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What’s Guillain-Barré Syndrome, Rare Condition Behind Pune Health Alert? Doctor Explains Symptoms, Precautions

Following medical treatment, the majority of patients begin to recover after two to four weeks from onset of symptoms. About 85% return to baseline within one year. 

Pune has reported multiple cases of the Guillain-Barré Syndrome (GBS) – local authorities peg the number at over 50, according to a report in The Indian Express — and this has led to a health alert from major hospitals. A report in The Times of India says that a high-end PCR test of three of the GBS patients —  affected by paralysis following stomach infection — revealed the bacteria Campylobacter jejuni, which is linked to contaminated food and water. All 3 patients, one of whom is on ventilator support, are residents of the Sinhagad Road area. 

GBS is a neurological disorder named after two French neurologists, Georges Guillain and Jean-Alexandre Barré. Dr Guillain and Dr Barre, along with their radiologist colleague Dr André Strohl, described its distinct features almost 100 years ago — in 1916, to be precise. 

The authorities in Pune are investigating the outbreak of this rare condition through household surveys in the affected areas, and by collecting the medical histories of the patients, the Indian Express reported.

Speaking to ABP Live, Dr Lomesh Bhirud, neurologist and neuro-interventionalist at Ruby Hall Clinic, Pune, warned that GBS progresses rapidly and needs to be addressed medically. 

Following medical treatment, the majority of patients begin to recover after two to four weeks from onset of symptoms. About 85% return to baseline within one year. About 5-10% have remaining disabling motor and sensory deficits.

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How Rare Is It?

About one in 1 lakh people will ever catch it in their lifetime. Compare that with diabetes, which affects 11.4% of India’s population. That means 11 or more people among 100, on average, have diabetes. 

History of Guillain-Barré Syndrome

One of the earliest cases of what is now known as GBS was reported in 1859 by French neurologist Jean Baptiste Octave Landry. Throughout the 19th century, similar cases were reported. Landry’s greatest achievement was to provide the first description of ascending paralysis or GBS. For more than half a century, Landry was the eponym for the disease.
In 1916, French doctors Guillain, Barré, and Strohl first noticed a peculiar flaccid paralysis in two hospitalised soldiers. The soldiers had developed acute paralysis with areflexia, from which they recovered spontaneously.

The disease is also known as Strohl’s syndrome.

Symptoms of GBS

As per the official website of the United States government’s National Institute of Neurological Disorders and Stroke, these are the symptoms one must look out for when suspecting GBS:

  1. Weakness while walking, climbing: This usually comes on quickly and worsens over hours or days. Most people reach the greatest stage of weakness within the first two weeks after symptoms appear; by the third week, 90% of affected people are at their weakest.
  2. Sensation changes: In GBS, the brain may receive abnormal sensory signals from the rest of the body due to the nerve damage associated with the condition. Patients may feel a tingling, a sense of insects crawling under the skin (called formications), and pain. Or a deep muscular pain in the back and/or legs. Children will begin to have difficulty walking, and they may refuse to walk. These sensations tend to disappear before the major, longer-term symptoms appear. 
  3. Difficulty with eye muscles and vision.
  4. Difficulty swallowing, speaking, or chewing.
  5. Pricking or pins and needles in the hands and feet.
  6. Pain that can be severe, particularly at night.
  7. Coordination problems and unsteadiness.
  8. Abnormal heart rate or blood pressure.

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Treatment of GBS

According to the American Medical Association (Journal of Ethics), GBS requires hospitalisation for supportive care and for close monitoring of respiratory function and signs of dysautonomy (a complication in the working of the body’s autonomic nervous system a.k.a. ANS, which controls automatic body functions like heart rate, blood pressure, breathing, and digestion).
Patients – if deemed necessary by the treating doctor – are administered intravenous immunoglobulin G therapy and plasma exchange. Use of steroids is not indicated.
Older patients are likely to develop complications and, therefore, may manifest an early need for ventilator support.

Does GBS Kill?

GBS mortality, estimated at about 5%, results from respiratory distress syndrome, aspiration pneumonia, sepsis, pulmonary embolism, and arrhythmias, according to the AMA. Relapse of disease may occur months to years from the first episode in 2-3% of patients, warns the AMA paper.

ABP Live asked Dr Lomesh Bhirud to explain the disease’s characteristics in layman’s terms, and what precautions to take. Here is what he said:

ABP: How can a non-medical citizen recognise GBS symptoms? When to approach a doctor?

Dr Lomesh Bhirud: Early symptoms include weakness or tingling in the legs, which may spread to the arms and face, difficulty walking, or even breathing issues. Seek immediate medical help if symptoms escalate rapidly, especially after a recent illness, as early intervention can prevent severe complications.

ABP: What are the different causes of GBS?

Dr Lomesh Bhirud: Typically, GBS emerges from infections, surgeries, or even vaccinations. Campylobacter jejuni, influenza, and Epstein-Bar viruses are some possible harmful causes. The answer to the question is, immune response that attacks the nerves.

ABP: How might Campylobacter jejuni contaminate food or water sources?

Dr Lomesh Bhirud: This bacteria can contaminate food or water through poor handling or hygiene, such as eating undercooked poultry, unpasteurised dairy, or drinking/consuming untreated water. Poor sanitation can also enable the bacteria to spread in the environment, thus causing outbreaks.

The writer is a senior independent journalist.

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