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Toscana virus associated with Guillain–Barré syndrome: a case–control study

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Abstract

Guillain–Barré syndrome (GBS) is an acute-onset, immune-mediated polyradiculoneuropathy, often precipitated by an antecedent infection. An association of GBS with vector-borne viral infections has been suggested, with evidence for the involvement of Zika, Dengue, Chikungunya and West Nile virus (WNV). This prospective case–control study was conducted to identify vector-borne viral infections in GBS. Thirteen individuals newly diagnosed as GBS were enrolled. Disease severity, prognostic factors and nerve conduction patterns were assessed. Eleven individuals with non-infectious conditions requiring cerebrospinal fluid (CSF) analysis were included as controls. Plasma, CSF and urine specimens were evaluated via nucleic acid amplification assays aimed to detect a broad spectrum of viruses. WNV and Toscana virus (TOSV) IgM/IgG antibodies were screened using commercial immunofluorescence assays and confirmed via virus neutralization tests (VNT). Partial TOSV nucleocapsid and genotype 1 polymerase sequences were detected in CSF of a patient with normal pressure hydrocephalus. Two control subjects had VNT-confirmed TOSV IgM in plasma. VNT-confirmed WNV and TOSV IgG were detected in 15.4% and 61.5% of GBS patients, respectively. Variations in WNV IgG and TOSV IgM detection rates were not statistically significant among study cohorts. However, TOSV IgG was significantly more frequent in GBS patients. No difference was observed for disease form or prognostic scores for virus markers. Follow-up serological profiles were identical to the initial findings. We have identified TOSV as a potential precipitating agent in GBS, with some rare clinical presentations of symptomatic TOSV infections.

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Acknowledgements

The authors are grateful to Dr. Muhittin Serdar, Acıbadem Mehmet Ali Aydınlar University, for support in statistical analyses. Preliminary findings of this study have been presented at the Peripheral Nerve Society—PNS Annual Meeting, held during 8–12 July 2017 in Sitges, Barcelona, Spain. This publication was supported by the European Virus Archive goes Global (EVAg) project that has received funding from the European Union’s Horizon 2020 research and innovation programme under Grant agreement no 653316.

Funding

The study was supported by the Hacettepe University Scientific Research Projects Coordination Unit funds (Project ID:15364: THD-2017-15364).

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Authors and Affiliations

  1. Faculty of Medicine, Department of Neurology, Hacettepe University Hospitals, Hacettepe University, Floor A, Sihhiye, 06100, Ankara, Turkey

    Serhat Vahip Okar, Can Ebru Bekircan-Kurt & Sevim Erdem-Özdamar

  2. Faculty of Veterinary Medicine, Department of Virology, Ankara University, 06110, Ankara, Turkey

    Sabri Hacıoğlu & Aykut Özkul

  3. Faculty of Medicine, Department of Medical Microbiology, Virology Unit, Hacettepe University, 06100, Ankara, Turkey

    Koray Ergünay

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  1. Serhat Vahip Okar
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  2. Can Ebru Bekircan-Kurt
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Correspondence to Serhat Vahip Okar.

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Okar, S.V., Bekircan-Kurt, C.E., Hacıoğlu, S. et al. Toscana virus associated with Guillain–Barré syndrome: a case–control study. Acta Neurol Belg 121, 661–668 (2021). https://doi.org/10.1007/s13760-020-01279-5

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