Zika virus and Guillain–Barré syndrome in Bangladesh GeurtsvanKessel, Corine H.; Islam, Zhahirul; Islam, Md. Badrul ...
Annals of clinical and translational neurology,
20/May , Letnik:
5, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Objective
Previous studies have associated Guillain–Barré syndrome (GBS) with Zika virus (ZIKV) outbreaks in South America and Oceania. In Asia, ZIKV is known to circulate widely, but the association ...with Guillain–Barré syndrome is unclear. We investigated whether endemic ZIKV infection is associated with the development of GBS.
Methods
A prospective study was conducted from 2011 to 2015 in Bangladesh. A total of 418 patients and 418 healthy family controls were included in the study. Patients were diagnosed with GBS prior to inclusion according to established criteria. Detailed information on the epidemiology, clinical presentation, electrophysiology, diagnosis, disease severity, and clinical course were obtained during a follow‐up of 1 year using a predefined protocol.
Results
ZIKV‐neutralizing antibodies were detected in our study from 2013 onwards. The prevalence of ZIKV‐neutralizing antibodies was not significantly higher in patients with GBS compared to healthy controls (OR 2.23, P = 0.14, 95% CI 0.77–6.53). Serological evidence for prior ZIKV infection in patients with GBS was associated with more frequent cranial, sensory, and autonomic nerve involvement compared to GBS patients with Campylobacter jejuni, the predominant preceding infection in GBS worldwide. Nerve‐conduction studies revealed that ZIKV antibodies were associated with a demyelinating subtype of GBS, while C. jejuni infections were related to an axonal subtype.
Interpretation
No significant association was found between ZIKV infection and GBS in Bangladesh, but GBS following ZIKV infection was characterized by a distinct clinical and electrophysiological subtype compared to C. jejuni infection. These findings indicate that ZIKV may precede a specific GBS subtype but the risk is low.
The process of debridement currently includes the removal of skin, soft tissue, tendon, and bone, and can even include amputation of digits. This chapter discusses different debridement techniques: ...mechanical debridement; biological debridement; enzymatic debridement; autolytic debridement; and wound cleansing. Two additional wound treatments discussed are WF10 and hydrogen peroxide. Surgical debridement is still considered the gold standard; however, as mentioned earlier, there are multiple forms of debridement. Sharp, surgical excision of debris and necrotic tissue is the fastest and most accessible method. The choice of a specific type of debridement predominantly depends on clinicians’ experiences and preferences, but also on the co‐morbidities and the desires of the patient. There are several developments in the approaches that could have a significant impact on the future of debridement.
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