Diagnosis Of Guillain-Barre Syndrome Research Articles

Covid-19 associated Guillain-Barré syndrome: A series of a relatively uncommon neurological complication

Background and aimsThe COVID-19 pandemic has turned the world topsy turvy since its emergence and has claimed innumerable lives worldwide. Neurological manifestations of the disease have raised several eyebrows around the world among which Guillain-Barré syndrome (GBS) deserve special mention. Although majority of the cases of the coronavirus disease 2019 (COVID-19) present with respiratory symptoms, extrapulmonary manifestations are being increasingly reported. We conducted this study to analyze detailed clinical presentations and outcome in a series of eight cases (n = 8) with COVID-19 associated GBS. MethodsAn observational prospective study was conducted among patients with post-infectious/para-infectious GBS. 8 patients were subclassified into acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN) and acute motor and sensory axonal neuropathy (AMSAN) as per electrodiagnostic criteria and were followed up from admission to 6 months post discharge, to obtain a comprehensive clinical profile and outcome in these patients. ResultsThe diagnosis of GBS was confirmed as per Asbury criteria, supported by electrodiagnostic features in nerve conduction velocity test. Among the series of 8 patients, 3 were diagnosed as AIDP, 3 had AMAN and the remaining 2 patients had AMSAN. 3 patients of GBS were afebrile and were diagnosed as COVID-19 after a positive assay on routine screening. Cerebro-spinal fluid analysis for SARS-Cov-2 RT-PCR and serum anti-ganglioside antibodies were negative in all the patients. ConclusionGBS in patients with COVID-19 should be differentiated from critical illness neuropathy and myopathy. Early diagnosis is important as it is associated with poor outcome and prolonged invasive ventilation.

RARE PATHOGEN LINKED TO GUILLAIN-BARRÉ SYNDROME AND RESPIRATORY FAILURE

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Guillain Barre Syndrome (GBS) is a rapidly progressive peripheral neuropathy that presents as diminished deep tendon reflex with ascending symmetrical weakness of the lower extremities, secondary to a gastrointestinal or respiratory illness. Incidence is more common in males and range from 1 to 3 out of 100,000 cases per year. Approximately 10 to 30% of patients required mechanical ventilation. Potential triggering events include trauma, immunization, surgery, and infections by organism such as Campylobacter, Cytomegalovirus, Mycoplasma pneumonia, Epstein Barr virus and HIV. CASE PRESENTATION: A 75-year-old male with medical history of peripheral vascular disease and diabetes mellitus type 2, who arrive to the emergency unit with 1 day evolution of vomiting, bloody diarrhea, and general malaise. He denies fever, chills, chest pain, shortness of breath, cough, abdominal pain, dysuria, sick contacts, or recent travel. The patient refers recent ingestion of street meat tacos. Physical examination remarkable for right lower extremity above the knee amputation, hypotension, and tachycardia. He was admitted to intensive care unit with septic shock and started on broad spectrum antibiotics. The gram stain show gram negative bacilli bacteria, with a gull wing shape, similar in morphology to the Campylobacter species. On fourth day of admission, he developed hypoactivity, hypercapnic respiratory failure requiring mechanical ventilation. His neurological examination was remarkable for generalized areflexia and marked distal more than proximal upper extremity weakness. Lumbar puncture (LP) was performed, and results correlated with this diagnosis of GBS. Final blood and stool cultures showed Anaerobiospirillum succiniproducens. The organism was initially confused with Campylobacter species due to morphological similarities. DISCUSSION: Two known Anaerobiospirillum sp. infect humans, A. thomassi which cause diarrhea and A. succiniproducens which is a motile, gram-negative, spiral anaerobe with flagella and is a rare cause of diarrheal illness and bacteremia in humans. McNeil et al showed that 17 of 22 patient had gastrointestinal symptoms and suggest that the gastrointestinal tract was likely the portal of entry. A. succiniciproducens have been isolated from rectal swabs of cat and dogs but not in humans. The optimal antimicrobial treatment for A. succiniciproducens still remains to be determined. CONCLUSIONS: This case is intended to arise medical awareness of this uncommon organisms, Anaerobiospirillum succiniproducens, which may lead to GBS. Early diagnosis and treatment with immunoglobulins are required to reduced neurological disability and risk of respiratory failure. Nerve conduction testing, along with albuminocytologic dissociation serves as helpful diagnostical studies, still clinical suspicion is important in atypical cases. REFERENCE #1: Epstein DAJ, Anaerobiospirillum succiniproducens bacteremia and pyomyisitis. Journal of Clinical Microbiology 55:665-669 REFERENCE #2: Kelesidis T, Bloodstream Infection with Anaerobiospirillum succiniciproducens: A Potentially Lethal Infection. South Med J. 2011 Mar;104 (3): 205-214 REFERENCE #3: McNeil MM, Martone WJ, Dowell VR, Jr. Bacteremia with Anaerobiospirillum succiniciproducens. Rev Infect Dis1987;9:737–42. DISCLOSURES: No relevant relationships by Onix Cantres-Fonseca, source=Web Response No relevant relationships by Marlene Farinacci Vilaro, source=Web Response No relevant relationships by Vanessa Fonseca Ferrer, source=Web Response No relevant relationships by Luis Gerena Montano, source=Web Response No relevant relationships by SULIMAR MORALES, source=Web Response No relevant relationships by William Rodriguez-Cintron, source=Web Response

