Despite the enormous magnitude of Zika virus (ZIKV) infection epidemics in the Americas (Musso et al., 2018Musso D. Rodriguez-Morales A.J. Levi J.E. Cao-Lormeau V.M. Gubler D.J. Unexpected outbreaks of arbovirus infections: lessons learned from the Pacific and tropical America.Lancet Infect Dis. 2018; 18: e355-e361Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar), studies describing its many consequences, such as congenital Zika syndrome (CZS) (Alvarado-Socarras et al., 2018Alvarado-Socarras J.L. Idrovo A.J. Contreras-Garcia G.A. Rodriguez-Morales A.J. Audcent T.A. Mogollon-Mendoza A.C. et al.Congenital microcephaly: a diagnostic challenge during Zika epidemics.Travel Med Infect Dis. 2018; 23: 14-20Crossref PubMed Scopus (23) Google Scholar) and Guillain–Barré syndrome (GBS) (Villamil-Gomez et al., 2017Villamil-Gomez W.E. Sanchez-Herrera A.R. Hernandez H. Hernandez-Iriarte J. Diaz-Ricardo K. Castellanos J. et al.Guillain-Barre syndrome during the Zika virus outbreak in Sucre, Colombia, 2016.Travel Med Infect Dis. 2017; 16: 62-63Crossref PubMed Scopus (20) Google Scholar), are lacking for many countries across the region. This mainly concerns reports from the countries of Central America, such as Honduras. Honduras was affected by a ZIKV epidemic during the years 2016–2017 (Zambrano et al., 2019Zambrano L.I. Vasquez-Bonilla W.O. Fuentes-Barahona I.C. Claudio da Silva J. Valle-Reconco J.A. Medina M.T. et al.Spatial distribution of Zika in Honduras during 2016-2017 using geographic information systems (GIS) — implications for public health and travel medicine.Travel Med Infect Dis. 2019; Crossref Scopus (7) Google Scholar). This study was performed to assess the clinical profiles and the frequency of GBS associated with ZIKV during the outbreak in Honduras in 2016–2017. A retrospective observational study was performed. Data from patients who met the diagnostic criteria for GBS, according to the Brighton Collaboration (levels 1 or 2), with recent ZIKV infection and screening for other etiologies of GBS, were retrieved and recorded. Cases of ZIKV were clinically and laboratory-confirmed (RT-PCR). A total of 108 cases of GBS were studied. During the same period, 32 607 cases of ZIKV (0.3% of them) diagnosed by clinical surveillance and 326 confirmed by RT-PCR (33.1% of them) occurred. The mean age of the patients was 34.9 years and 58.9% were male. These patients were from the capital area, Francisco Morazán Province (35.2%), Choluteca (11.1%), and Comayagua (11.11%), among other areas of the country. Electrophysiological tests were consistent with the primary demyelinating form of the disease. Of the total patients, 10.2% were positive for dengue virus (DENV), chikungunya virus (CHIKV), or ZIKV (Table 1), including six (5.6%) cases due to ZIKV infection and one (0.9%) due to ZIKV–DENV co-infection, among other etiologies (Table 1). Among those with ZIKV GBS, the mean age of the patients was 35.4 years and 67% were male. These ZIKV patients presented fever and rash among other clinical manifestations (Table 1).Table 1Clinical characteristics of patients with GBS, Honduras, 2016–2017.VariablesMeanSD Age (years)34.3523.2 Delay between symptoms and diagnosis (days)4.382.72 Mean time in the ICU (days)14.513.06Number% Male6458.9 EtiologyZIKV RT-PCR-positive65.6ZIKV/DENV RT-PCR-positive10.9CHIKV RT-PCR-positive10.9DENV IgM-positive (RT-PCR-negative)10.9CHIKV IgM-positive (RT-PCR-negative)10.9ZIKV/DENV/CHIKV RT-PCR-negative/IgM-negative9789.8 Clinical manifestations of ZIKV RT-PCR-positive patients (n = 6)Fever3/6Paresthesia3/6Rash2/6Asthenia1/6Myalgia1/6CHIKV, chikungunya virus; DENV, dengue virus; GBS, Guillain–Barré syndrome; ICU, intensive care unit; IgM, immunoglobulin M; RT-PCR, reverse transcriptase polymerase chain reaction test; SD, standard deviation; ZIKV, Zika virus. Open table in a new tab CHIKV, chikungunya virus; DENV, dengue virus; GBS, Guillain–Barré syndrome; ICU, intensive care unit; IgM, immunoglobulin M; RT-PCR, reverse transcriptase polymerase chain reaction test; SD, standard deviation; ZIKV, Zika virus. The delay between symptom onset and diagnosis was a mean of 4.38 ± 2.72 days; the mean time in the ICU was 14.5 ± 13.06 days (Table 1). Treatment comprised intravenous immunoglobulin (IVIG) in all patients. Twenty-four patients required intubation and assisted ventilation (22.2%). Eleven fatal cases occurred (case fatality rate 10%). The remaining cases had made a satisfactory recovery at the 1-year follow-up. Since 2017, cases of ZIKV have been seen sporadically in Honduras, as well as associated GBS cases. Previous ecological analyses in the Americas, including data from Honduras, have found