Dengue Infection May Increase Risk of Guillain-Barré Syndrome: NEJM
Brazil: Brazilian researchers have found in a new study, published in The New England Journal of Medicine, that dengue infection is associated with an increased risk of Guillain–Barré syndrome (GBS), with the highest risk occurring around two weeks after symptom onset and persisting for up to six weeks. While earlier case reports had hinted at such a connection, the present analysis offers robust quantitative evidence supporting this association.
Dengue, the fastest-spreading mosquito-borne viral disease, caused an estimated 14 million cases worldwide in 2024. While it commonly presents with fever and systemic symptoms, it can rarely lead to neurological complications such as Guillain–Barré syndrome, a serious autoimmune disorder affecting peripheral nerves. Although earlier reports suggested a possible link, large-scale evidence quantifying this risk has been limited.
To bridge this gap, researchers led by Dr. Thiago Cerqueira-Silva and Dr. Enny Paixão conducted a nationwide analysis using linked Brazilian health databases from 2023–2024, including hospitalization, dengue notification, and mortality records. Using a self-controlled case series approach, where patients served as their own controls, they assessed the risk of Guillain–Barré syndrome within 1 to 42 days after laboratory-confirmed dengue infection—identified through RT-PCR, NS1 antigen, or IgM testing—and compared it with a later control period.
The following were the key findings:
- A total of 5,055 hospitalizations for Guillain–Barré syndrome were identified during the study period.
- Among these, 147 cases had documented dengue infection.
- Out of the 147 cases, 89 hospitalizations occurred within the defined risk window of 1 to 42 days after dengue symptom onset.
- A significantly increased risk of Guillain–Barré syndrome was observed during this period.
- The incidence rate ratio was 16.75 compared to the baseline period.
- The risk was highest within the first two weeks after symptom onset.
- The risk gradually declined and returned to baseline levels by approximately six weeks.
- An estimated 35.5 excess Guillain–Barré syndrome cases per million laboratory-confirmed dengue infections were reported during this timeframe.
- Sensitivity analyses restricted to RT-PCR or NS1-confirmed cases, as well as clinically diagnosed cases, showed consistent findings.
- Positive control outcomes, including stroke and myocardial infarction, showed expected associations.
- Negative control outcomes, such as fractures, showed no association. Top of Form
- The magnitude of risk observed in this study is comparable to that reported with other established triggers of Guillain–Barré syndrome, including influenza and Campylobacter jejuni infection.
- While bacterial and viral pathogens are widely recognized as common triggers globally, evidence from tropical regions such as Brazil, India, and Malaysia suggests that arboviral infections like dengue may play a more prominent role in these settings.
These findings reinforce the robustness and internal validity of the analysis and carry important clinical and public health implications.
The researchers suggest that clinicians in dengue-endemic regions should remain vigilant for Guillain–Barré syndrome in patients presenting with progressive weakness during or soon after dengue infection, as early diagnosis enables timely treatment with intravenous immunoglobulin or plasmapheresis to limit disease progression and improve outcomes. The study also highlights the neurological burden of dengue and highlights the need to strengthen preventive strategies, including vaccination.
Reference:
DOI: 10.1056/NEJMc2519008
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