To evaluate the clinical, immune and virological features of Guillain-Barré syndrome (GBS) in the aftermath of the Zika epidemic in Colombia.

Starting in 2014, infection by Zika virus (ZIKV) caused a major epidemic in the Americas. Between 2015 and 2016, an increase in the number of GBS cases and other central nervous system complications was observed during the outbreak of ZIKV.

Clinical and immmuno-virological features were studied in an observational study of 198 patients with GBS evaluated from January 2016 to June 2018, at twelve university-based hospitals in Colombia as part of the Neuroviruses Emerging in the Americas Study (NEAS).

Of 198 patients, 108 (55%) were diagnosed during the epidemic phase (January-July 2016) and 90 (45%) cases during the post-epidemic period (August 2016-June 2018). Overall analysis showed male predominance (68%) and average age of 49 (±17) years. Fever, non-purulent conjunctivitis and exanthema preceding neurological symptoms were more commonly reported in GBS during the ZIKV-epidemic phase (p<0.05). Neurological symptoms were similarly distributed in both groups, except for paresthesia and facial palsy, which were more frequently found in the GBS ZIKV-epidemic group (p<0.05). The acute inflammatory demyelinating polyneuropathy (AIDP) was the most frequent variant of GBS presented during the ZIKV-epidemic phase (70%). Virological studies in the post-epidemic GBS cases showed negative RT-PCR for ZIKV and other arbovirus such as Chikungunya and dengue. Positive anti-flavivirus IgG are detected in post-epidemic GBS cases although the prevalence of such antibodies is also high in control subjects.

ZIKV-GBS presented a characteristic preceding clinical profile of fever, exanthema and high frequency of facial paralysis as compared with post-epidemic GBS cases.  Despite ZIKV has almost disappeared, cases of GBS continue to present in several areas of Colombia, possibly associated with other triggering factors which may include C. jejuni and other infectious etiologies.