**4. Diagnosis of dengue and other arbovirosis in the context of the Guillain Barre syndrome epidemic**

During the months of June–July of 2019, 35 cases were registered and diagnosed as the Guillain-Barre Syndrome, at the Almanzor Aguinaga Asenjo National Hospital of Chiclayo in Peru, of which 22 had electrophysiology results compatible with the said syndrome, two had a normal result, and 11 were not evaluated with the mentioned diagnostic test. Three cases had IgG for flavivirus, three cases had IgG for flavivirus and IgG for chikungunya concomitantly, four cases had IgG for chikungunya, and one case had IgM for chikungunya. In other words, there were 11 cases of patients with a history of flavivirus or chikungunya infections in the context of the presentation of Guillain-Barre syndrome [43]. These patients were evaluated with the recomLine Tropical Fever IgG and IgM tests, immunoblot of German origin that has a sensitivity for IgG of 100% for primary infection by Zika, 100% for secondary infection for dengue or Zika, and 98.6% for primary infection by dengue; also the IgM has a sensitivity of 72.7% for dengue or Zika, and both tests have a specificity of 96–100%. On the other hand, the mentioned test describes a sensitivity and specificity of 100% for both IgM and IgG for chikungunya's diagnosis [44].

In the literature, there is the case of a dengue patient who developed Guillain-Barre syndrome, who presented the NS1 antigen on the second day of symptoms with subsequent IgM and IgG positive on the sixth day of evolution [45]. There is also another case described with similar laboratory findings, but that developed the syndrome approximately 2 weeks after the onset of dengue symptoms [46]. Therefore, this syndrome could develop early or late in relation to the onset of symptoms due to infection. In our cases, we did not have positive IgM and we did not have the opportunity to evaluate the NS1 antigen, but it is noteworthy that all cases detected with flavivirus antibodies only had positive IgG in their results. The previous cases described in the existing literature may represent primary cases of dengue since they raised IgM values early.

In our cases, the majority of patients did not show joint pain during the diagnosis of Guillain-Barre syndrome, which could suggest that these are non-acute cases, but as described in the case cited, this syndrome may occur during convalescence of the dengue; on the other hand, in an endemic area such as Lambayeque-Peru, the presence of cases with secondary infection that usually have low IgM values and not even increase it (**Figure 5**) should not attract attention [47]. In addition, Ramabhatta et al. [48] conducted a study on a sample of 568 cases diagnosed of dengue and showed that IgG-positive patients were more prone to complications

**43**

**Figure 6.**

*Situation of Dengue after the Phenomenon of the Coastal El Niño*

**5.1 Lethality in the context of Peru and Latin America**

than IgM-positive patients, therefore, the etiological association between dengue and Guillain-Barre syndrome in the Lambayeque region could not be ruled out.

In 2014, according to WHO and Pan American Health Organization (PAHO), the average fatality rate for the Americas is 0.04%, being among the countries with the highest rate, followed by Dominican Republic with 1.54%, Peru with 0.12%, compared to Guatemala and Colombia that have 0.07% [49]. In Colombia and Peru, the most frequent serotype 2 prevailed, and in the Dominican Republic serotype 4

Nationally, the Center for Epidemiology, Prevention and Control of Diseases of the Ministry of Health, reported in 2017, 76,093 cases of dengue in the country (3.03 times more cases in relation to 2016, and the largest number of cases reported in the last 5 years [9, 51] and 92 reports of deaths by dengue, the highest number

About 43.6% came from Piura, 17.1% from Loreto, 9.9% from Madre de Dios, 8.8% from Ucayali, 4.2% from San Martín, and the remaining 16.4% from other regions; all the age groups were affected, but with a greater proportion in people

In the Piura Healthcare Network, 30 deaths associated with dengue virus were confirmed by laboratory, and occurred between epidemiological weeks Nos. 08 and 35, over 8 months; a similar panorama reported by the Lambayeque Healthcare Network, which reported the death of six dengue-associated patients, until epidemiological week No. 20 [13, 52]; although this information could be underestimated, because in many cases it is attributed to pneumonia, and actually the cases of dengue are not properly diagnosed, causing figures not approximate to

*Death toll and dengue lethality in Peru, 2008–2017. Source: Metaxenic disease surveillance system of the Center* 

*for Epidemiology, Disease Prevention and Control of the Ministry of Health (CDC-Perú).*

*DOI: http://dx.doi.org/10.5772/intechopen.92095*

reported in the last 10 years) (**Figure 6**).

over 65 (37%) and young adults (21.7%) [9].

**5. Dengue lethality**

prevailed [50].

reality [53].

than IgM-positive patients, therefore, the etiological association between dengue and Guillain-Barre syndrome in the Lambayeque region could not be ruled out.
