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.
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.



Clinical and demographic data from patients with GBS treated in 5 intensive care units and with recent history of ZIKV in Cúcuta, 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.



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. Seventy-nine 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.



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.
Intensive Care Unit, Clínica Norte, Cúcuta, Norte de Santander, Colombia, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
Arturo
A
Arias
Fundación Universitaria de Ciencias de la Salud, Grupo Ciencias Básicas en Salud, Bogotá, Colombia.
Lilian
L
Torres-Tobar
Fundación Universitaria de Ciencias de la Salud, Grupo Ciencias Básicas en Salud, Bogotá, Colombia.
Gualberto
G
Hernández
SOMEFYR, Cúcuta, Colombia.
Deyanira
D
Paipilla
Neurology Department, Hospital de San José-Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
Eduardo
E
Palacios
SOMEFYR, Cúcuta, Colombia.
Yahaira
Y
Torres
Intensive Care Unit, Clínica Norte, Cúcuta, Colombia.
Julian
J
Duran
Jefe Centro de Pacientes Críticos, Clínica Indisa-Universidad Andrés Bello, Viña del Mar, Chile.
Sebastian
S
Ugarte U
Research Division, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
Adriana
A
Ardila-Sierra
Research Division, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia. Electronic address: gcastellanos@fucsalud.edu.co.
Gabriel
G
Castellanos
D000293:Adolescent; D000328:Adult; D000368:Aged; D003105:Colombia / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D020275:Guillain-Barre Syndrome / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012367:RNA, Viral / Q000134:cerebrospinal fluid; D012121:Respiration, Artificial; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013129:Spinal Puncture; D055815:Young Adult; D000071244:Zika Virus / Q000235:genetics; D000071243:Zika Virus Infection / Q000453:epidemiology*
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D012367:RNA, Viral
Case reports; Disease outbreaks; Guillain-Barré syndrome; Polyradiculoneuropathy; Zika virus infection