that ZIKV (Dos Santos et al., 2016Dos Santos T. Rodriguez A. Almiron M. Sanhueza A. Ramon P. de Oliveira W.K. et al.Zika Virus and the Guillain-Barre Syndrome — case series from seven countries.N Engl J Med. 2016; 375: 1598-1601Crossref PubMed Scopus (231) Google Scholar), in addition to other arboviruses (Villamil-Gomez et al., 2016Villamil-Gomez W. Silvera L.A. Paez-Castellanos J. Rodriguez-Morales A.J. Guillain-Barre syndrome after Chikungunya infection: a case in Colombia.Enferm Infecc Microbiol Clin. 2016; 34: 140-141Crossref PubMed Scopus (17) Google Scholar), is associated with GBS. Although ZIKV infection is usually benign, the clinical evolution can even be fatal in non-GBS cases (Arzuza-Ortega et al., 2016Arzuza-Ortega L. Polo A. Perez-Tatis G. Lopez-Garcia H. Parra E. Pardo-Herrera L.C. et al.Fatal sickle cell disease and Zika virus infection in girl from Colombia.Emerg Infect Dis. 2016; 22: 925-927Crossref PubMed Scopus (76) Google Scholar, Sarmiento-Ospina et al., 2016Sarmiento-Ospina A. Vasquez-Serna H. Jimenez-Canizales C.E. Villamil-Gomez W.E. Rodriguez-Morales A.J. Zika virus associated deaths in Colombia.Lancet Infect Dis. 2016; 16: 523-524Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar, Rodriguez-Morales et al., 2019Rodriguez-Morales A.J. Ramirez-Vallejo E. Alvarado-Arnez L.E. Paniz-Mondolfi A. Zambrano L.I. Ko A.I. Fatal Zika virus disease in adults: a critical reappraisal of an under-recognized clinical entity.Int J Infect Dis. 2019; Abstract Full Text Full Text PDF Scopus (7) Google Scholar). In the context of GBS, countries at risk of ZIKV epidemics require adequate intensive care bed capacity for the management of severe cases (Villamil-Gomez et al., 2017Villamil-Gomez W.E. Sanchez-Herrera A.R. Hernandez H. Hernandez-Iriarte J. Diaz-Ricardo K. Castellanos J. et al.Guillain-Barre syndrome during the Zika virus outbreak in Sucre, Colombia, 2016.Travel Med Infect Dis. 2017; 16: 62-63Crossref PubMed Scopus (20) Google Scholar, Dos Santos et al., 2016Dos Santos T. Rodriguez A. Almiron M. Sanhueza A. Ramon P. de Oliveira W.K. et al.Zika Virus and the Guillain-Barre Syndrome — case series from seven countries.N Engl J Med. 2016; 375: 1598-1601Crossref PubMed Scopus (231) Google Scholar, Villamil-Gomez et al., 2016Villamil-Gomez W. Silvera L.A. Paez-Castellanos J. Rodriguez-Morales A.J. Guillain-Barre syndrome after Chikungunya infection: a case in Colombia.Enferm Infecc Microbiol Clin. 2016; 34: 140-141Crossref PubMed Scopus (17) Google Scholar). In fact, the GBS cases in the present study were from areas affected by ZIKV epidemics (Zambrano et al., 2019Zambrano L.I. Vasquez-Bonilla W.O. Fuentes-Barahona I.C. Claudio da Silva J. Valle-Reconco J.A. Medina M.T. et al.Spatial distribution of Zika in Honduras during 2016-2017 using geographic information systems (GIS) — implications for public health and travel medicine.Travel Med Infect Dis. 2019; Crossref Scopus (7) Google Scholar), as well as previous DENV and CHIKV (Zambrano et al., 2017Zambrano L.I. Sierra M. Lara B. Rodriguez-Nunez I. Medina M.T. Lozada-Riascos C.O. et al.Estimating and mapping the incidence of dengue and chikungunya in Honduras during 2015 using Geographic Information Systems (GIS).J Infect Public Health. 2017; 10: 446-456Crossref PubMed Scopus (34) Google Scholar). It can be argued that arbovirus RNA detection by RT-PCR should be part of the study of GBS cases. Most studies have suggested that the numbers of cases of GBS were significantly increased in the Americas during the ZIKV epidemics of 2016 (Dos Santos et al., 2016Dos Santos T. Rodriguez A. Almiron M. Sanhueza A. Ramon P. de Oliveira W.K. et al.Zika Virus and the Guillain-Barre Syndrome — case series from seven countries.N Engl J Med. 2016; 375: 1598-1601Crossref PubMed Scopus (231) Google Scholar). Adherence to protocols for the care of patients with acute neurological syndromes in ZIKV endemic areas is clearly vital, and the training and education of healthcare workers, including travel medicine practitioners dealing with people visiting endemic areas, particularly in Latin America, should be prioritized. Finally, in addition to GBS, the spectrum of the neurological consequences of ZIKV include not only CZS and GBS, but also encephalitis, meningoencephalitis, myelitis, sensory neuropathies, optic neuropathy, seizures, and epilepsy, among other reported complications (Medina and Medina-Montoya, 2017Medina M.T. Medina-Montoya M. New spectrum of the neurologic consequences of Zika.J Neurol Sci. 2017; 383: 214-215Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar). Dirección de Investigación Científica (DICU), Universidad Nacional Autonoma de Honduras.