ABSTRACT

Objective: To describe the demographic, clinical and laboratory features and, treatment and outcomes of Zika outbreak associated neurological syndromes.

Methods: Zika outbreak associated neurological syndromes refer to specific neurological syndromes characterized by acute or sub-acute monophasic bilateral areflexic or hyporeflexic limb weakness and/or sensory impairment with or without cranial nerve, meningeal, myelopathic or encephalopathic abnormalities with or without antecedent viral symptoms and without a more reasonable explanation during the Zika outbreak April to September 2016 at the Kingston Public Hospital (KPH). Medical records of men and women aged 12 years and over meeting these criteria were identified from intra-hospital records and reviewed for specific neurological syndrome classification based on clinical features, cerebrospinal fluid analysis, brain and spinal cord magnetic resonance imaging and neurophysiology.

Results: Thirty-five cases were identified and 25 medical records reviewed. Three, eleven and seven patients met Brighton diagnostic criteria for guillain barre Syndrome (GBS) levels 1, 2 and 3, respectively. Other neurological syndromes were transverse myelitis (1), meningoencephalitis (2) and acute disseminated encephalomyelitis or ADEM (1). These four patients had additional findings typical of GBS. Twenty-one reported antecedent viral symptoms, 12 required mechanical ventilation for respiratory failure and 23 received Intravenous Immunoglobulin (IVIg). Four of the 25 (16%) patients died.

Conclusion: The current Zika outbreak in Jamaica has been accompanied by a spectrum of immunologically mediated acute neurological syndromes, the most common of which is GBS and appears associated with significant morbidity and mortality.