Guillain-Barré syndrome in patients with a recent history of Zika in Cúcuta, Colombia, a descriptive case series of 19 patients from December 2015 to March 2016

Abstract Purpose Zika virus (ZIKV) infection is an emerging global threat and a public health problem in the Americas. Guillain-Barré syndrome (GBS) has been recently associated to ZIKV. This report presents a case series of GBS possibly associated to ZIKV. Methods Clinical and demographic data from patients with GBS treated in five intensive care units and with recent history of ZIKV in Cúcuta, Colombia were collected from December 1st, 2015 to April 30th, 2016. Electrophysiological examination, lumbar puncture and RT-PCR for ZIKV were performed in 14, 10 and 1 patients, respectively. Results Nineteen patients with GBS and a recent history of acute viral syndrome compatible with ZIKV infection were studied (mean age: 44 years, range 17–78). Neurological symptoms developed at a median of 10 days after the onset of the viral symptoms. Albuminocytological dissociation was found in eight cases. Electrophysiological criteria for acute motor axonal neuropathy were found in all patients tested. Five patients met level I, eight patients level II and six patients level III of diagnostic certainty for GBS in the Brighton classification. Fifteen patients required respiratory assistance, 16 received intravenous immunoglobulins, and three had plasmapheresis. Seventy nine percent of patients were in Hughes GBS disability scale IV-V at discharge and no patients died during the observation period. Acute ZIKV infection, confirmed by RT-PCR, was observed for one patient. Conclusions All cases of this GBS outbreak had a recent history ZIKV infection, reinforcing existing evidence for the association between GBS and ZIKV. Future genetic and immunologic studies are warranted to further investigate the cause of the outbreak in detail.