An Outbreak of Guillain-Barre Syndrome with Respiratory Failure in Joypurhat, Bangladesh, 2018
DOI:
https://doi.org/10.59096/osir.v14i3.262528Keywords:
Guillain-Barre Syndrome, GBS, respiratory muscle paralysis, mechanical ventilation, Bangladesh, fatalityAbstract
We describe an investigation to identify the causative agent and risk factors for a cluster of Guillain-Barre Syndrome (GBS) reported in northern Bangladesh, November 2018. Medical record review and verbal autopsies were conducted. We actively searched for and interviewed other GBS cases in the hospital to gather demographic and clinical information. Blood samples were collected for serological testing for campylobacter and molecular testing for dengue, Zika, and Chikungunya and stool samples for poliovirus. We identified 13 GBS patients of which eight were males. The case fatality rate was 23%. We found development of respiratory muscle paralysis in 10 patients; three had rapid involvement within 48 hours and eventually died in the acute progressive phase without mechanical ventilation support. Serological tests confirmed the presence of antibodies against Campylobacter jejuni in three of seven patients. All other tests were negative. The high case fatality rate was due to rapid onset of respiratory muscle paralysis. We recommend establishing a surveillance system to timely capture and report GBS patients and to enhance investigation capacity. We also recommend that sufficient quantity of mechanical ventilators be present in peripheral tertiary hospitals.
References
ScienceDirect. Guillain-barre syndrome - an overview [Internet]. Philadelphia: Elsevier's Health Sciences; 2009 May 21 [cited 2021 Feb 23]. <https://www.sciencedirect.com/topics/neuroscience/guillain-barre-syndrome>
Willison HJ, Jacobs BC, van Doorn PA. Guillain-barré syndrome. Lancet [Internet]. 2016 Aug [cited 2019 Apr 29];388(10045):717–27. <https://linkinghub.elsevier.com/retrieve/pii/s0140673616003391>
Sejvar JJ, Baughman AL, Wise M, Morgan OW. Population incidence of guillain-barré syndrome: a systematic review and meta-analysis. Neuroepidemiology [Internet]. 2011 [cited 2020 Dec 11];36(2):123-33. <https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5703046/>
Islam Z, Gilbert M, Mohammad QD, Klaij K, Li J, van Rijs W, et al. Guillain-barré syndrome-related Campylobacter jejuni in Bangladesh: ganglioside mimicry and cross-reactive antibodies. PLoS One [Internet]. 2012 Aug 27 [cited 2019 Mar 20];7(8):e43976. <https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0043976>
Zhang HL, Wu J, Ni FM. Axonal variant of guillain-barré syndrome associated with campylobacter infection in bangladesh. 2010 Jul 13 [cited 2019 apr 25];75(2): 194-5. <https://n.neurology.org/content/axonal-variant-guillain-barr%c3%a9-syndrome-associated-campylobacter-infection-bangladesh>
Islam Z, van Belkum A, Cody AJ, Tabor H, Jacobs BC, Talukder KA, Endtz HP. Campylobacter jejuni HS:23 and Guillain-barré syndrome, Bangladesh. Emerg Infect Dis [Internet]. 2009 Aug [cited 2019 Mar 20];15(8):1315–7. <https://www.ncbi.nlm.nih.gov/pmc/articles/pmc2815972/>
Rosen BA. Guillain-barré syndrome. Pediatr rev [Internet]. 2012 Apr 1 [cited 2021 Jan 21];33(4):164–70; quiz 170-1. <https://europepmc.org/article/med/22474113>
Dimachkie MM, Barohn RJ. Guillain-barré syndrome and variants. Neurol Clin [Internet]. 2013 May [cited 2020 Dec 11];31(2):491–510. <https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3939842/>
Islam Z, Papri N, Ara G, Ishaque T, Alam AU, Jahan I, et al. Risk factors for respiratory failure in Guillain-barre syndrome in Bangladesh: a prospective study. Ann Clin Transl Neurol [Internet]. 2019 Jan 7 [cited 2021 Feb 23];6(2):324–32. <https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6389747/>
