Probable Zika virus-associated Guillain-Barré syndrome: Challenges with clinico-laboratory diagnosis.
A 55year old woman in New York City presented in May 2016 with progressive weakness, ataxia, paresthesia, and areflexia, shortly after returning from the Dominican Republic. Lumbar puncture revealed cytoalbuminological dissociation. Due to her recent travel, Zika-associated Guillain Barré syndrome (GBS) was suspected and she underwent evaluation for recent flavivirus exposure. Zika virus RNA was not detected in serum, but Zika virus immunoglobulin M (IgM) was detected in both serum and cerebrospinal fluid. Dengue virus IgM in serum was equivocal and dengue virus IgG was detected in the serum. Plaque-reduction neutralization testing showed elevated titers to both Zika virus and dengue virus, providing evidence of recent infection with a flavivirus. The patient was diagnosed with probable Zika virus-associated GBS based on clinical findings, ancillary testing, and laboratory assays according to current guidance from the Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists. Zika virus transmission in the Americas is resulting in increasing numbers of patients presenting with Zika virus-associated neurological syndromes. Clinical and laboratory diagnosis in these cases can be challenging and may be aided by consultation with CDC, and state and local public health agencies.
Department of Neurology, Columbia University Medical Center, New York, NY, United States.
Eliza
E
Miller
Columbia University College of Physicians and Surgeons, New York, NY, United States.
Zoe
Z
Becker
Department of Psychiatry, Columbia University Medical Center, New York, NY, United States.
Daniel
D
Shalev
Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, NY, United States; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Christopher T
CT
Lee
Department of Neurology, Columbia University Medical Center, New York, NY, United States.
Comana
C
Cioroiu
Department of Neurology, Columbia University Medical Center, New York, NY, United States. Electronic address: ktt2115@cumc.columbia.edu.
Kiran
K
Thakur
D005260:Female; D020275:Guillain-Barre Syndrome / Q000175:diagnosis / Q000209:etiology / Q000821:virology; D006801:Humans; D008875:Middle Aged; D009519:New York City; D000071244:Zika Virus / Q000472:pathogenicity*; D000071243:Zika Virus Infection / Q000150:complications*
Flavivirus; Guillain-Barré syndrome; Zika virus