Elsevier

Journal of Clinical Virology

Volume 77, April 2016, Pages 29-31
Journal of Clinical Virology

Case report
Early Guillain–Barré Syndrome associated with acute dengue fever

https://doi.org/10.1016/j.jcv.2016.01.016Get rights and content

Highlights

  • Concomitant detection of dengue virus in three Guillain–Barré syndrome patients.

  • Diagnosis of dengue confirmed by RT-PCR on both sera and cerebrospinal fluid.

  • Complete recovery within one week of three Guillain–Barré syndrome patients.

Abstract

Various forms of neurological manifestations are reported in dengue fever. We describe here three cases of concomitant Guillain–Barré syndrome and dengue virus (DENV) infection during the largest DENV-1 outbreak in New Caledonia. Research of viral RNA was positive in both blood and CSF samples. All patients were treated with intravenous polyvalent immunoglobulins and recovered without sequelae within one week.

Section snippets

Why this case is important?

We report herein three cases of concomitant Guillain–Barré syndrome (GBS) and dengue fever during the largest dengue virus (DENV) outbreak ever reported in New Caledonia (2012–2013) [1]. To our knowledge, these cases represent the first description of concomitant GBS and DENV infection diagnosed by RT-PCR. In our cases both sera and cerebrospinal fluid (CSF) taken before two and after three days of the onset of neurological symptoms were positive for DENV. The three patients were treated with

Case description

The three patients were two males and one female with a mean age of sixty years old (range 55–68). They were from various origins, Melanesian, Indonesian and Caucasian. One of them had a significant medical history of Basedow disease but without treatment (Table 1).

Dengue fever (DF) symptoms included acute fever, headaches, muscle and joint pains without any haemorrhagic signs. Mean latency between fever and the neurological symptoms was 2 days (range 1–3). Only in case 2 the diagnosis of DF was

Other similar and contrasting cases in the literature

Dengue is the most prevalent arthropod-borne human viral infection in tropical and subtropical countries. DENV is a single-stranded, positive-sense RNA virus of the genus Flavivirus transmitted by Aedes mosquitoes. Infection with one of the four distinct serotypes (DENV-1 to DENV-4) does not provide long-term cross-protective immunity against the three others. Incidence of dengue has grown dramatically over the last decades [3]. Over 40% of the world's population is now at risk. WHO currently

Discussion

These three cases of GBS with DENV RT-PCR positive in both serum and CSF are original. The simultaneous occurrence of GBS and DF has only been described in two cases [7], [8] but the diagnostic has not been confirmed by RT-PCR, NS1 antigen or cell culture. In all others cases of GBS, DF occurred at least one week after the beginning of DF and after the viremic phase that is usually lasting 7 days after the disease onset [3]. In our cases, detection of viral RNA in both serum and CSF samples

Conflict of interest

None to declare.

Funding

None.

Ethical approval

None.

Acknowledgments

We would like to thank the personnel from Gaston Bourret Hospital and Institut Pasteur in New Caledonia for their work during this dengue outbreak.

References (13)

There are more references available in the full text version of this article.

Cited by (37)

  • Brain and Central Nervous System Infections: Viruses

    2022, Encyclopedia of Infection and Immunity
  • Guillain-Barré syndrome during the Zika virus outbreak in Northeast Brazil: An observational cohort study

    2021, Journal of the Neurological Sciences
    Citation Excerpt :

    A recent DENV infection was found in just one patient in this cohort. This may be because there was no outbreak of DENV during the study period, also, there have been conflicting reports in literature about the presumed association between DENV and GBS [34,36]. A larger proportion of cases with a recent infection with both ZIKV and CHIKV was admitted to the ICU and mechanically ventilated compared to the other patients, and the duration of hospital admission was longer in this group.

  • A scoping review of Chikungunya virus infection: epidemiology, clinical characteristics, viral co-circulation complications, and control

    2018, Acta Tropica
    Citation Excerpt :

    Guillain-Barré syndrome (GBS), for instance, has been associated with CHIKV infection (Lebrun et al., 2009; Oehler et al., 2015). GBS comprises an acute inflammatory demyelinating polyneuropathy of global incidence, in which about two-thirds of cases occur after bacterial (e.g. Campylobacter jejuni) (Heikema et al., 2015) or viral infection (Oehler et al., 2015), such as by Dengue- (Simon et al., 2016), West Nile- (Leis and Stokic, 2012), Influenza- (Choi and Yeon, 2016), Cytomegalo- (Steger et al., 2012), Human Immunodeficiency- (Girgin et al., 2014), Epstein-Barr (Phillips, 1973; Kim et al., 2016) and Zika viruses (Rozé et al., 2017). During the more recent CHIKV outbreaks, total or partial alopecia on the head or body, predominately in female patients, and ophthalmological alterations, such as uveitis and retinitis, were described during the chronic phase of infection (Martínez-Pulgarín et al., 2016; Cunha and Trinta, 2017).

  • Zika virus: History, epidemiology, transmission, and clinical presentation

    2017, Journal of Neuroimmunology
    Citation Excerpt :

    Guillain-Barré syndrome is an autoimmune disease in which the immune system attacks part of the peripheral nervous system, causing tingling, muscle weakness, paralysis, and even death (Creange, 2016; Goodfellow and Willison, 2016). Previously, this neuromuscular complication had been associated with infection by other arboviruses, such as DENV (Carod-Artal et al., 2013; Ralapanawa et al., 2015; Simon et al., 2016; Verma et al., 2014) and chikungunya virus (Wielanek et al., 2007). The temporal and geographic association of ZIKV with Guillain-Barré syndrome was initially observed during the 2013–2014 outbreak reported in French Polynesia (ECDC, 2014; Musso et al., 2014b; Oehler et al., 2014) and subsequently during the 2015–2016 outbreak that is still ongoing in the Americas (Broutet et al., 2016; Roze et al., 2016; Thomas et al., 2016).

View all citing articles on Scopus
View full text