Relapsing inflammatory neuropathy with normal peripheral nerve conduction studies – a paradoxical phenomenon in two patients

The diagnosis of Guillain Barre Syndrome and Chronic Inflammatory Demyelinating Polyneuropathy depends on an appropriate history, examination, CSF cyto-protein dissociation and abnormal peripheral nerve conduction studies (PNCS). We present two cases suggestive of GBS but with repeatedly normal PNCS, a paradoxical phenomenon.

GUILLAIN-BARRÉ SYNDROME FOLLOWING COVID-19 PNEUMONIA: ARE THEY RELATED?

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Guillain-Barre syndrome (GBS) is an immune-mediated polyneuropathy affecting the peripheral nervous system. Immune system activation in response to a viral or bacterial infection, which cross-reacts with the peripheral nerve components, is GBS's proposed mechanism. Epstein-Barr virus, campylobacter, cytomegalovirus, influenza, and mycoplasma are the most commonly associated infections with GBS development. Since the beginning of the coronavirus 2019 (COVID-19) pandemic, there have been isolated reports of the disease's neurological manifestations and sequelae. In early February 2020 itself, COVID-19 associated GBS has been reported from Italy and China. Here we are reporting the case of a GBS after severe COVID-19 pneumonia. CASE PRESENTATION: A 68-year- old Caucasian male with a history of obstructive sleep apnea, hypertension, and restless leg syndrome came to the hospital with worsening reparatory difficulty. He was diagnosed with COVID-19 pneumonia a week ago and was on remdesivir and dexamethasone therapy at home. At the time of presentation, he was found to be in respiratory failure, which eventually required intubation and mechanical ventilation. After spending 14 days on mechanical ventilation, the patient was extubated. His respiratory status significantly improved, but he was found to have confused mentation on day two after extubation. An MRI scan and EEG showed no significant abnormality. His confusion improved over the next two days, but he gradually developed bilateral upper and lower extremity symmetrical weaknesses with loss of deep tendon reflexes and touch sensation. The patient was also found to have alternating tachycardia and bradycardia around this period. The weakness progressed over the next week. CSF analysis revealed a protein level of 77mg/dL (normal: 8–43 mg/dL) with total nucleated cells of 3 (normal 0-8 ). CSF meningitis/encephalitis PCR panel for the 17 most common pathogens was negative (the panel did not have COVID-19). Nerve conduction studies were not done due to lack of availability. A diagnosis of GBS was made, and the patient was transferred to a higher center for plasmapheresis. DISCUSSION: COVID-19 leading to GBS does not come as a surprise;similar viruses, including Severe acute respiratory syndrome coronavirus and middle east respiratory syndrome coronavirus, had been reported to trigger GBS. If the CSF findings and autonomic nervous system involvement were absent, post-intensive care syndrome and critical care neuropathy might have been close differentials. There are isolated reports of blood transfusions leading to GBS;although unlikely, the patient's reception of convalescent plasma cannot be overlooked. The absence of nerve conduction studies also truncates the confidence of GBS diagnosis here. CONCLUSIONS: GBS may be triggered by COVID-19 infection, although more evidence is needed to establish the causation. REFERENCE #1: Caress JB, Castoro RJ, Simmons Z, Scelsa SN, Lewis RA, Ahlawat A, Narayanaswami P. COVID-19-associated Guillain-Barre syndrome: The early pandemic experience. Muscle Nerve. 2020 Oct;62(4):485-491. doi: 10.1002/mus.27024. Epub 2020 Aug 11. PMID: 32678460;PMCID: PMC7405390. REFERENCE #2: Rajdev K, Victor N, Buckholtz ES, Hariharan P, Saeed MA, Hershberger DM, Bista S. A Case of Guillain-Barre Syndrome Associated With COVID-19. J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620961198. doi: 10.1177/2324709620961198. PMID: 32981333;PMCID: PMC7545753. REFERENCE #3: Scheidl E, Canseco DD, Hadji-Naumov A, Bereznai B. Guillain-Barre syndrome during SARS-CoV-2 pandemic: A case report and review of recent literature. J Peripher Nerv Syst. 2020 Jun;25(2):204-207. doi: 10.1111/jns.12382. Epub 2020 May 26. PMID: 32388880;PMCID: PMC7273104. DISCLOSURES: No relevant relationships by Arthur Cecchini, source=Web Response No relevant relationships by Bhavesh Gajjar, source=Web Response No relevant relationships by Rasheed Musa, source=Web Response No relevant relati nships by Akesh Thomas, source=Web Response

