Guillain-Barré: understand the syndrome – 07/10/2023 – Health

The Peruvian government declared a national health emergency on Saturday (7/8) due to the “unusual increase” in cases of Guillain Barré syndrome.

According to data from the local Ministry of Health, the country registered 182 patients with the disease in the first half of 2023. Of these, four died, 31 are still hospitalized and 147 were discharged.

According to the published note, the health emergency decree is valid for 90 days and will allow the authorities to accelerate the purchase of supplies and medicines to deal with the sudden increase in notifications of this problem.

The Peruvian Minister of Health, César Vásquez, declared that the decision came after “an important increase [de casos] during the last few weeks”, demanding “state actions to protect the health and life of the population”.

What is Guillain Barré syndrome and what are the main forms of diagnosis and treatment?

The attack of an old ally

Guillain Barré syndrome is classified as an autoimmune disease, in which the immune system itself starts attacking certain parts of an individual’s body.

In the specific case of this disease, the affected region is the peripheral nervous system, responsible for making communication between the brain and the different regions and structures of our organism.

But what leads to this sudden attack by the defense cells?

According to the Brazilian Ministry of Health, the syndrome is usually caused by a previous infectious process.

So far, agents identified as possible triggers for Guillain Barré syndrome are:

• campylobacterone of the bacteria behind diarrhea;
• Zika;
• Dengue;
• Chikungunya;
• Cytomegalovirus;
• Epstein-Barr virus;
• Influenza A (one of the causes of the flu);
• Mycoplasma pneumoniae;
• Enterovirus D68;
• Hepatitis A, B and C;
• HIV;
• Sars-CoV-2 (causing covid-19).

The ministry points out that “many viruses and bacteria have already been temporally associated with the development of Guillain Barré syndrome, although in general it is difficult to prove the true causality of the disease”.

And there is no relationship between the severity of the infection and the onset of the disease: even mild cases with few symptoms can trigger an attack on the peripheral nervous system.

According to official records in Brazil, one to four cases per 100,000 inhabitants are detected each year. The disease is most common in the age group of 20 to 40 years.

Infectologist Raquel Stucchi, from the State University of Campinas (Unicamp), adds that Guillain Barré is also occasionally associated with a vaccine reaction, although this side effect is considered rare.

“Several vaccines have this causal relationship with the syndrome, which can occur within 60 to 90 days after administration of the dose”, says the doctor, who is also a member of the Brazilian Society of Infectology.

In the specific case of immunizers against covid-19, the Centers for Disease Control and Prevention (CDC) of the United States point out that this adverse event in those who took the doses of Janssen or AstraZeneca is also classified as something rare, although it is more frequent. than that observed in the population mean.

According to the authorities, the benefits of getting vaccinated — and therefore being protected from the infectious diseases for which the doses are applied — outweigh the possible risks observed so far.

Guillain Barré’s symptoms

Generally speaking, the syndrome begins with tingling or a feeling of weakness. These discomforts are progressive and usually start with the lower limbs (feet and legs). Over time, they “go up” to the torso, arms and hands.

The UK National Health Service (NHS) points out that the most common symptoms of Guillain Barré are:

• Numbness;
• itches;
• Muscle weakness;
• Pain;
• Balance and coordination problems.

If these signs don’t go away or get worse after a few days – with the onset of difficulties moving around, swallowing or breathing – it’s important to seek a doctor as soon as possible for a thorough evaluation.

The diagnosis of the disease depends on some tests, such as the analysis of the cerebrospinal fluid (the cerebrospinal fluid, present in the spinal cord and brain).

Ways of recovery

Early detection of the syndrome is essential to start treatment as soon as possible.

In this way, the disease does not progress and does not affect other muscles vital for survival – such as the diaphragm, which plays a key role in breathing.

In the acute phase, in which the patient is hospitalized, Guillain Barré is treated with medications known as intravenous immunoglobulins (IVIg).

This drug brings antibodies taken from several donors, in an attempt to contain the unregulated action of the immune system.

If that first option doesn’t work, specialists usually resort to plasmapheresis, a procedure that replaces the individual’s blood plasma to rid it of antibodies that possibly triggered the condition.

When the acute problem is resolved, the person is discharged and returned home. Even so, she may still need rehabilitation treatments – involving physiotherapy, speech therapy and psychology, among others.

The Ministry of Health ensures that all these treatments are available in the Unified Health System (SUS).

Health emergency in Peru

The note published by the Ministry of Health on the sudden increase in cases does not mention possible explanations for the high identified.

Stucchi points out that the sudden increase in Guillain Barré cases in Peru demands an in-depth assessment of possible infectious causes.

“We know, for example, that Peru is experiencing its worst dengue epidemic”, recalls the infectologist.

The current outbreak of the disease transmitted by the Aedes aegypti bite there even led to the downfall of the then Minister of Health, Rosa Gutiérrez, on June 15.

According to official records from the local government, there are already more than 146 thousand cases and 248 deaths from dengue in the first half of 2023 alone.

“Dengue is perhaps an explanation, but a broader analysis is necessary to make sure that other agents cannot be behind this scenario”, adds Stucchi. “An investigation is necessary and fundamental.”

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This text was originally published here.