Guillain-Barré syndrome after the Zika epidemic in Colombia: A multicenter, matched case-control study

Background Zika produced the highest increase in the incidence of Guillain-Barré syndrome (GBS) in Latin America in the last decade. The Neuroinfections Emerging in the Americas Study (NEAS) was established in 2016 to investigate the association of emerging infectious dis-orders with GBS in Colombia. The present study assessed the role of preceding infections, including arboviruses and other pathogens, as risk factors for GBS. Methods A case-control study was conducted prospectively between June 2016 and December 2019 in 5 Colombian cities. We recruited newly diagnosed patients with GBS and a house control plus an age and season-matched-hospital control per case. Clinical information, blood, CSF, and urine samples were used to diagnose bacterial and viral infections. Anti-glycolipid antibodies were identified in serum. Statistical analyses were performed using conditional logistic regression. Findings Fifty-seven patients with GBS, 66·7% male, 52 years of median age, were recruited along with 77 (55 house and 22 hospital) controls. GBS was associated with presenting diarrhea (adjusted OR 10·94; 95% CI 1·8-66·29; p=0·009) and a history of recent upper respiratory tract infection (aOR 13·91; 95% CI 2·38-81·1 p=0·003). Specific recent infections did not significantly differ between cases and controls, but the number of infections was associated with GBS (aOR=1·77 95% CI 1·04-3·01 p=0·03). C. jejuni (74%), M. pneumo-niae (23%), and Chikungunya (7%) were the most frequent infections. Anti-glycolipid IgG against GM1 and their heterodimer complexes were identified to be associated with GBS. Conclusions After the Zika epidemic, infections causing diarrhea and upper respiratory diseases con-tributed to the burden of GBS in Colombia. Prevention and control of food-borne pathogens could reduce the incidence of GBS in Colombia.