POST-INFECTIOUS DEMYELINATING POLYNEUROPATHY SECONDARY TO COVID-19 INFECTION

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Coronavirus disease 2019 (Covid-19) began late 2019 in Wuhan, China, declared health care emergency in January 2020 and by March 2020 was declared a pandemic by the WHO. Although respiratory symptoms are most commonly reported, it is important to notice that neurologic complications have been increasingly recognized. Symptoms include headache, dizziness, anosmia, ageusia, and encephalopathy. Demyelinating polyneuropathy presenting as post infectious sequela has not yet been well described. CASE PRESENTATION: Three weeks after being diagnosed with Covid-19, when fully recovered, a 66-year-old man presented with sudden onset walking difficulties owning to symmetric weakness in the lower extremities that rapidly progressed to the upper extremities. Once in respiratory distress with a negative inspiratory force of negative 12, he was intubated due to neuromuscular failure. The diagnosis of Guillain-Barre syndrome (GBS) was made through clinical evaluation in junction with Cerebrospinal Fluid (CSF) analysis (revealing albumin-cytological dissociation), electromyography, and magnetic resonance imaging. He had no significant improvement with intravenous immunoglobulin (400mg/kg/day for five days) and, thus, was started on plasmapheresis treatment (five sessions every other day). Although he only had a mild response, the patient was able to answer simple questions and was enrolled in a long-term physical and occupational therapy. DISCUSSION: Guillain-Barre is an immune-mediated disease that affects the peripheral neurons and nerve roots usually after a preceding respiratory or gastrointestinal illness. There are several proposed mechanisms through which Covid-19 can affect the nervous system. It is thought that the virus can enter the cells via an angiotensin-converting enzyme 2 receptor, invading the peripheral nerve terminals and spreading to the dorsal root ganglion. Then, it potentially shares epitopes similar to neurons, allowing the activation of a cell-mediated immunity leading to neuronal dysfunction. GBS as a sequela of Covid-19 has not been well reported in literature. The case hereby presented had a temporal relationship between the resolution of Covid-19 and the neurologic symptoms. Its rapid progression affecting the peripheral nerves and the albumin-cytological evidence dissociation on CSF analysis led us to consider Guillain-Barre as a strong differential. The poor clinical response despite aggressive treatments is usually associated with a worse prognosis and significant likelihood of reliance on mechanical ventilation. CONCLUSIONS: By reporting this case, we aim to reiterate the importance of fully understanding the spectrum of Covid-19 related complications, in order to prevent further mortality. REFERENCE #1: Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. REFERENCE #2: Zubair AS, McAlpine LS, Gardin T, et al. Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019: A Review. JAMA Neurol. 2020;77(8):1018–1027. REFERENCE #3: Hughes RA, Cornblath DR. Guillain-Barre syndrome. Lancet. 2005 Nov 5;366(9497):1653-66. DISCLOSURES: No relevant relationships by Christiana Atuaka, source=Web Response No relevant relationships by Nishil Dalsania, source=Web Response No relevant relationships by Claudia De Araujo Duarte, source=Web Response No relevant relationships by Bruno De Brito Gomes, source=Web Response No relevant relationships by Varun tej Gonuguntla, source=Web Response No relevant relationships by Ravikaran Patti, source=Web Response No relevant relationships by Chanaka Seneviratne, source=Web Response No relevant relationships by Navjot Somal, source=Web Response

