Guillain-Barré Syndrome Following Zika Virus Infection Is Associated With a Diverse Spectrum of Peripheral Nerve Reactive Antibodies

BACKGROUND AND OBJECTIVES

Recent outbreaks of Zika virus (ZIKV) in South and Central America have highlighted significant neurologic side effects. Concurrence with the inflammatory neuropathy Guillain-Barré syndrome (GBS) is observed in 1:4,000 ZIKV cases. Whether the neurologic symptoms of ZIKV infection are immune mediated is unclear. We used rodent and human live cellular models to screen for anti-peripheral nerve reactive IgG and IgM autoantibodies in the sera of patients with ZIKV with and without GBS.

METHODS

In this study, 52 patients with ZIKV-GBS were compared with 134 ZIKV-infected patients without GBS and 91 non-ZIKV controls. Positive sera were taken forward for target identification by immunoprecipitation and mass spectrometry, and candidate antigens were validated by ELISA and cell-based assays. Autoantibody reactions against glycolipid antigens were also screened on an array.

RESULTS

Overall, IgG antibody reactivities to rat Schwann cells (SCs) (6.5%) and myelinated cocultures (9.6%) were significantly higher, albeit infrequent, in the ZIKV-GBS group compared with all controls. IgM antibody immunoreactivity to dorsal root ganglia neurones (32.3%) and SCs (19.4%) was more frequently observed in the ZIKV-GBS group compared with other controls, whereas IgM reactivity to cocultures was as common in ZIKV and non-ZIKV sera. Strong axonal-binding ZIKV-GBS serum IgG antibodies from 1 patient were confirmed to react with neurofascin 155 and 186. Serum from a ZIKV-infected patient without GBS displayed strong myelin-binding and putative antilipid antigen reaction characteristics. There was, however, no significant association of ZIKV-GBS with any known antiglycolipid antibodies.

DISCUSSION

Autoantibody responses in ZIKV-GBS target heterogeneous peripheral nerve antigens suggesting heterogeneity of the humoral immune response despite a common prodromal infection.

Recent African strains of Zika virus display higher transmissibility and fetal pathogenicity than Asian strains

The global emergence of Zika virus (ZIKV) revealed the unprecedented ability for a mosquito-borne virus to cause congenital birth defects. A puzzling aspect of ZIKV emergence is that all human outbreaks and birth defects to date have been exclusively associated with the Asian ZIKV lineage, despite a growing body of laboratory evidence pointing towards higher transmissibility and pathogenicity of the African ZIKV lineage. Whether this apparent paradox reflects the use of relatively old African ZIKV strains in most laboratory studies is unclear. Here, we experimentally compare seven low-passage ZIKV strains representing the recently circulating viral genetic diversity. We find that recent African ZIKV strains display higher transmissibility in mosquitoes and higher lethality in both adult and fetal mice than their Asian counterparts. We emphasize the high epidemic potential of African ZIKV strains and suggest that they could more easily go unnoticed by public health surveillance systems than Asian strains due to their propensity to cause fetal loss rather than birth defects.

Here, the authors compare seven low passage Zika virus (ZIKV) strains representing the recently circulating viral genetic diversity of African and Asian strains and find that African ZIKV strains have higher transmissibility in mosquitoes and higher lethality in both adult and fetal mice.

Enhanced Zika virus susceptibility of globally invasive Aedes aegypti populations

The drivers and patterns of zoonotic virus emergence in the human population are poorly understood. The mosquito Aedes aegypti is a major arbovirus vector native to Africa that invaded most of the world's tropical belt over the past four centuries, after the evolution of a "domestic" form that specialized in biting humans and breeding in water storage containers. Here, we show that human specialization and subsequent spread of A. aegypti out of Africa were accompanied by an increase in its intrinsic ability to acquire and transmit the emerging human pathogen Zika virus. Thus, the recent evolution and global expansion of A. aegypti promoted arbovirus emergence not solely through increased vector-host contact but also as a result of enhanced vector susceptibility.

Spatiotemporal Heterogeneity in the Distribution of Chikungunya and Zika Virus Case Incidences during their 2014 to 2016 Epidemics in Barranquilla, Colombia

Chikungunya virus (CHIKV) and Zika virus (ZIKV) have recently emerged as globally important infections. This study aimed to explore the spatiotemporal heterogeneity in the occurrence of CHIKV and ZIKV outbreaks throughout the major international seaport city of Barranquilla, Colombia in 2014 and 2016 and the potential for clustering. Incidence data were fitted using multiple Bayesian Poisson models based on multiple explanatory variables as potential risk factors identified from other studies and options for random effects. A best fit model was used to analyse their case incidence risks and identify any risk factors during their epidemics. Neighbourhoods in the northern region were hotspots for both CHIKV and ZIKV outbreaks. Additional hotspots occurred in the southwestern and some eastern/southeastern areas during their outbreaks containing part of, or immediately adjacent to, the major circular city road with its import/export cargo warehouses and harbour area. Multivariate conditional autoregressive models strongly identified higher socioeconomic strata and living in a neighbourhood near a major road as risk factors for ZIKV case incidences. These findings will help to appropriately focus vector control efforts but also challenge the belief that these infections are driven by social vulnerability and merit further study both in Barranquilla and throughout the world's tropical and subtropical regions.

