Joseph R. Anticaglia MD
Medical Advisory Board
IN 2015, the Zika virus outbreak in Recife, Brazil made international headlines. The Brazilian Health Ministry and the World Health Organization rang the alarm bell because pregnant woman infected with the Zika virus were suspected of giving birth to children with birth defects, most notably, microcephaly. (1, 2)
However, what has gone under the radar is the association of the Zika virus with the rise in the incidence of a paralyzing neurologic disorder, the Guillain-Barre’ Syndrome.
What is the Guillain-Barre’ Syndrome (GBS)?
Guillain-Barre’ syndrome is a rare disorder with potentially shocking consequences. It affects the nerves of the legs, arms and body and its ill effects have increased in frequency since the ZIKV outbreak. The bite of the female infected Adeles mosquito transmits the virus to people. (3) It seems that the Zika virus disables the body’s ability to distinguish the invading Zika virus from the body’s own normal nerve tissue.
In the cases of Guillain-Barre’ infected with the ZIKV, the person’s defense system (antibodies) does not seek and destroy the harmful Zika virus but rather attacks the body’s peripheral nervous system — the nerves outside the brain and spinal cord. This self-destruct act (autoimmune disease) can lead to muscle weakness and paralysis of the whole body.
What Are the Symptoms?
GBS usually begins with complaints of weakness or tingling sensations in both legs that varies in severity. The muscle weakness can move up to involve both arms, the face, the muscles of swallowing or those muscles that control eye movement (ascending paralysis). Some patients cannot blink or close the eye. When the muscles of breathing are involved, the person needs hospitalization and the insertion of a breathing tube to stay alive. (4)
Some individuals with GBS complain of nerve pain or deep muscle achiness. Others with GBS have experienced cardiac irregularities, blood pressure problems and impaired sphincter control.
How is GBS Diagnosed?
As usual, the medical history and physical examination of the patient are essential — but especially helpful for the diagnosis of GBS. Characteristically, people with GBS note that the numbness and weakness started in both feet and legs, (it is symmetrical), moved upwards to involve the arms and body and it happened suddenly! Not infrequently there’s a precipitating cause such as the ZIKV, but other viruses and causes can also bring on GBS.
Spinal taps and nerve conductivity tests (NCT) have been used to aid in the diagnosis and prognosis of GBS patients. NCT tests are used to evaluate peripheral nerves, namely, how the nerves are relaying signals from the brain to the muscles to cause movement. It can give doctors information as to whether the person is recovering from GBS or not.
How is it Treated?
GBS patients need to be admitted into the hospital to monitor the blood pressure, heart rate and to minimize the danger of a respiratory arrest, the stoppage of breathing. Two treatments have been used to minimize the progression of the disorder and quicken the recovery from GBS.
Plasmapheresis is a technique, in this instance, to clean your blood of the Zika virus. Blood is drawn from the individual and the plasma, the liquid part of the blood is separated and removed from the red and white blood cells. The plasma is replaced by donor plasma or substitute plasma. This technique has improved the outcomes of patients with GBS.
Another treatment is Immunoglobulin therapy. Here, a “battalion” of healthy antibodies (Immunoglobulins) from blood donors are injected into the GBS patient to fight the Zika viruses that have ravaged the peripheral nerves. This immune therapy hastens recovery.
Recovery
When GBS comes on suddenly and in older patients, full recovery is not a certainty and can take months to years for it to happen.
The median hospital stay for GBS is seven days. After being discharged from the hospital, patients may require physical therapy, need to use a walker or wheelchair, take advantage of support groups or undergo psychological counseling.
In short, GBS is rare but worrisome. Neurologic problems persist in one out of five patients and people have died from the complications of GBS. Public officials should take the necessary steps to limit the spread of the Zika virus and make people more aware of its dangers.
The recovery from GBS for many patients has been a shattering experience both physically and mentally.
References:
- Joseph R. Anticaglia, MD; Zika Virus Key Facts You Need to Know; HC Smart, May15, 2016
- Microcephaly — the circumference of an infant’s head is smaller than normal because the ZIKV attacks the fetal brain cells thus interfering with its normal development
- The virus can also be sexually transmitted
- CDC; Zika Virus; April 14, 2016
- Ben-Joseph, Elana Pearl MD; Guillain-Barre Syndrome; Teens Health. March, 2013.
- Walling, Anne D.; Guillain-Barre Syndrome; Am. Fam. Physician, Feb. 1, 2013.
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.