Guillain Barre Syndrome as a Complication of COVID-19: A Systematic Review

BACKGROUND: In January 2020, the first case of Guillain Barre syndrome (GBS) due to COVID-19 was documented in China. GBS is known to be postinfectious following several types of infections. Although causality can only be proven through large epidemiological studies, we intended to study this association by a thorough review of the literature. METHODS: We searched PubMed, EMBASE, and Google scholar and included all papers with English or Spanish full text and original data of patients with GBS and recent COVID infection. Variables of interest were demographics, diagnostic investigations, and the latency between arboviral and neurological symptoms. Further variables were pooled to identify GBS clinical and electrophysiological variants, used treatments, and outcomes. The certainty of GBS diagnosis was verified using Brighton criteria. RESULTS: We identified a total of 109 GBS cases. Ninety-nine cases had confirmed COVID-19 infection with an average age of 56.07 years. The average latency period between the arboviral symptoms and neurologic manifestations for confirmed COVID-19 cases was 12.2 d. The predominant GBS clinical and electromyography variants were the classical sensorimotor GBS and acute demyelinating polyneuropathy respectively. Forty cases required intensive care, 33 cases required mechanical ventilation, and 6 cases were complicated by death. CONCLUSIONS: Studies on COVID-19-related GBS commonly reported sensorimotor demyelinating GBS with frequent facial palsy. The time between the onset of infectious and neurological symptoms suggests a postinfectious mechanism. Early diagnosis of GBS in COVID-19 patients is important as it might be associated with a severe disease course requiring intensive care and mechanical ventilation.

Patient‐reported symptoms and experience following Guillain‐Barré syndrome and related conditions: Questionnaire development and validation

BackgroundGuillain‐Barré syndrome (GBS) is a rare inflammatory peripheral nerve disorder with variable recovery. Evidence is lacking on experiences of people with GBS and measurement of these experiences.ObjectiveWe aimed to develop and validate an instrument to measure experiences of people with GBS.DesignWe used a cross‐sectional design and online self‐administered questionnaire survey. Question domains, based on a previous systematic review and qualitative study, covered experiences of GBS, symptom severity at each stage, healthcare and factors supporting or hindering recovery. Descriptive, exploratory factor and reliability analyses and multivariable regression analysis were used to investigate the relationships between variables of interest, explore questionnaire reliability and validity and identify factors predicting recovery.Setting and ParticipantsPeople with a previous diagnosis of GBS were recruited through a social media advert.ResultsA total of 291 responders, of different sexes, and marital statuses, were included, with most diagnosed between 2015 and 2019. Factor analysis showed four scales: symptoms, information provided, factors affecting recovery and care received. Positive social interactions, physical activity including physiotherapy and movement, changes made at home and immunoglobulin treatment were important for recovery. Multivariable models showed that immunoglobulin and/or plasma exchange were significant predictors of recovery. Employment and recovery factors (positive interactions, work support and changes at work or home, physical activity and therapy), though associated with recovery, did not reach statistical significance.ConclusionThe questionnaire demonstrated good internal reliability of scales and subscales and construct validity for people following GBS.Patient ContributionPatients were involved in developing and piloting the questionnaire.