Hughes RA, Bihari D. Acute neuromuscular respiratory paralysis. J Neurol Neurosurg Psychiatry [Internet]. 1993 Apr 1 [cited 2020 Nov 4];56(4):334–43. <https://jnnp.bmj.com/lookup/doi/10.1136/jnnp.56.4.334>
van den Berg B, Bunschoten C, van Doorn PA, Jacobs BC. Mortality in Guillain-barré syndrome. Neurology [Internet]. 2013 Apr 30 [cited 2021 Jan 21];80(18):1650–4. <https://n.neurology.org/content/80/18/1650>
Melone MA, Heming N, Meng P, Mompoint D, Aboab J, Clair B, et al. Early mechanical ventilation in patients with Guillain-Barré syndrome at high risk of respiratory failure: a randomized trial. Ann Intensive Care [Internet]. 2020 Sep 30 [cited 2020 Dec 11];10(1):128. <https://doi.org/10.1186/s13613-020-00742-z>
Styczynski AR, Malta JMAS, Krow-Lucal ER, Percio J, Nóbrega ME, Vargas A, et al. Increased rates of Guillain-barré syndrome associated with Zika virus outbreak in the Salvador metropolitan area, Brazil. PloS Negl Trop Dis [Internet]. 2017 Aug 30 [cited 2020 dec 11];11(8). <https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5595339/>
González-Suárez I, Sanz-Gallego I, Rodríguez de Rivera FJ, Arpa J. Guillain-barré syndrome: natural history and prognostic factors: a retrospective review of 106 cases. BMC Neurol [Internet]. 2013 Jul 22 [cited 2019 Apr 28];13:95. <https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3723666/>
Andary MT. Guillain-barre syndrome: practice essentials, background, pathophysiology [Internet]. New York: Medscape; 2020 Jun 24 [cited 2020 Nov 4]. <https://emedicine.medscape.com/article/315632-overview#a6>
Nichols EK, Byass P, Chandramohan D, Clark SJ, Flaxman AD, Jakob R, et al. The WHO 2016 verbal autopsy instrument: an international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0. PloS Med [Internet]. 2018 Jan 10 [cited 2021 Mar 20];15(1):e1002486. <https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002486>
Piccione EA, Salame K, Katirji B. Guillain-Barré syndrome and related disorders. In: Katirji B, Kaminski HJ, Ruff RL, editors. Neuromuscular disorders in clinical practice [Internet]. New york: Springer; 2014 [cited 2021 Feb 23]. p.573–603. <https://doi.org/10.1007/978-1-4614-6567-6_28>
Sharshar T, Chevret S, Bourdain F, Raphaël JC, French Cooperative Group on Plasma Exchange in Guillain-barré syndrome. Early predictors of mechanical ventilation in guillain-barré syndrome. Crit Care Med. 2003 Jan;31(1):278–83.
Meena AK, Khadilkar SV, Murthy JMK. Treatment guidelines for Guillain–barré syndrome. Ann Indian Acad Neurol [Internet]. 2011 Jul [cited 2021 Feb 23];14(Suppl 1):S73–81. <https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3152164/>
Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of guillain–barré syndrome in ten steps. Nat Rev Neurol [Internet]. 2019 Nov [cited 2021 Feb 23];15(11):671–83. <https://www.nature.com/articles/s41582-019-0250-9>
Aylward S. Guillian Barre Syndrome: Diseases and conditions [Internet]. Mumbai: Pediatric Oncall; 2001 Jun 3 [cited 2021 Feb 23]. <https://www.pediatriconcall.com/articles/pediatric-neurology/guillian-barre-syndrome/guillian-barre-syndrome-introduction>
Harms M. Inpatient management of Guillain-barré syndrome. Neurohospitalist [Internet]. 2011 Apr [cited 2020 Dec 11];1(2):78–84. <https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3726082/>
Ishaque T, Islam MB, Ara G, Endtz HP, Mohammad QD, Jacobs BC, et al. High mortality from Guillain-barré syndrome in bangladesh. J Peripher Nerv Syst [Internet]. 2017 [cited 2021 Feb 23];22(2):121–6. <https://onlinelibrary.wiley.com/doi/abs/10.1111/jns.12215>
Sharma CM, Kumawat BL, Ralot T, Tripathi G, Dixit S. Guillain-barré syndrome occurring during dengue fever. J Indian Med Assoc. 2011 Sep 1;109:675, 682.
