Editors' ChoiceInfectious Disease

A puzzling path from infection to Guillain-Barré syndrome

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Science Translational Medicine  17 Feb 2016:
Vol. 8, Issue 326, pp. 326ec28
DOI: 10.1126/scitranslmed.aaf3849

The enigmatic Guillain-Barré syndrome (GBS) is now recognized as a set of paralyzing illnesses that affect all demographic groups and often occur after an infection. The most common and well-proven association is GBS and campylobacter jejuni infection–but other pathogens have been linked to the syndrome, such as flu, cytomegalovirus, and Epstein-Barr virus. Most recently, GBS cases were reported after Zika virus infection. Whether and which pathogens actually cause GBS is difficult to establish because of a shortage of model systems for many of the organisms and for GBS itself. Further, just how the various infections may trigger GBS is not well understood. It is thought that antibodies that cross-react between the pathogen and host play a role in pathogenesis, and cellular mechanisms have also been proposed, but there is much more to learn on this topic. A recent report by Simon and colleagues provides an unusually clear link between a specific pathogen and onset of GBS.

The authors describe three cases of patients who developed paralysis during primary infection with dengue virus, which, like Zika, is in the flavivirus family and is not typically associated with neurological symptoms. The cases are noteworthy because, in each, GBS symptoms occurred early in dengue infection rather than in the following weeks, as is typically the case. One of the patients was found to be positive for autoantibodies that have been connected with GBS, suggesting that the virus may have triggered an autoimmune etiology of symptoms. The other two patients developed GBS within the first days of infection and were negative for autoantibodies, raising the prospect that the virus itself caused symptoms of paralysis, possibly through infection of peripheral nerves. Although the molecular mechanisms remain unclear, these new cases represent convincing examples of GBS occurring secondary to infection and suggest that autoimmunity may not be the only path to GBS symptoms.

O. Simon et al., Early Guillain-Barré syndrome associated with acute dengue fever J. Clin. Virol. (2016). [Abstract]

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