Real-world safety data for the Pfizer BNT162b2 SARS-CoV-2 vaccine: historical cohort study

ObjectiveThe Pfizer BNT162b2 vaccine showed a reassuring safety profile in clinical trials, but real-world data are scarce. Bell's palsy, herpes zoster, Guillain–Barré syndrome (GBS) and other neurological complaints in proximity to vaccination have received special public attention. We compared their rates among vaccinated and unvaccinated individuals. MethodsIndividuals ≥16 years vaccinated with at least one dose of BNT162b2 were eligible for this historical cohort study in a health maintenance organization insuring 1.2 million citizens. Each vaccinee was matched to a non-vaccinated control by sex, age, population sector (general Jewish, Arab, ultra-orthodox Jewish) and comorbidities. Diagnosis of Covid-19 before or after vaccination was an exclusion criterion. The outcome was a diagnosis of Bell's palsy, GBS, herpes zoster or symptoms of numbness or tingling, coded in the visit diagnosis field using ICD-9 codes. Diagnoses of Bell's palsy and GBS were verified by individual file review. ResultsOf 406 148 individuals vaccinated during the study period, 394 609 (97.2%) were eligible (11 539 excluded). A total of 233 159 (59.1%) were matched with unvaccinated controls. Mean follow was 43 ± 15.14 days. In vaccinated and unvaccinated individuals there were 23 versus 24 cases of Bell's palsy (RR 0.96, CI 0.54–1.70), one versus zero cases of GBS, 151 versus 141 cases of herpes zoster (RR 1.07, CI 0.85–1.35) and 605 versus 497 cases of numbness or tingling (RR 1.22, CI 1.08–1.37), respectively. DiscussionNo association was found between vaccination, Bell's palsy, herpes zoster or GBS. Symptoms of numbness or tingling were more common among vaccinees. This study adds reassuring data regarding the safety of the BNT162b2 vaccine.

Axonal-Variant Guillian-Barre Syndrome Temporally Associated With mRNA-Based Moderna SARS-CoV-2 Vaccine

We present a case of an 86-year-old woman who presented with a progressive quadriparesis two days after her second dose of Moderna SARS-CoV-2 vaccine, with cerebrospinal fluid (CSF) evidence of cytoalbuminocytological dissociation and electromyogram/nerve conduction studies (EMG/NCS) findings suggestive of acute axonal motor neuropathy. Her clinical symptoms did not improve with plasmapheresis.There appears to be a potential temporal association between the inoculation of mRNA-based SARS-CoV-2 vaccines and the development of Guillain-Barre Syndrome (GBS). Despite this possible association, infection prevention using highly effective mRNA-based vaccines remains highly recommended. Large epidemiological studies of SARS-CoV-2 vaccine-related adverse events are needed. Physicians should be aware of this possible temporal association since the prompt diagnosis and treatment of GBS can drastically improve outcomes.The aim is to report a case of axonal-variant GBS that was temporally associated with an mRNA-based SARS-CoV-2 vaccine.

Guillain Barre Syndrome and Posterior Reversible Encephalopathy Syndrome as Complications of Coronavirus Disease-2019

Guillain-Barre syndrome (GBS) is a rare inflammatory disorder that most commonly occurs as a response to a preceding infection. Although GBS is most commonly associated with Campylobacter jejuni infection, several reports have indicated a relationship between the novel coronavirus disease-2019 (COVID-19) and GBS. Here, we present a case of a 72-year-old female diagnosed with COVID-19 who developed progressive lower and upper extremity weakness one month following her COVID-19 diagnosis. Magnetic resonance imaging (MRI) of the spine confirmed the diagnosis of GBS and her hospital course was further complicated by posterior reversible encephalopathy syndrome (PRES). She responded well to intravenous immunoglobulin (IVIG) and subacute inpatient rehabilitation.

Treatment Options for COVID-19-Related Guillain-Barré Syndrome: A Systematic Review of Literature.

