Guillain-Barree syndrome in patients with a recent history of Zika in Cucuta, Colombia: A descriptive case series of 19 patients from December 2015 to March 2016

Purpose: Zika virus (ZIKV) infection is an emerging global threat and a public health problem in the Americas. Guillain-Barree 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 5 intensive care units and with recent history of ZIKV in Cucuta, Colombia were collected from December 1 2015 to April 30 2016. Electrophysiological examination, lumbar puncture, and reverse transcriptase-polymerase chain reaction 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). Neurologic symptoms developed at a median of 10 days after the onset of the viral symptoms. Albuminocytological dissociation was found in 8 cases. Electrophysiological criteria for acute motor axonal neuropathy were found in all patients tested. Five patients met level 1, 8 patients level 2, and 6 patients level 3 of diagnostic certainty for GBS in the Brighton classification. Fifteen patients required respiratory assistance, 16 received intravenous immunoglobulins, and 3 had plasmapheresis. Seventynine percent of patients were in Hughes GBS disability scale 4 to 5 at discharge and no patients died during the observation period. Acute ZIKV infection, confirmed by reverse transcriptase-polymerase chain reaction, was observed for 1 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. (C) 2016 Elsevier Inc. All rights reserved.