Muscle weakness, sensory loss? Get tested for Guillain-Barre Syndrome

CHENNAI: In light of the recent cases of Guillain-Barre Syndrome (GBS) reported across the country, the State Health Department has instructed medical officers to focus on creating awareness about the disease and strengthen surveillance, also to detect and report suspected GBS cases.

As many as 21 deaths were reported in India, including 17 in Maharashtra, one in Tamil Nadu, Andhra Pradesh, West Bengal and Assam each. Though the health officials deny an outbreak in Tamil Nadu so far, medical officers have been asked to maintain surveillance.

An advisory from the department said that it was imperative to enhance public awareness and implement preventive measures to prevent further cases. GBS is a rare but treatable neurological disorder, often developing after bacterial or viral infections.

The outbreak in Maharashtra is traced to a pathogen called campylobacter jejuni, a leading cause of foodborne infections, and the biggest driver of GBS worldwide. This link was discovered in the 1990s in rural China, where the pathogen was common in chickens. GBS outbreaks occurred every monsoon as children played in water contaminated by chicken or duck droppings.

“What happened in Pune is unusual because such a large number of people do not usually get affected in a short duration of time,” explained Dr GC Elanthiraiyan, consultant-neurology, SRM Global Hospitals. “It’s important to ensure that clean and boiled drinking water is consumed. Though there is no cure, plasma exchange and intravenous immunoglobulin can help shorten the illness duration.”

Other triggers for GBS include the flu, Epstein-Barr virus, cytomegalovirus, and Zika virus.

Symptoms

GBS is a rare autoimmune condition where the immune system attacks the peripheral nerves, causing muscle weakness and sensory loss. It is more common in adults and men, though it can affect people of all ages.

Most GBS patients recover fully, though severe cases can cause paralysis and breathing difficulties, requiring intensive care.

“The main symptom is weakness of muscles that are supplied by the affected nerves. It requires immediate admission as it can rapidly become very serious. With appropriate treatment and monitoring, most people make a full recovery,” said Dr R Shrivarthan, consultant, neurology department, MGM Healthcare.

Muscle weakness starts in extremities such as the feet and hands, and moves upwards towards the centre of the body. Legs are affected more often than the arms.

“If the nerves in the head, neck and chest are affected, the patient will have difficulty in swallowing, eye movements and breathing. Sensory symptoms may include tingling or numbness. The symptoms usually begin in the toes and/or fingertips,” he added.

There is pain along with numbness in the limbs. In case of numbness, a consultation with the neurologist is important. A diarrhoeal illness indicates infection and can lead to difficulty in swallowing and breathing. A patient can also experience neck muscle weakness besides the limb weakness.

One in 2 people with GBS develop either nerve pain or deep aching muscle pain. This tends to be worse with movement and at night.

The autonomic nervous system is responsible for body functions like sweating, breathing, heart beat and digestion. In GBS, nerves within this system may be affected, causing problems with blood pressure, pulse, vision and lack of sweating.

While GBS is more common in older people but depending on the bacteria affecting the immune system, it can occur in children too affecting the body’s natural immunity. “GBS can occur in children and is common in those in the 5-11 age group. Though it’s a rare disorder, it occurs as a cluster and requires attention to ensure that outbreak is contained. Such outbreaks have been reported earlier as well. However, it’s curable if it’s identified at an earlier stage,” said Dr Madhuri Prabu, consultant-neonatologist and paediatrician, Motherhood Hospital.

Diagnosis, Treatment

People often miss the early diagnosis of GBS due to an acute lack of awareness about identifying symptoms such as paraesthesia (pins-and-needles sensation in the limbs), not being vigilant to check deep tendon reflexes, or misinterpreting the complaints of leg, back, or sciatic pain.

The Directorate of Public Health and Preventive Medicine has stated that diagnosis of GBS is based on symptoms, neurological exams, and tests such as lumbar puncture or electromyography (EMG). Early hospitalisation is crucial for monitoring respiratory and cardiac function. Rehabilitation may be needed for muscle recovery after the acute phase.

Immunoglobulin is given as an injection directly into a vein. How it works is still unclear. It may alter the immune system and help to clear the abnormal proteins (antibodies), opined doctors.

People with GBS who receive immunoglobulin, on average, have a quicker time to recovery compared with those who do not have this treatment.

DPH advisory

DPH director Dr TS Selvavinayagam instructed the public to boil water before consumption or use bottled water if the safety of the source is uncertain. Wash vegetables and fruits thoroughly, and ensure to cook poultry, meat, and seafood properly.

Additionally, cases of diarrhoea, sudden limb weakness, numbness should be reported to health authorities for early intervention.

Medical officers and healthcare staff have been asked to educate the general public on the importance of food and water safety to help prevent infections linked to GBS, and also provide reassurance that GBS is treatable with timely medical intervention. They have been asked to detect and refer suspected or probable GBS cases to the nearest tertiary care health facility immediately.

What is GBS?

Guillain-Barre Syndrome (GBS) is a condition in which the body’s immune system attacks the nerves, causing weakness and numbness of limbs, and in worse cases, paralysis. GBS is a serious condition that requires immediate hospitalisation because it can worsen quickly. The sooner treatment begins, faster the chances are of a complete recovery.

GBS patients usually experience their most significant weakness within 2 weeks after symptoms begin, which are as follows:

· Pins-and-needles feeling in fingers, toes, ankles or wrists (paraesthesia)

· Weakness in the legs that spreads to the upper body

· Unsteady walk, unable to walk or climb stairs

· Trouble with facial movements, including speaking, chewing or swallowing

· Double vision or inability to move the eyes

· Severe pain that may feel achy, shooting or cramp-like that may worsen at night

· Trouble with bladder control or bowel function

· Rapid heart rate, low or high BP

· Trouble breathing