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Association of dengue infection and Guillain-Barré syndrome in Malaysia
  1. Cheng-Yin Tan1,
  2. Siti Nur Omaira Razali1,
  3. Khean Jin Goh1,
  4. I-Ching Sam2,
  5. Nortina Shahrizaila1
  1. 1 Department of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  2. 2 Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  1. Correspondence to Dr Nortina Shahrizaila,Department of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia; nortina{at}um.edu.my

https://doi.org/10.1136/jnnp-2019-320756

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    Introduction

    Guillain-Barré syndrome (GBS) is postulated to be triggered by infections that result in an immune response against peripheral nerve antigens.1 Patients with GBS typically have antecedent infections,2 including Campylobacter jejuni, cytomegalovirus (CMV), Mycoplasma pneumoniae, Epstein-Barr virus (EBV), hepatitis E virus, Haemophilus influenzae and more recently, Zika virus3–5 (online supplementary s1). In Malaysia, arthropod-borne viruses are common pathogens. Dengue virus is hyperendemic whereas Zika virus, from the same flavivirus family, is rare, accounting for only eight cases nationwide since 2015.

    Supplemental material

    [jnnp-2019-320756supp001.pdf]

    In the current study, we aimed to determine the association between a recent dengue infection and GBS, and describe the clinical characteristics of such cases.

    Methods

    Consecutive patients with GBS presenting to University Malaya Medical Centre (UMMC) in Kuala Lumpur between 2010 and 2018 were recruited. Pretreatment serum samples were collected and stored in a −80°C freezer. Baseline demographics, clinical characteristics and ancillary test findings were obtained. GBS severity was evaluated with Medical Research Council (MRC) sum score and GBS disability score (GDS). Poor outcome was defined as GDS ≥3 at 6 months. GBS electrodiagnosis was determined based on Uncini et al criteria (online supplementary s2).

    Sera were also obtained from age-matched and gender-matched patients with other neurological diseases (ONDs) who were admitted within 2 weeks of the GBS patient admission. Sera from patients with GBS and OND were tested for dengue IgM antibodies, and in patients with GBS, anti-ganglioside IgG antibodies against …

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    Footnotes

    • Contributors Study design and concept: NS. Experiments and procedures: C-YT, SNOR, I-CS. Data analysis and interpretation: C-YT, SNOR, I-CS and NS. Manuscript drafting: C-YT and NS. Manuscript editing: all authors. Approval of final draft: all authors.

    • Funding The study was supported by grant from University of Malaya (BK074-2017).

    • Competing interests NS receives research support from the Malaysian Ministry of Education, ALS Association, Sydney South East Asia Centre and Hovid Berhad.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by University Malaya Medical Centre (UMMC) Medical Research Ethics Committee (MREC ID no: 2017215-4916).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All relevant data are presented in the article. Further information is available from the corresponding author.

    • Citation Tan C-Y, Razali SNO, Goh KJ, et al. J Neurol

      Neurosurg Psychiatry Epub ahead of print: [please

      include Day Month Year]. doi:10.1136/jnnp-2019-

      320756