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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. 1Department of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  2. 2Department 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

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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.

Supplementary data

[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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