Zika-Related Guillain-Barré Syndrome

October 6, 2016

Zika-Related Guillain-Barré Syndrome

  1. Stephen G. Baum, MD

The incidence of this neurologic syndrome has increased in Puerto Rican patients with Zika virus infection.

  1. Stephen G. Baum, MD

Locally acquired Zika virus (ZV) infection in Puerto Rico was first recognized in December 2015. ZV infection has been associated with Guillain-Barré syndrome (GBS), a postinfectious, autoimmune-induced, bilateral flaccid paralysis (NEJM JW Infect Dis Apr 2016 and Lancet 2016; 387:1531). In February 2016, the Puerto Rico Department of Health in conjunction with the Centers for Disease Control and Prevention instituted a passive surveillance assessment of the incidence of GBS. From January to July 31, 2016, 56 patients with GBS were identified, of whom 34 (61%) had evidence of recent ZV or other flavivirus infection. Researchers now report on findings in these patients.

Among the 34 patients, median age was 55 years (range, 21–88 years). All required hospitalization (21 required intensive care) and were treated with intravenous immunoglobulin G. One patient developed septic shock and died. An additional 26 patients with non-GBS neurologic disease were identified, 7 of whom had evidence of ZV or other flavivirus infection.

The incidence of GBS associated with evidence of ZV or other flavivirus infection was 2.5 times the GBS incidence not associated with such evidence. The most common antecedent symptoms in patients with GBS and proven infection were rash (53%), fever (35%), and diarrhea (21%); median interval between infection symptoms and GBS was 5 days (range, 0–17 days). The most common GBS symptoms included hypo- or areflexia (97%), leg weakness (97%), leg paresthesia (75%), arm weakness (75%), facial weakness (63%), arm numbness (59%), and dysphagia (59%). Cytoalbuminologic dissociation characteristic of GBS was found in the 25 patients who underwent lumbar puncture.


This evidence supports an etiologic association between ZV or other flavivirus infection and development of GBS. Practitioners in endemic areas (the number and breadth of which are increasing) or who care for patients returning from these areas should be conscious of this association and notify local public health authorities when a patient develops GBS.

Editor Disclosures at Time of Publication

  • Disclosures for Stephen G. Baum, MD at time of publication Consultant / Advisory board Clinical Infectious Diseases (Editorial Advisory Board) Speaker’s bureau UpToDate (author) Editorial boards Medical Letter (Board of Directors, Chairman)


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