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N Engl J Med. 2016 Oct 20;375(16):1513-1523. Epub 2016 Oct 5.

Guillain-Barré Syndrome Associated with Zika Virus Infection in Colombia.

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From the Department of Microbiology (B.P., A.F.Z.-V.), the Department of Internal Medicine, Hospital Universitario del Valle (A.F.Z.-V., G.Z.), and Escuela de Salud Publica (L.O.), Universidad del Valle, Cali, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cucuta (J.L.), Universidad de Antioquia, Clinica Leon XIII, Neuroclinica, Medellin (J.A.J.-A., R.L.-G.), Universidad Surcolombiana, Hospital Universitario de Neiva (G.G.-M., C.L.B.), and Clinica Medilaser (J.A.A.), Neiva, Clinica La Misericordia Internacional, Barranquilla (J.V., K.H.R., M.T.M.), and Instituto Nacional de Salud, Bogota (O.P., M.L.O.) - all in Colombia; and the Departments of Neurology (A.K., D.R.C., L.S.M., P.B., C.A.P.) and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore.



Zika virus (ZIKV) infection has been linked to the Guillain-Barré syndrome. From November 2015 through March 2016, clusters of cases of the Guillain-Barré syndrome were observed during the outbreak of ZIKV infection in Colombia. We characterized the clinical features of cases of Guillain-Barré syndrome in the context of this ZIKV infection outbreak and investigated their relationship with ZIKV infection.


A total of 68 patients with the Guillain-Barré syndrome at six Colombian hospitals were evaluated clinically, and virologic studies were completed for 42 of the patients. We performed reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays for ZIKV in blood, cerebrospinal fluid, and urine, as well as antiflavivirus antibody assays.


A total of 66 patients (97%) had symptoms compatible with ZIKV infection before the onset of the Guillain-Barré syndrome. The median period between the onset of symptoms of ZIKV infection and symptoms of the Guillain-Barré syndrome was 7 days (interquartile range, 3 to 10). Among the 68 patients with the Guillain-Barré syndrome, 50% were found to have bilateral facial paralysis on examination. Among 46 patients in whom nerve-conduction studies and electromyography were performed, the results in 36 patients (78%) were consistent with the acute inflammatory demyelinating polyneuropathy subtype of the Guillain-Barré syndrome. Among the 42 patients who had samples tested for ZIKV by RT-PCR, the results were positive in 17 patients (40%). Most of the positive RT-PCR results were in urine samples (in 16 of the 17 patients with positive RT-PCR results), although 3 samples of cerebrospinal fluid were also positive. In 18 of 42 patients (43%) with the Guillain-Barré syndrome who underwent laboratory testing, the presence of ZIKV infection was supported by clinical and immunologic findings. In 20 of these 42 patients (48%), the Guillain-Barré syndrome had a parainfectious onset. All patients tested were negative for dengue virus infection as assessed by RT-PCR.


The evidence of ZIKV infection documented by RT-PCR among patients with the Guillain-Barré syndrome during the outbreak of ZIKV infection in Colombia lends support to the role of the infection in the development of the Guillain-Barré syndrome. (Funded by the Bart McLean Fund for Neuroimmunology Research and others.).

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