Zika's effects on pregnant women, quite rightly, have grabbed most media attention. But the virus can also have other serious consequences such as Guillain-Barré syndrome, which occurs when the immune system attacks nerves, causing progressive paralysis. Hospitals and health-care providers need to prepare to recognize and treat this neurological emergency, Stanford neurologist Carl Gold, MD and his University of California, San Francisco colleague write in JAMA Neurology.
He explained in an email:
As a neurohospitalist, I have experience diagnosing and managing patients with Guillain-Barré syndrome, the most common cause of acute paralysis. Caring for patients with this condition is often challenging. They may present with mild symptoms and then rapidly deteriorate, and they often develop complications including respiratory failure, deep vein thromboses, and sudden swings in blood pressure.
As cases of Guillain-Barre syndrome started to be reported in association with Zika virus infection, I began to think about the challenges that a significant increase in the incidence of Guillain-Barré syndrome might pose to the United States health-care system. I was motivated to write this article to highlight some of these major challenges, with the idea that it might generate discussion and appropriate planning.
One challenge is ensuring that patients receive a rapid diagnosis and treatment is started quickly, Gold says. Treatment is possible, but no guarantee of recovery. Here's Gold:
Treatment with intravenous immunoglobulin or plasma exchange appears to provide the greatest benefit in terms of hastening motor recovery when started within two weeks of the onset of Guillain-Barré syndrome, and some patients may recover completely over weeks or months. However, the rate and degree of recovery vary among patients. For those with severe Guillain-Barré syndrome, about one in five patients will be unable to walk independently six months after the onset of symptoms. For about one in 20 patients, Guillain-Barré syndrome is fatal.
Physicians, public-health officials, educators and others need to start planning now to minimize the number and severity of Guillain-Barré syndrome cases, Gold and his co-author urge.
Previously: Countdown to Childx: Talking Zika with a Stanford infectious disease expert, Zika is just one of many tropical viruses headed our way, says Stanford expert and Talking about the Zika virus
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