Guillain-Barre Syndrome Following Viral Infections: Considerations for Future Treatment and Research

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Exploratory Research and Hypothesis in Medicine 2018 vol. 3 | 4–5
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Editorial
Guillain-Barré Syndrome Following Viral Infections: Considerations
for Future Treatment and Research
Lili Wang*
Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
As the world’s population grows in an explosive way, the cir-
cumstances we live in become more crowed than ever in human
history. Although medicine and biotechnology have developed tre-
mendously in the new century, the growing density of population
has brought us unexpected challenges in public health. This not
only causes the emergence of new viruses but also makes coin-
fection and super-infection more common than previously (Table
11–14). However, the symptoms of these infections, although se-
vere and life threatening in extreme cases, share some common
characteristics in outcomes. Many of them cause Guillain-Barré
syndrome (GBS) and respiratory emergency. The case reported by
Hariharan et al.15 has provided a good reference for the treatment
outcomes of such conditions.
GBS is an autoimmune disorder, in which the immune system
attacks the peripheral nervous system. It causes muscle weakness,
due to damage to nerve cells and their supporting structures.16
Different types of GBS feature different types of immune attack.
Although it is a relatively rare event, GBS could be life threaten-
ing, with bulbar and respiratory involvement. It is reported that
in two-thirds of patients, neuropathic GBS occurs after an infec-
tion.17 GBS is a known sequelae of Dengue infection,18 and has
been reported in inuenza virus, herpesvirus and hepatitis virus
infections, etc.16,19 Literally, any virus infection has the potential
to cause GBS. Due to the rising pandemics of Zika virus in recent
years, GBS has become a focus of discussion. In 2013–2014, GBS
was reported from the areas of Zika virus outbreaks, and in 2015,
reported again in Oceania and the Americas. Statistically, during
Zika pandemics in French Polynesia, among 28,000 persons un-
der medical care, 38 (0.14%) patients developed GBS, compatible
with the acute motor axonal neuropathy subtype of the disease.20
In recent years, virus-caused pandemics seem to have a trend
of taking off, and the syndromes caused by these diseases have
also showed some new and more complicating characteristics. One
typical example is the reoccurrence of Zika virus. On its initial ap-
pearance in the 1950s, it seemed to be mild.21 As such, Zika virus
infection was considered as benign throughout the 20th century.22
But, in the recent 2015 outbreak in Brazil, it was reported to be as-
sociated with GBS and microcephaly.23 Considering Dengue and
Zika viruses are from the same Flavivirus family, it is not surpris-
ing that the symptoms of Zika infection are often confused with
Dengue virus infection and Dengue-chikingunya super-infections
when causing GBS.
In all the cases reported for the 2013–2015 Zika virus break-
outs, the infected persons showed mild fevers, headaches and body
pains. These symptoms are very similar to those of Dengue and
chikingunya infections, two other viral diseases that are often en-
demic in the same areas and are also transmitted by Aedes mosqui-
toes. Indeed, this may have caused many Zika infections to be mis-
taken as Dengue or chikingunya. Considering the possibilities of
super-infections of multiple viruses, it is very difcult to conrm
that the associated GBS is due to which viral infection(s). Even
though the example provided by this case report has signicant
clinical magnicence (without associated thrombocytopenia),15
the complication is very similar to concurrent Zika virus infection.
Under specic conditions that cause respiratory emergency, the
treatment used in this case report can be applied to GBS induced
by Zika virus infection.
Although GBS is a rare event in virus infection, the lethal con-
sequence needs proper treatment and that’s where we should pro-
vide corresponding care to the patients. In Table 1, the main viruses
causing pandemics in recent years are listed. One thing worth notic-
ing is that most of these viruses can cause GBS and/or respiratory
emergency. As the emerging viruses like Zika virus have no proper
vaccines to prevent infection, under a condition when there is a new
virus pandemic without proper vaccines, the treatment of a severe
lethal syndrome becomes the focus of emergency. This paper may
provide some valuable references when coping with emerging vi-
ruses that can cause GBS and/or respiratory emergency.
Traditionally, the method to treat respiratory emergency usu-
ally involves surgical tracheostomy. In this case, percutaneous
dilatational tracheostomy (PCT) was performed instead of classi-
cal tracheostomy. Compared to the old method, PCT has a smaller
size of incision and quicker recovery. Also, PCT is supposed to be
a bedside procedure that can be performed by every physician,24
with less assistance and material.25 These traits t the require-
ments when there is a breakout of viruses and large numbers of
patients need to be taken care of. PCT could be a potential life-
saving method when facing certain future emerging virus attacks
that cause respiratory emergency. Another critical method used in
this case report is IV-Ig immune therapy. Based on the response
of the patients while the treatments were going on, it is clear that
IV-Ig here plays a key role in the patient’s recovery. However, this
is not surprising, for IV-Ig immune therapy is already a routine
method to treat GBS clinically.
In summary, although this case report provided a specic condi-
tion of combined chikungunya and Dengue infection, it could be-
come very typical in future virus pandemics. The successful treat-
ment of this condition provided valuable reference for emerging
virus pandemics that may require a similar treatment for GBS and
life-threatening breathing problems.
Abbreviations: GBS, Guillain-Barré syndrome; PCT, percutaneous dilatational tra-
cheostomy.
Received: October 9, 2017; Revised: February 9, 2018; Accepted: February 23, 2018
*Correspondence to: Lili Wang, Department of Medicine, Division of Infectious
Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA. E-mail:
lili.wang@mssm.edu
How to cite this article: Wang L. Guillain-Barré Syndrome Following Viral Infec-
tions: Considerations for Future Treatment and Research. Exploratory Research and
Hypothesis 2018;3(1):4–5. doi: 10.14218/ERHM.2017.00035.

DOI: 10.14218/ERHM.2017.00035 | Volume 3 Issue 1, March 2018 5
Wang L. Treat GBS caused by viral infection Explor Res Hypothesis Med
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Table 1. Recent virus pandemics and their relaonship to Guillain-Barré syndrome and respiratory distress syndrome
Outbreaks Year May cause Guillain-Barré
syndrome
May cause respiratory
distress syndrome
Severe acute respiratory syndrome 2002–2003 Unknown Yes 1
Chikungunya 2006 Yes 2Yes 3
Zika virus in Yap Island, Federated States of Micronesia 2007 Yes 4Unknown
H1N1 inuenza 2009–2010 Yes 5Yes 6
Measles in Congo 2010–now Unknown Yes 7
Middle East respiratory syndrome 2012–now Unknown Yes 8
Zika virus in French Polynesia 2013–2014 Yes 9Yes 10
Chikungunya 2013–now Yes2Yes3
Ebola in West Africa 2013–now Unknown Yes 11
Zika virus in Brazil and Colombia 2015–now Yes 12 Yes 10
Dengue fever in Hawaii and tropical Asian islands 2015, 2017–now Ye s13 Yes14