The Zika Epidemic Is Gone But Other Pathogens Are Triggering Guillain-Barré Syndrome in Colombia: A Case-control Study
Carlos Pardo-Villamizar1, Lyda Osorio2, Beatriz Parra2, Jose Enrique Vargas Manotas3, Reydmar Lopez4, Jorge Jimenez4, Jairo Lizarazo Niño5, Martha Moyano2, Gustavo Ramos6, Juan Rojas7, Fernando Rosso8, Christian Rojas Cerón2, Julie Benavides9, Viviana Martinez10, Mario Llanos11, Maria Garcia-Dominguez1, Jaime Quintero8, Maria Fernanda Ramos Sanchez5, Jose Enciso2, Daniela Zuluaga Lotero2, David Acero-Garces2, Susana Dominguez Penuela1
1Johns Hopkins University School of Medicine, 2Universidad del Valle, 3Universidad Simon Bolivar and Clinica La Misericordia, 4Universidad de Antioquia and Clinica Leon XIII, 5Hospital Universitario Erasmo Meoz, 6Clinica Rey David, 7Fundación Clínica Infantil Club Noel, 8Fundacion Valle del Lili, 9Universidad Cooperativa de Colombia-Pasto, 10Hospital Universitario de Pasto, 11Rey David clinic
Objective:
We aimed to investigate the association of emerging infectious disorders with Guillain-Barré syndrome (GBS) in Colombia following the 2015-2016 Zika outbreak.
Background:
GBS is frequently associated with sporadic or epidemic infectious disorders. The role of preceding infections as a risk factor for GBS has been highlighted recently by emerging viral and bacterial infectious disorders, as major clusters of GBS have been observed recently in Latin America.
Design/Methods:
A prospective case-control study was conducted between June 2016 and December 2019 in 9 university-based hospitals across 5 Colombian cities, included in the Neuroinfections Emerging in the Americas Study (NEAS). Newly diagnosed patients with GBS were matched with healthy household and age and season-matched hospital controls. Clinical information, blood, CSF, and urine samples were used for immunological and molecular assays to establish the presence of recent infection preceding enrollment into the study. Serum was used to identify anti-gangliosides antibodies. Analyses were performed using conditional logistic regression.
Results:
Fifty-seven patients with GBS, 67% male, with a median age (IQR) of 52 years (24–64) were recruited along with 77 controls. The associations of GBS with male sex (aOR, 4.4; 95% CI 2-9.7; p<0·0001), preceding diarrhea (aOR, 5.5; 95% CI 1.6-19.4; p=0·008), and history of recent upper respiratory tract infection (aOR, 8.25; 95% CI 2.4-28.3 p=0·001) were statistically significant. Specific recent infections did not significantly differ between cases and controls, but the number of infections was significantly associated with GBS (aOR=1.77 CI 1.04-3.01 p=0.034). Overall, C. jejuni , M. pneumoniae and Chikungunya virus were the most frequent infections in GBS cases.
Conclusions:
After the ZIKV epidemic, C. jejuni, M. pneumoniae, and Chikungunya virus were the most common preceding infections in GBS in Colombia. The high frequency of C. jejuni, diarrhea, and upper respiratory infections underlies the importance of such risk factors as pathogenic triggers for GBS.