zika and neurologic problems in brazil

STAT (see statnew.com) has frequent updates on Zika, noting the following:

·         --Puerto Rico reported the biggest weekly rise in Zika cases yet, with 1,336 new cases for the week ending June 30, including 533 pregnant women diagnosed with the virus
·         --Two patients who were infected with the Zika virus have developed severe thrombocytopenia
·         --Brazilian researchers have observed a sharp increase in cases of Guillain-Barré syndrome

for this last point, there was a recent release of an article in Neurology (see doi:10.1212/WNL.0000000000003024​) from Brazilian neurologists who started a study group in Rio to further understand the Zika-related neurologic disorders (Guillain-Barré syndrome --GBS, meningoencephalitis, transverse myelitis), finding that in the period Dec 5, 2015 to <arch 18, 2016, there were:
    --20 confirmed cases of GBS (there had previously been 15 case in 24 months prior to Zika: so average GBS cases increased from 0.67/month to 5.4/month)
    --17 were associated with a viral prodrome consistent with Zika (pruritic rash, fever, arthralgias).
    --but there is an issue with associating all cases with Zika, since Zika is so prevalent there and 80% of cases are asymptomatic, making the causal link difficult especially in those without a clear prodrome
   --they have also seen Zika-related AMAN (acute motor axonal neuropathy)​, acute motor sensory polyneuropathy, acute inflammatory demyelinating polyradiculoneuropathy, chronic inflammatory demyelinating polyradiculoneuropathy, and Miller Fisher variant along with encephalitis, transverse myelitis and acute disseminated encephalomyelitis following a Zika prodrome.
    --the neurological associations are not limited to Brazil’s outbreak/variant: there were cases of Zika-related  GBS and AMAN in French Polynesia, which is genetically distinct from Brazil.

--also a couple of recent new transmissions: from an infected woman to her male sexual partner, and a possible case of a domestic worker getting infected.

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