Zika virus-induced neurological critical illness in Latin America: Severe Guillain-Barre Syndrome and encephalitis

Sebastián, Ugarte Ubiergo; Ricardo, Arenas Villamizar Angel; Alvarez, Bruno C.; Cubides, Angela; Luna, Angélica F.; Arroyo-Parejo, Max; Acuña, Cayri E.; Quintero, Agamenón V.; Villareal, Orlando Ch.; Pinillos, Oscar S.; Vieda, Elías; Bello, Manuel; Peña, Susana; Dueñas-Castell, Carmelo; Rodriguez, Gloria M.V.; Ranero, Jorge L.M.; López, Rosa L.M.; Olaya, Sandra G.; Vergara, José C.; Tandazo, Ana; Ospina, Juan P.S.; Leyton Soto, Igor M.; Fowler, R.A.; Marshall, John C.

Zika virus (ZIKAV) is classically described as causing minor symptoms in adult patients, however neurologic complications have been recognized. The recent outbreak in Central and South America has resulted in serious illness in some adult patients. We report adult patients in Latin America diagnosed with ZIKAV infection admitted to Intensive Care Units (ICUs). METHODS: Multicenter, prospective case series of adult patients with laboratory diagnosis of ZIKAV in 16 ICUs in 8 countries. RESULTS: Between December 1st 2015 and April 2nd 2016, 16 ICUs in 8 countries enrolled 49 critically ill patients with diagnosis of ZIKAV infection. We included 10 critically ill patients with ZIKAV infection, as diagnosed with RT-PCR, admitted to the ICU. Neurologic manifestations concordant with Guillain-Barre Syndrome (GBS) were present in all patients, although 2 evolved into an encephalitis-like picture. 2 cases died, one due to encephalitis, the other septic shock. CONCLUSIONS: Differing from what was usually reported, ZIKAV infection can result in life-threatening neurologic illness in adults, including GBS and encephalitis. Collaborative reporting to identify severe illness from an emerging pathogen can provide valuable insights into disease epidemiology and clinical presentation, and inform public health authorities about acute care priorities.