Zika and dengue but not chikungunya are associated with Guillain-Barré syndrome in Mexico: a case-control study

Background Zika, dengue and chikungunya viruses (ZIKV, CHIKV and DENV) are temporally associated with neurological diseases such as Guillain-Barre syndrome (GBS). Because these three arboviruses coexist in Mexico, the frequency and severity of GBS could theoretically increase. This study aimed to determine the association between these arboviruses and GBS in a Mexican population, and to establish the clinical features of the patients, including the severity of the infection.Methodology/Principal findings A case-control study was conducted (2016/07/01-2018/06/30) in hospitals from the Instituto Mexicano del Seguro Social. Serum and urine samples were collected to determine the exposure to ZIKV, DENV and CHIKV by RT-qPCR and serology (IgM). The association between arboviral infection and GBS was analysed with χ 2 or exact Fisher tests and Kruskall-Wallis folloed by Mann Whitney U test for comparing symptomatology. A p ≤ 0.05 was considered as significant. Ninety-seven GBS cases and 184 controls were included. Evidence of association of GBS with ZIKV acute infection (OR, 8.04; 95% CI, 0.89–73.01, p =0.047), as well as ZIKV recent infection (OR, 16.68; 95% CI, 2.05–135.31; p = 0.001) and Flavivirus (ZIKV and DENV) recent infection (OR, 5.8; 95% CI, 1.8-18.8; p = 0.002) was observed. Cases with GBS associated with ZIKV demonstrated a greater impairment of functional status, a higher percentage of mechanical ventilation and mortality. Dizziness, ataxia and low blood pressure showed statistically signifant differences in cases with GBS associated with DENV. Co-infection cases were not observed.Conclusions/Significance According to the laboratory results, an association between ZIKV or ZIKV and DENV infection in patients with GBS was found. Cases of GBS associated with ZIKV but not with DENV exhibited a more severe clinical picture. Cases with co-infection were not found.