Cao-Lormeau V, Blake S, Mons S, Lastere S, Roche C, Vanhomwegen J, et al. Guillain-barré syndrome outbreak caused by zika virus infection in french polynesia. Lancet lond engl [Internet]. 2016 Apr 9 [cited 2021 Jul 26];387(10027):1531–9. <https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5444521/>
Barbi L, Coelho AVC, Alencar LCA, Crovella S. Prevalence of Guillain-barré syndrome among Zika virus infected cases: a systematic review and meta-analysis. Braz J Infect Dis [Internet]. 2018 Mar 1 [cited 2021 Jul 26];22(2):137–41. <https://www.sciencedirect.com/science/article/pii/s1413867017309340>
Zambrano LI, Fuentes-Barahona IC, Soto-Fernández RJ, Zuniga C, da Silva JC, Rodriguez-Morales AJ. Guillain–barré syndrome associated with zika virus infection in Honduras, 2016–2017. Int J Infect Dis [Internet]. 2019 Jul 1 [cited 2021 Jul 26];84:136–7. <https://www.ijidonline.com/article/s1201-9712(19)30214-0/abstract>
Rafique I, Saqib MAN, Munir MA, Qureshi H, Taseer IUH, Iqbal R, et al. Asymptomatic dengue infection in adults of major cities of pakistan. Asian Pac J Trop Med [Internet]. 2017 Oct 1 [cited 2021 Jul 26];10(10):1002–6. <https://www.sciencedirect.com/science/article/pii/s1995764517308908>
International Centre for Diarrhoeal Disease Research, Bangladesh. Researchers in icddr,b highlight risks of Guillain-Barré syndrome to children under 15 in Bangladesh[Internet]. Dhaka (BD): International Centre for Diarrhoeal Disease Research, Bangladesh: 2011 Aug 18 [cited 2021 Jul 26]. <https://www.icddrb.org/news-and-events/news?id=557&task=view>
Nachamkin I, Allos BM, Ho T. Campylobacter species and Guillain-barré syndrome. Clin Microbiol Rev [Internet]. 1998 Jul 1 [cited 2020 Nov 5];11(3):555–67. <https://cmr.asm.org/content/11/3/555>
Koga M, Gilbert M, Li J, Koike S, Takahashi m, Furukawa K, et al. Antecedent infections in fisher syndrome: a common pathogenesis of molecular mimicry. Neurology. 2005 May 10;64(9):1605–11.
Nyati KK, Nyati R. Role of campylobacter jejuni infection in the pathogenesis of Guillain-barré syndrome: an update. Biomed Res Int [Internet]. 2013 Aug 13 [cited 2021 Jul 26];2013:e852195. <https://www.hindawi.com/journals/bmri/2013/852195/>
Baker MG, Kvalsvig A, Zhang J, Lake R, Sears A, Wilson N. Declining Guillain-barré syndrome after campylobacteriosis control, New Zealand, 1988–2010. Emerg Infect Dis [Internet]. 2012 Feb [cited 2019 Apr 28];18(2):226–33. <https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3310455/>
Drenthen J, Yuki N, Meulstee J, Maathuis EM, van Doorn PA, Visser GH, et al. Guillain-barré syndrome subtypes related to campylobacter infection. J Neurol Neurosurg Psychiatry. 2011 Mar;82(3):300–5.
Bae JS, Yuki N, Kuwabara S, Kim JK, Vucic S, Lin CS, et al. Guillain–barré syndrome in asia. J Neurol Neurosurg Psychiatry [Internet]. 2014 Aug 1 [cited 2021 Jul 27];85(8):907–13. <https://jnnp.bmj.com/content/85/8/907>
Allos BM. Association between Campylobacter infection and Guillain-barré syndrome. J Infect Dis [Internet]. 1997 Dec [cited 2021 Jul 27]:176 Suppl 2:S125-8. <https://academic.oup.com/jid/article/176/supplement_2/s125/841642?login=true>
Souayah N, Nasar A, Suri MFK, Qureshi AI. Guillain–barre syndrome after vaccination in United States: a report from the cdc/fda vaccine adverse event reporting system. Vaccine [Internet]. 2007 Jul 20 [cited 2021 Aug 23];25(29):5253–5. <https://www.sciencedirect.com/science/article/pii/s0264410x07005476>
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Outbreak, Surveillance, Investigation & Response (OSIR) Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
