Neurological expertise is essential for Zika virus infection

  • Shakir R
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Abstract

As highlighted in the Lancet editorial,1\r
the neurological consequences of Zika\r
virus infection might be devastating.\r
Microcephaly—recently linked to Zika\r
infection2\r
—can lead to lifelong major\r
disabilities; long-term neurological\r
problems and convulsions associated\r
Published Online\r
February 24, 2016\r
http://dx.doi.org/10.1016/\r
S1474-4422(16)00072-7\r
Correspondence\r
354 www.thelancet.com/neurology Vol 15 April 2016\r
with severe psychomotor retardation\r
are expected consequences. Therefore,\r
medical support during the early\r
stages of development is crucial for\r
positive outcomes later in life.\r
Guillain-Barré syndrome has\r
also been reported in increased\r
numbers of patients in many Zikaaff\r
ected countries. Whether Zika\r
virus infection causes Guillain-Barré\r
syndrome is uncertain, but we know\r
that in the absence of supportive\r
treatment—more than 5% of aff ected\r
individuals will die. Moreover, we do\r
not know if individuals with Zika virus\r
infection who do not show symptoms\r
could go on to develop Guillain-Barré\r
syndrome.\r
Neurological expertise is therefore\r
crucial to deal with potential Zika\r
sequelae. Infants with microcephaly\r
and individuals (of all ages) with\r
Guillain-Barré syndrome. Neurological\r
care is needed at the outset of GuillainBarré\r
syndrome for a correct diagnosis\r
and to proceed with treatments such\r
as intravenous immunoglobulins\r
or plasma exchange.3,4 In the UK,\r
the Department of Health places\r
the highest priority on the use of\r
intravenous immunoglobulins for\r
Guillain-Barré syndrome because of\r
risk to life without treatment.5,6 In\r
many economically deprived areas hit\r
hardest by these disorders, there is a\r
shortage of neurologists, inadequate\r
funding for immunoglobulins\r
or plasma exchange, and scarce\r
intensive-care facilities to cope with\r
the 25% of patients with Zika virus\r
infection presenting with respiratorymuscle\r
weakness.7\r
To cope with this situation, national\r
governments, WHO, the UN, and\r
other aid agencies should coordinate\r
the provision of intravenous\r
immunoglobulin to be dispensed\r
to individuals who have a clinically\r
confi rmed diagnosis of Guillain-Barré\r
syndrome. Additionally, to avoid\r
inappropriate and wasteful use of\r
expensive treatments and yet keep\r
mortality down, guidelines for general\r
practitioners should be produced

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Authors

  • Raad Shakir

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