Letter to the Editor
Guillain–Barré syndrome due to Zika virus during pregnancy
Síndrome de Guillain-Barré debido al virus del Zika durante el embarazo
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Symptoms in pregnant women include malaise, muscle weakness and breathing problems. The pathophysiological mechanism of GBS from ZV is unknown but may be of immunological origin.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> A case of GBS during pregnancy because of ZV presented itself.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 28-year-old patient who was 26 weeks pregnant who had ascending limb weakness with difficulties in speech and swallowing. Her neurological examination showed alterations of cranial nerves and speech, decreased muscle strength in limbs and areflexia. She had a history of myalgia, fever, skin rash and conjunctivitis 10 days before her current profile, considering the possibility of ZV infection.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Laboratory tests were normal. An increase in protein in the cerebrospinal fluid (CSF) was observed: 2.59<span class="elsevierStyleHsp" style=""></span>g/l with seven leukocytes/ml. Electromyography revealed diffuse demyelinating disorder with high distal motor latency, conduction block, acute denervation without axonal abnormalities. Serologic tests were negative for common agents and positive against ganglioside GQ1b and ZV.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was admitted the next day, presenting progressive respiratory failure so was transferred to intensive care for mechanical ventilation, starting with intravenous immunoglobulin treatment for 5 days. On the seventh day of hospitalisation, a gradual improvement in muscle strength was observed and mechanical ventilation was suspended. The patient was discharged after 3 weeks of hospitalisation, recovering completely. At 39 weeks she had a vaginal delivery of a newborn female in good condition.</p><p id="par0025" class="elsevierStylePara elsevierViewall">There have been sporadic reports of ZV infection in humans in Asia and Africa since 1960. It is transmitted by mosquitoes, although there have been reports of transmission between humans, probably sexually.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The infection is symptomatic in 18% of cases.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> It is presented as an influenza-like syndrome and can be confused with dengue. Symptoms are fever, arthralgia in smaller joints, myalgia, headache, conjunctivitis and skin rash.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">GBS is a demyelinating inflammatory polyradiculopathy. Two thirds of patients have a history of infection 6 weeks prior to diagnosis, with respiratory or gastrointestinal symptoms. The most commonly associated infectious agents include <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span>, <span class="elsevierStyleItalic">Campylobacter jejuni</span>, Cytomegalovirus and Epstein–Barr virus.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The explanation for their appearance in patients infected with ZV is unknown but may be due to an evolution towards more pathogenic genotypes or host susceptibility. The history of infection by dengue type 1 and 3 may be a predisposing factor for GBS through ZV, which has already been described in patients with dengue.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The GBS results in paraesthesia or weakness of the limbs. Other findings include: respiratory failure, alteration of cranial nerves, sensory symptoms and symptoms of autonomic dysfunction. The appearance–diagnosis interval in pregnancy is longer than a week in many cases because the initial symptoms are similar to those of a normal pregnancy. The disease appears 1–4 weeks after infection and recovery takes weeks or months.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnosis is based on clinical and neurophysiological tests, supported by CSF tests. Other findings include: respiratory failure, alteration of cranial nerves, sensory and symptoms of autonomic dysfunction. CSF shows increase of proteins with normal cell count.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Nerve conduction is abnormal in 90% of cases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Early diagnosis is important because it has a rapid progress, which leads to the use of mechanical ventilation. Maternal mortality is 7%, and 20% of patients have disabilities after 12 months.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">GBS treatment in pregnancy includes intravenous immunoglobulin and plasmapheresis. In pregnancy, the safety of intravenous immunoglobulin has been established, based on its use in the treatment of different conditions<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>. The benefits of plasmapheresis are higher in the seven days following its onset, but also provides advantages when used within 30 days.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Variations in the maternal heart rate and blood pressure secondary to autonomic dysfunction have been described, so it must therefore be controlled without interference with the foetal-placental flow.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Reyna-Villasmil E, López-Sánchez G, Santos-Bolívar J. Síndrome de Guillain-Barré debido al virus del Zika durante el embarazo. Med Clin (Barc). 2016;146:331–332.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Zika virus infection, Cambodia, 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Heang" 1 => "C.Y. Yasuda" 2 => "L. Sovann" 3 => "A.D. Haddow" 4 => "A.P. Travassos da Rosa" 5 => "R.B. 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