar age‐distribution in Finland as in other European countries. Sex‐associated susceptibility for GBS appears to be different in children‐adolescents and adults.

The Epidemiology of Guillain-Barré Syndrome in Children under 15 Years Old in Southwest Iran

Background: Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuropathy, which has become the most common cause of acute flaccid paralysis. An accurate estimation of GBS occurrence would be useful for investigating the potential causal relationships between risk factors and GBS. The aim of the study was to analyze the incidence, annual time trend, and some epidemiological aspects of GBS in children in the Southwest of Iran. Methods: This was a retrospective study conducted by the Department of Pediatrics of Ahvaz Jundishapur University of Medical Sciences from January 2006 to December 2015. We extracted data from the national database of Acute Flaccid Paralysis Surveillance System. Results: A total of 184 subjects with GBS were assessed. The mean age of subjects was 5.43 ± 4.07 years. The average annual incidence rate of GBS was 1.51 per 100,000 children under 15 years old (95% CI: 1.29-1.73). There was no significant statistical difference in GBS incidence rate between girls and boys (p = 0.376). The highest and lowest proportions of the GBS occurrences were in autumn (32.2%) and summer (14.7%), respectively. Conclusions: The findings indicated that the annual incidence rate of GBS in this study was similar to those in other studies in this area.

Seasonal occurrence of Guillain-Barre syndrome over a 5-year period

Background: Guillain-Barre syndrome (GBS) is an acute onset, immune-mediated disorder of the peripheral nervous system . Seasonal occurrence of GBS have not been adequately studied in past.

A REPORT ABOUT ZIKA VIRUS IN BRAZIL

Zika virus, a Flavivirus first isolated in Africa, has spread to many countries around the world including Brazil. In this country, seven months after the football world cup, it was registered the occurrence of a epidemic, subsequently related to cases of microcephaly and Guillain-Barre syndrome. The virus is transmited via mosquito from Aedes genus, often following the bite from an infected vector. The febrile disease is self-limited, and there is no specific treatment. Few months after this outbreak in Brazil, the authorities recognized the relationship between the Zika virus and the occurrence of Guillain Barre syndrome and microcephaly in newborns, correponding to fetal cerebral malformation or brain lesions. This finding is being a worldwide alert for strengthening the preventive measures, restricted to prevent insect bites and care for the environment.

Risperidone - A Probable Cause of Guillain-Barre Syndrome: A Case Report

Background: Guillain-Barre syndrome (GBS) is an acute immune-mediated demyelinating polyneuropathy, and it has been suggested that immune-mediated mechanism underlying the pathogenesis of GBS was triggered by infectious agents, vaccination, head trauma, operation, and malignancy. Risperidone, one of the secondgeneration antipsychotic drugs, tends to alter cytokine levels that could partly be attributed to GBS occurrence. Findings: We herein present a 7 year-old-girl who developed GBS under risperidone treatment. The possibility of occurrence of GBS triggered by risperidone was analyzed using causality assessment scales of Naranjo and World Health Organization Collaborating Centre for International Drug Monitoring, the Uppsala Monitoring Centre (WHO–UMC). The results indicated that risperidone was a probable cause of GBS. Conclusion: Patients with newly-emerging neurologic symptoms under risperidone should undergo detailed neurologic examination, and if necessary neurophysiologic assessment.

Campylobacter jejuni capsular genotypes are related to Guillain–Barré syndrome

In about one in a thousand cases, a Campylobacter jejuni infection results in the severe polyneuropathy Guillain–Barré syndrome (GBS). It is established that sialylated lipo-oligosaccharides (LOS) of C. jejuni are a crucial virulence factor in GBS development. Frequent detection of C. jejuni with sialylated LOS in stools derived from patients with uncomplicated enteritis implies that additional bacterial factors should be involved. To assess whether the polysaccharide capsule is a marker for GBS, the capsular genotypes of two geographically distinct GBS-associated C. jejuni strain collections and an uncomplicated enteritis control collection were determined. Capsular genotyping of C. jejuni strains from the Netherlands revealed that three capsular genotypes, HS1/44c, HS2 and HS4c, were dominant in GBS-associated strains and capsular types HS1/44c and HS4c were significantly associated with GBS (p 0.05 and p 0.01, respectively) when compared with uncomplicated enteritis. In a GBS-associated strain collection from Bangladesh, capsular types HS23/36c, HS19 and HS41 were most prevalent and the capsular types HS19 and HS41 were associated with GBS (p 0.008 and p 0.02, respectively). Next, specific combinations of the LOS class and capsular genotypes were identified that were related to the occurrence of GBS. Multilocus sequence typing revealed restricted genetic diversity for strain populations with the capsular types HS2, HS19 and HS41. We conclude that capsular types HS1/44c, HS2, HS4c, HS19, HS23/36c and HS41 are markers for GBS. Besides a crucial role for sialylated LOS of C. jejuni in GBS pathogenesis, the identified capsules may contribute to GBS susceptibility.