The single water-surface sweep estimation method accurately estimates very low (n = 4) to low-moderate (n = 25-100) and high (n > 100) Aedes aegypti (Diptera: Culicidae) pupae numbers in large water containers up to 13 times faster than the exhaustive sweep and total count method and without any sediment contamination

OBJECTIVE

To confirm that a single water-surface sweep-net collection coupled with three calibration factors (2.6, 3.0 and 3.5 for 1/3, 2/3 and 3/3 water levels, respectively) (WSCF) could accurately estimate very low to high Aedes aegypti pupae numbers in water containers more rapidly than the exhaustive 5-sweep and total count (ESTC) method recommended by WHO.

METHODS

Both methods were compared in semi-field trials using low (n = 25) to moderate (n = 50-100) pupae numbers in a 250-l drum at 1/3, 2/3 and 3/3 water levels, and by their mean-time determinations using 200 pupae in three 220- to 1024-l water containers at these water levels. Accuracy was further assessed using 69.1% (393/569) of the field-based drums and tanks which contained <100 pupae.

RESULTS

The WSCF method accurately estimated total populations in the semi-field trials up to 13.0 times faster than the ESTC method (all P < 0.001); no significant differences (all P-values ≥ 0.05) were obtained between the methods for very low (n = 4) to low-moderate (n = 25-100) and high (n > 100) pupae numbers/container and without sediment disturbance.

CONCLUSION

The simple WSCF method sensitively, accurately and robustly estimated total pupae numbers in their principal breeding sites worldwide, containers with >20 l water volumes, significantly (2.7- to 13.0-fold: all P-values <0.001) faster than the ESTC method for very low to high pupae numbers/container without contaminating the clean water by sediment disturbance which is generated using the WHO-recommended ESTC method. The WSCF method seems ideal for global community-based surveillance and control programmes.

Molecular serovar characterization of Leptospira isolates from animals and water in Colombia

INTRODUCTION

Leptospirosis is a bacterial disease transmitted directly or indirectly from animals to humans that may result in severe hemorrhagic, hepatic/renal and pulmonary disease. There are 20 known Leptospira species and hundreds of serovars, some of which belong to different species. It is essential to identify pathogenic Leptospira serovars and their potential reservoirs to prepare adequate control strategies.

OBJECTIVE

To characterize the Leptospira serovars isolated from rodents, dogs, pigs and water samples in Colombia.

MATERIALS AND METHODS

Leptospira organisms were isolated and cultured, and pathogenic strains were identified using a polymerase chain-reaction (PCR). Leptospira DNA and Salmonella Braenderup H9812 (molecular weight standard) DNA were cleaved using NotI and subjected to pulsed-field gel electrophoresis (PFGE). The PFGE patterns were analyzed based on bacterial strain-typing criteria and Dice coefficients (DCs) between these isolates and over 200 Leptospira organisms isolated from other parts of the world.

RESULTS

All of the isolates were pathogenic strains, and five were genetically characterized. The P275 (84% DC) and P282 (95% DC) pig isolates were related to the Leptospira interrogans Pomona serovar; the I15 (DC: 100%) rat isolate was identical to the Leptospira interrogans Icterohameorrhagiae or Copenhageni serovars, while the C67 (64% DC) dog and A42 (60% DC) water isolates were not related (< 73.7% DC) to any of the 200 reference serovars; the closest serovars were the Leptospira noguchii Nicaragua and Orleans serovars, respectively.

CONCLUSION

This was the first molecular characterization of Colombian Leptospira spp isolates; these isolates will be used to develop a Colombian diagnostic panel.

The use of direct sequencing of dengue virus cDNA from individual field-collected Aedes aegypti for surveillance and epidemiological studies

The relative efficiencies of four methods to extract viral RNA from individual dengue-2 virus (D-2V)-infected mosquitoes, Aedes aegypti (L.) (Diptera: Culicidae), were compared. The most efficient of these methods was then used to extract viral RNA for the preparation of cDNA from the abdomens of six engorged D-2V-infected mosquitoes and sera from three dengue fever (DF) patients collected in an isolated rural town in Colombia. Comparisons of viral envelope (E) gene sequences from each of these strongly suggested that the D-2V population which circulated in this study area was a homogeneous genotype which was unrelated to any of the D-2 viruses isolated from elsewhere in the world. When coupled with our rapid method to identify viruses in individual mosquitoes (Romero-Vivas et al. (1998) Medical and Veterinary Entomology, 12, 101-105), the methodology we describe should be useful for epidemiological and surveillance studies of dengue viruses and other arboviruses.

Determination of dengue virus serotypes in individual Aedes aegypti mosquitoes in Colombia

Adult Aedes aegypti mosquitoes were collected in Puerto Triunfo, central Colombia, where dengue is endemic, during a six month period. Viral infection within the head of each individual mosquito was identified by an immunofluorescent assay (IFA) using a flavivirus-specific monoclonal antibody. The dengue virus serotype, present in each flavivirus-positive specimen, was then determined in portions of the remaining thorax using IFAs with serotype-specific monoclonal antibodies. Among 2065 female Aedes aegypti collected and tested, twenty-four flavivirus-positive individuals were found (minimum infection rate 11.6%), three identified as dengue type-1 and twenty-one as dengue type-2 virus. This was consistent with the isolation of only these two serotypes of dengue virus from dengue fever patients within this town. No vertical transmission of dengue virus could be detected in 1552 male Aedes aegypti collected. This method is inexpensive, simple, rapid to perform and suitable for use in developing countries to identify and distinguish different serotypes of dengue virus in their vectors during eco-epidemiological investigations.