title: Flavivirus cross-reactivity in serological tests and Guillain-Barré syndrome in a hematopoietic stem cell transplant patient: A case report.
abstract: Serological diagnosis of flavivirus infection is a challenge, particularly in the context of a disease associated with immune response enhancement in a transplant patient, where aspects such as previous flavivirus infections may be involved with the outcome. We report a case of a pediatric patient who developed Guillain-Barré syndrome (GBS) after matched-unrelated hematopoietic stem cell transplantation (HSCT). The patient lives in a Brazilian region that is experiencing an epidemic of Zika virus (ZIKV) and dengue virus (DENV). Because an increasing number of cases of GBS, likely triggered by ZIKV infection, are being reported in Brazil, samples from the patient were tested for both ZIKV and DENV infection. Serological assays strongly suggested a recent ZIKV infection, although infection by DENV or co-infection with both viruses cannot be ruled out. The presence of anti-DENV immunoglobulin-G in donor serum led to the hypothesis that antibodies from the donor could have enhanced the severity of the ZIKV infection. This hypothesis is in agreement with the recent findings that DENV sero-cross-reactivity drives antibody-dependent enhancement of ZIKV infection. These findings highlight the need for discussion of the indication to perform previous flavivirus tests in HSCT donors, especially in areas where ZIKV and other flaviviruses co-circulate.
authors.affiliation: Laboratory of Virology, Universidade Federal do Paraná, Paraná, Brazil.
authors.forename: Sonia M
authors.identifier: http://orcid.org/0000-0001-7907-7585
authors.initials: SM
authors.lastname: Raboni
authors.affiliation: Bone Marrow Transplant Division, Universidade Federal do Paraná, Paraná, Brazil.
authors.forename: Carmem
authors.initials: C
authors.lastname: Bonfim
authors.affiliation: Hospital Epidemiology Division, Universidade Federal do Paraná, Paraná, Brazil.
authors.forename: Bernardo M
authors.initials: BM
authors.lastname: Almeida
authors.affiliation: Molecular Virology Laboratory, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Camila
authors.initials: C
authors.lastname: Zanluca
authors.affiliation: Molecular Virology Laboratory, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Koishi
authors.affiliation: Neuromuscular Disease Service, Neurology Division, Universidade Federal do Paraná, Paraná, Brazil.
authors.forename: Paula R V P
authors.initials: PRVP
authors.lastname: Rodrigues
authors.affiliation: Neuromuscular Disease Service, Neurology Division, Universidade Federal do Paraná, Paraná, Brazil.
authors.forename: Claudia K
authors.initials: CK
authors.lastname: Kay
authors.affiliation: Bone Marrow Transplant Division, Universidade Federal do Paraná, Paraná, Brazil.
authors.forename: Lisandro L
authors.initials: LL
authors.lastname: Ribeiro
authors.affiliation: Neuromuscular Disease Service, Neurology Division, Universidade Federal do Paraná, Paraná, Brazil.
authors.forename: Rosana H
authors.initials: RH
authors.lastname: Scola
authors.affiliation: Molecular Virology Laboratory, Instituto Carlos Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Claudia N
authors.initials: CN
authors.lastname: Duarte Dos Santos
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D001938:Brazil; D002648:Child; D060085:Coinfection; D003429:Cross Reactions; D003715:Dengue / Q000150:complications* / Q000175:diagnosis / Q000821:virology; D003716:Dengue Virus / Q000276:immunology*; D005260:Female; D020275:Guillain-Barre Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D012698:Serologic Tests; D000071244:Zika Virus / Q000276:immunology*; D000071243:Zika Virus Infection / Q000150:complications* / Q000175:diagnosis / Q000821:virology
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M
keywords: Dengue virus; Guillain-Barré syndrome; Zika virus; hematopoietic stem cell transplantation