Background:Central nervous system complications are reported in an increasing number of patients with Coronavirus Disease 2019 (COVID-19). COVID-19–related Guillain-Barré syndrome (GBS) is of particular importance given its association with higher mortality rates and prolonged respiratory failure.Review Summary:We conducted a systematic review of published cases for COVID-19–related GBS, and provide a summary of clinical management strategies for these cases. Sixty-three studies, including 86 patients, were included. Seventy-six cases with reported outcome data were eligible for the outcome analysis. Ninety-nine percent of patients were diagnosed with COVID-19 before diagnosis of GBS (median: 14 d prior, interquartile range: 7 to 20). Intravenous immunotherapy (intravenous immunoglobulin: 0.4 g/kg/d for 5 d) was the most frequently used treatment approach. The review indicated that the outcome was not favorable in 26% of cases (persistent neurological deficits). A mortality rate of 3.5% was observed in patients with COVID-19–related GBS.Conclusions:Although evidence to support specific treatments is lacking, clinicians should consider the benefits of immunotherapy and plasma exchange in addition to the standard antimicrobial and supportive therapies for patients who meet the diagnostic criteria for acute sensory and motor polyradiculoneuritis. Intravenous immunoglobulin treatment alone is not shown to result in improved outcomes or mortality. More extensive studies aimed at exploring the neurological manifestations and complications of COVID-19 and distinctive treatment options for COVID-19–related GBS are warranted.

Very early and early neurophysiological abnormalities in Guillain-Barré syndrome: A 4-year retrospective study.

Background and purposeIn its initial stages, Guillain–Barré syndrome (GBS) is difficult to identify, because diagnostic criteria may not always be fulfilled. With this retrospective study, we wanted to identify the most common electrophysiological abnormalities seen on neurophysiological examination of GBS patients and its variants in the early phases.MethodsWe reviewed the clinical records of patients admitted to our Neurology Unit with a confirmed diagnosis of GBS. The study sample was divided in two subgroups according to whether the neurophysiological examination was performed: within 7 days (very early group) or within 7–15 days (early group). H reflex, F waves, and motor and sensory conduction parameters were judged abnormal if they were outside the normal range for at least two nerves. We evaluated neurophysiological findings in Miller–Fisher syndrome (MFS) separately.ResultsThe study sample comprised 36 patients. In GBS, the most frequent abnormal neurophysiological parameter was the bilateral absence of the H reflex, followed by F wave abnormalities. Motor conduction parameters were altered in less than 50% of patients, and even less common were sensory nerve action potential reduction and the "sural‐sparing" pattern. In MFS, H reflex was absent bilaterally in 100% of patients, followed by a predominant peripheral sensory involvement, whereas motor conduction parameters were frequently normal.ConclusionsBilateral absence of the H reflex is the most sensitive parameter in early diagnosis of GBS and its variants.

P-PN018. The co-occurrence of myasthenia gravis and Guillain-Barré Syndrome: A case report

Introduction . Myasthenia gravis (MG) is an autoimmune disease of neuromuscular junction with a prevalence of approximately 20 per 100,000 in the US and between 15 and 179 per million worldwide. Guillain-Barre Syndrome (GBS) is an autoimmune-related disease leading to generalized paralysis, characterized by acute severe ascending weakness. The co- occurrence of myasthenia gravis (MG) is uncommon with a few reported cases in the literature. Case report: A 34-year-old male with history of bilateral ophthalmoplegia, bilateral ptosis, areflexia and lower motor neuron tetraparesis. The symptoms seemed to be fluctuating in the early phase and progressive within 3 weeks. Patient was diagnosed with myasthenia gravis. The Acetylcholine Receptor Antibody (AChR) was positive. The Pyridostigmine therapy was administered but did not improve the symptoms fully. The repetitive nerve stimulation was positive and nerve conduction study showed axonal degeneration. Cerebrospinal fluid (CSF) analysis showed cytoalbuminergic dissociation. The patient was diagnosed with GBS Miller Fisher variant. The clinical symptoms improved after being administered with intravenous immunoglobulin (IVIg) therapy. A month later, the patient readmitted with worsening symptoms that was triggered by respiratory tract infection. These symptoms improved after administration of pyridostigmine, intravenous corticosteroid, and intravenous antibiotic. Results . This patient admitted to our hospital with symptoms fit with relapsing myasthenia gravis, and the course of the disease was also fit with Miller Fisher variant of Guillain Barre Syndrome. In this case, the MG diagnosis was confirmed with the presence of AChR antibody and positive repetitive nerve stimulation test. While, GBS diagnosis was supported by the CSF analysis profile, and nerve conduction study results. Conclusion . Although extremely rare, MG and GBS may present in the same patient with various characteristics. This case is unique and rarely occur, additional research needs to be conducted to understand the mechanism.

