Zika has been linked to birth defects.

The Zika epidemic flaring across the Americas has produced severalhot spots with large numbers ofcases. But there is no place quite like Turbo.The mosquito-borne virus has spread rapidly here and across lowland Colombia, but the city is unusual for the subsequent outbreak of a rare, debilitating disorder known asGuillain-Barre syndrome, whose precise link to the virus remainsunclear. Before Zika’s arrival in Turbo, a mostly Afro-Colombiantown of 60,000 set amid vast banana plantations on the country’s north coast, doctors typically saw one case of Guillain-Barre a year, if that.[How a tiny mosquito became one of the world’s ‘most efficient killers’]Get Zika news by emailWe will update you when news breaks about the virus.Sign upIn the past six weeks, there have been five, all of them severe. Three patients have died. One is fighting for his life in an intensive care unit. The fifth, a 10-year-old girl, hasn’t been able to move her legs in a week.The deaths, and the aggressiveness of the Guillain-Barre cases here, are among the first signs of a strange and worrisome pattern that is challenging the way doctors in Colombia and across Latin America are preparing for thespread of Zika.Much of the global attention to the virus has zeroed in on a suspected link tomicrocephaly, a congenital defect that leavesbabies with undersized heads and varying degrees of nerve damage. Brazilian officials say they may have hundreds or thousands of such cases related to Zika. But the photos of worried mothers and distressed infants may have given many people the impressionthat the virus poses no major risk to anyone else.[Zika prompts urgent debate about abortion in Latin America]That is not true, and certainly not here in Turbo, where rank sewage-filled canals line the streets and more and more people are arriving at the crowded emergency room with bloodshot eyes and itchy, red pockmarks,the telltale signs of Zika. Something about the virus– and researchers still don’t know what it is – appears to significantly increase the incidence of Guillain-Barre.The first resident here to get it was 41-year-old Eliana Uribe. She called in sick to her cousin’s dress shop one morning in mid-January, not long after missing several days of work with a strange rash and sore joints. Something was wrong with her feet, she said.A few hours later, when Uribe tried to walk, she collapsed.Herlegs felt “like rags.”The illness was creeping toward her torso.Uribe’s family carried her to the emergency room. German Gomez, the internist at the small public hospital, thought it might be Guillain-Barre. But he wasn’t sure.“I’d been here 15 months and hadn’t seen a single case,” he said.Two days later, Uribe lost control of her tongue and facial muscles. She fell short of breath. Doctors rushed her to a bigger hospital.Uribe died Feb. 2, her brain swamped in fluid – “severe hydrocephaly,” doctors told her family. “They never told us you could die from it,” said Katarina Lemus, Uribe’s cousin.What is hydrocephaly?The day after Uribe’s death, another Turbo resident, Edelberto Padilla, 51, also died with Guillain-Barre, at a differenthospital. He had the symptoms of Zika, too.The Colombian government hasconfirmed three fatalities with Guillain-Barre, including two of the Turbo patients, blaming the deaths on Zika.The U.S. Centers for Disease Control and Prevention (CDC) has confirmed two cases of Guillain-Barre related toZika in the United States, presumably among the more than 80 travelers infected by the virus who have returned to the country. Another Guillain-Barre case was reported in Puerto Rico.The normal prevalence rate for Guillain-Barre is one or two cases per 100,000 people, said Kenneth Gorson, a professor of neurology at Tufts University in Boston, who is one of the leading U.S. authorities on the disorder, named for the two French neurologists who discovered it exactly 100 years ago.At its most basic level, Guillain-Barre is what happens when a patient’s immune system fightsoff an infection and then goes haywire, as antibodies turn against the body’s own nervoussystem, Gorson said. They attack nerve cells, apparently mistaking them for a virus. In some instances,the antibodies strip away the membrane that protects nerve endings, called myelin, leaving the body’s muscles essentially unable to communicate with the brain.In his courses, Gorson tells students that Guillain-Barre itself isn’t fatal. “What kills people is being paralyzed in an intensive care unit,” he said. “It’s the complications from being on a ventilator for long periods of time, the risk of blood clots, wound infections from lack of movement or othernumerous medical complications that occur in paralyzed patients. Accessto quality care is critical.”Adults and children appear to be equally at risk of developing Guillain-Barre, but patients who already have health problems orcompromised immune systemsare less able to recover from it.[What you need to know about the Zika virus]One Guillain-Barre study in the Netherlands found a death rate of 1 in 20, “but that is with high-level care,” Gorson said. About one-quarter of patients need breathing assistance.Belarmina Ayarza, 58, contracted Zika while visiting her family in Turbo in January, then checked into a hospital in the city of Medellin 10 days later when she lost feeling in her legs. Doctors diagnosed Guillain-Barre, said her son, Jose Barrios. Ayarza was a diabetic, with high blood pressure. But her condition stabilized and Barrios was able to take her home in a wheelchair. On Feb. 7 she started convulsing in her bed. “Ipicked her up and held her in my arms,” Barrios said, “but shewas gone.” Doctors said she’d had a heart attack.Lack of high-level careIn the rural areas of Latin America where Zika is spreading, high-level care is often unavailable. Wait times at public hospitals, especially those swamped by Zika patients, can discourage patients from seeking care. Those with aggressive Guillain-Barre need complicated blood transfusions or a treatment known as immunoglobulin therapy to essentially wash out the harmful antibodies. But the treatments can cost more than$10,000, and patients may need several rounds.