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Guillain-Barré syndrome following varicella-zoster virus infection

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Abstract

We describe the frequency, clinical features, and electrophysiological and immunological phenotypes of Guillain-Barré Syndrome (GBS) patients treated at a single institution in Bangladesh who had preceding chicken pox (primary Varicella-zoster virus [VZV] infection) within 4 weeks of GBS onset. A literature review of GBS cases preceding VZV infection is also provided. Diagnosis of GBS was based on the National Institute of Neurological Disorders and Stroke criteria for GBS. Serum anti-VZV IgM and IgG antibodies were quantified by indirect chemiluminescence immunoassay (CLIA); anti-Campylobacter jejuni IgG, IgM, and IgA antibodies and anti-ganglioside GM1 IgM and IgG antibodies, by enzyme-linked immunosorbent assays. Neurophysiologic subtypes were categorized following the Hadden criteria. Of 536 patients with GBS, 7 (1.3%) had chicken pox within 4 weeks before GBS onset. Four of the seven cases were male (age range, 23 to 40 years old). All seven patients were bed-bound, six had sensory symptoms, and three required mechanical ventilation for respiratory failure. All seven patients had CSF albuminocytologic dissociation and evidence of demyelination in nerve conduction studies. Anti-VZV IgM antibodies were present and anti-GM1 and anti-Campylobacter jejuni lipo-oligosaccharides (LOS) were negative in all cases. All patients had excellent outcome at 1 year (able to run). A systematic literature review of GBS cases related to VZV revealed 39 previously reported patients with comparable clinical presentations and outcomes, of which 36 had neurophysiologic evidence of demyelination. VZV infection is associated with the demyelinating subtype of GBS, clearly distinct from the axonal form of GBS that predominate in countries like Bangladesh.

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Acknowledgments

The icddr,b acknowledges the Government of Bangladesh’s commitment, as well Global Affairs Canada (GAC), Swedish International Development Cooperation Agency (Sida), and UK Department for International Development (DFID). We are grateful to laboratory personnel at the Enteric Microbiology Laboratory Sciences & Services Division (LSSD) and library personnel from icddr,b for their support. We are indebted to the neurologists who referred their patients to us.

Funding

This research activity was funded by the icddr,b and the Government of Bangladesh.

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Authors and Affiliations

  1. Laboratory Sciences and Services Division (LSSD), International Centre for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh

    Badrul Islam, Zhahirul Islam, Israt Jahan & Hubert P. Endtz

  2. Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Badrul Islam & Hubert P. Endtz

  3. Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Corine H. GeurtsvanKessel

  4. Fondation Mérieux, Lyon, France

    Hubert P. Endtz

  5. National Institute of Neuroscience & Hospital, Dhaka, Bangladesh

    Quazi D. Mohammad

  6. Departments of Neurology and Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Bart C. Jacobs

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  1. Badrul Islam
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  2. Zhahirul Islam
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Correspondence to Badrul Islam.

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Islam, B., Islam, Z., GeurtsvanKessel, C.H. et al. Guillain-Barré syndrome following varicella-zoster virus infection. Eur J Clin Microbiol Infect Dis 37, 511–518 (2018). https://doi.org/10.1007/s10096-018-3199-5

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