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

Abstract

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.

Keywords: Critical care; Epidemic outbreak; Guillain-Barre Syndrome; Intensive Care Units; Latin America; Zika virus.

Fig. 1

Selection of reported patients with Zika virus infection in participating Intensive Care Units.

Fig. 2

Electromyography of a confirmed patient with diagnosed Guillain-Barre Syndrome associated with Zika virus infection (case 3), compatible with an asymmetrical mixed axonal and demyelinating polyneuropathy, showing: A) Activity increased insertion and few signs of instability membrane left dorsal interosseous muscles and triceps first left. B) Tibial and paraspinal bilateral L5 engine with morphologically normal motor units and recruitment slightly decreased from the distal. C) In other muscles motor activity units insertion, spontaneous activity and recruitment pattern showed normal.

Fig. 3

Magnetic resonance brain of a confirmed patient (case 4) with diagnosed with encephalitis associated with Zika virus infection showing: hyperintense lesions in frontal and temporal regions bilaterally, additionally subcortical damage can be found predominantly in the right side. These findings are compatible with a diagnosis of encephalitis.