Flavivirus cross‐reactivity in serological tests and Guillain‐Barré syndrome in a hematopoietic stem cell transplant patient: A case report. Issue 4 (3rd July 2017)

• Record Type: Journal Article
• Authors: Raboni, Sonia M.; Bonfim, Carmem; Almeida, Bernardo M.; Zanluca, Camila; Koishi, Andrea C.; Rodrigues, Paula R.V.P.; Kay, Claudia K.; Ribeiro, Lisandro L.; Scola, Rosana H.; Duarte dos Santos, Claudia N.
• Is Part Of: Transplant infectious disease. Volume 19:Issue 4(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-07-03
• Subjects: Dengue virus -- Guillain‐Barré syndrome -- hematopoietic stem cell transplantation -- Zika virus; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12700
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: Serological diagnosis of flavivirus infection is a challenge, particularly in the context of a disease associated with immune response enhancement in a transplant patient, where aspects such as previous flavivirus infections may be involved with the outcome. We report a case of a pediatric patient who developed Guillain‐Barré syndrome (GBS) after matched‐unrelated hematopoietic stem cell transplantation (HSCT). The patient lives in a Brazilian region that is experiencing an epidemic of Zika virus (ZIKV) and dengue virus (DENV). Because an increasing number of cases of GBS, likely triggered by ZIKV infection, are being reported in Brazil, samples from the patient were tested for both ZIKV and DENV infection. Serological assays strongly suggested a recent ZIKV infection, although infection by DENV or co‐infection with both viruses cannot be ruled out. The presence of anti‐DENV immunoglobulin‐G in donor serum led to the hypothesis that antibodies from the donor could have enhanced the severity of the ZIKV infection. This hypothesis is in agreement with the recent findings that DENV sero‐cross‐reactivity drives antibody‐dependent enhancement of ZIKV infection. These findings highlight the need for discussion of the indication to perform previous flavivirus tests in HSCT donors, especially in areas where ZIKV and other flaviviruses co‐circulate.