{"id":1106,"date":"2016-08-01T15:26:17","date_gmt":"2016-08-01T15:26:17","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=1106"},"modified":"2017-08-21T10:49:59","modified_gmt":"2017-08-21T10:49:59","slug":"primary-care-corner-with-geoffrey-modest-md-zika-and-neurologic-problems-in-brazil","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/08\/01\/primary-care-corner-with-geoffrey-modest-md-zika-and-neurologic-problems-in-brazil\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Zika and Neurologic Problems in Brazil"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest <\/strong><\/p>\n<p>STAT (see statnew.com) has frequent updates on Zika, noting the following:<\/p>\n<ul>\n<li>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<\/li>\n<li>Two patients who were infected with the Zika virus have developed severe thrombocytopenia<\/li>\n<li>Brazilian researchers have observed a sharp increase in cases of Guillain-Barr\u00e9 syndrome<\/li>\n<\/ul>\n<p>For this last point, there was a recent release of an\u00a0article\u00a0in Neurology (see doi:10.1212\/WNL.0000000000003024) from Brazilian neurologists who started a study group in Rio to\u00a0further understand the\u00a0Zika-related neurologic disorders (Guillain-Barr\u00e9 syndrome &#8211;GBS, meningoencephalitis, transverse myelitis), finding that in the period Dec 5,\u00a02015 to &lt;arch 18,\u00a02016, there were:<\/p>\n<ul>\n<li>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)<\/li>\n<li>17 were\u00a0associated\u00a0with a viral prodrome consistent\u00a0with\u00a0Zika (pruritic rash, fever, arthralgias).<\/li>\n<li>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<\/li>\n<li>They have also seen Zika-related AMAN\u00a0(acute motor\u00a0axonal\u00a0neuropathy), 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.<\/li>\n<li>The neurological associations are not limited to Brazil\u2019s outbreak\/variant: there were cases of Zika-related\u00a0GBS and AMAN\u00a0in French Polynesia, which is genetically distinct from Brazil.<\/li>\n<li>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.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: Zika and Neurologic Problems in Brazil  [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/08\/01\/primary-care-corner-with-geoffrey-modest-md-zika-and-neurologic-problems-in-brazil\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-1106","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1106","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=1106"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1106\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=1106"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=1106"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=1106"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}