P-PN035. TH17 pathway-related cytokine abnormalities in the plasma and cerebrospinal fluid in Guillain Barré Syndrome (GBS): A correlation analysis

Introduction . Guillain Barré Syndrome (GBS) is a monophasic immune-mediated disease of the peripheral nervous system, often triggered by antecedent gastrointestinal or respiratory infection. Compelling evidence suggests inflammatory cytokines as the critical drivers of the onset and progression in GBS. Elevated levels of pro-inflammatory cytokines were reported both in the plasma and cerebrospinal fluid (CSF) of patients with GBS. However, whether there exists a correlation between the levels of proinflammatory cytokines in plasma and CSF is inadequately explored. Methods . In this study, we recruited 37 (21 male and 16 female) patients with GBS from the emergency services of the National Institute of Mental Health and Neurosciences, Bangalore, India. Mean age of the patients was 36.65 ± 12.2 years. We analysed the levels of four Th17- pathway related cytokines, IL-6, IL-17A, IL-22 and IL-23, in both the plasma and CSF of patients with GBS by Multiplex Suspension Assay. The levels of these cytokines were correlated between plasma and CSF and also with various clinical features and electrophysiological subtypes. Results . Spearman’s correlation analysis suggests that there was no correlation in the levels of the Th17-pathway related cytokines, IL-6 (p = 0.11), IL-17A (p = 0.85), IL-22 (p = 0.45) and IL-23 (p = 0.76) between plasma and CSF in patients of GBS. Conclusion . Elevated levels of Th17 pathway related cytokines were observed both in the plasma and CSF in our earlier studies. Immune molecules in the CSF play pathogenic roles in various nervous system disorders. CSF analysis also plays important role in establishing the diagnosis of GBS. Though Th17 pathway-related cytokines are upregulated in both the plasma and CSF, however, they do not show any correlation. This may suggest that immune molecules in plasma and CSF may drive pathogenetic processes in GBS independently.

English

COVID-19 from Wuhan, China has spread easily all over the world. Most of the COVID-19 infected patients have fever and breathing disorders. Here, we report a case of Guillain-Barre syndrome (GBS) with a COVID-19 infection. GBS is a very rare disease with corona virus infection. It is really hard to diagnose. In this state the limbs of the patient are slowly weakened. The condition worsens daily with weakness of the limbs. The Guillain-Barre syndrome is a complex and acute or chronic neurological condition. Campylobacter jejuni and other viruses, including cytomegalovirus and Epstein Barr Virus, are causing this condition.1 It is a disorder that is progressive, symmetric, proximate, distal, and characterised by weakness. Muscle reflexes are reduced to absent. Aetiology is unclear, Death is uncommon. The diagnosis of GBS can be made by cerebrospinal fluid analysis and nerve conduction studies.2 We present a case of Guillain-Barre syndrome with COVID-19 infection, who presented to the emergency Outpatient department with complaints of weakness against his bilateral upper and lower limb.

Disease and Patient Characteristics Contributing to Diagnostic Delays in Patients With Guillain-Barré Syndrome.

Introduction: Diagnosis of Guillain Barre syndrome (GBS) is often made clinically. Certain patient and disease characteristics can cause delays in diagnosis and management.Methods: Observational retrospective study of forty-four patients diagnosed with GBS either clinically, cerebrospinal fluid analysis, and/or by electro-diagnostic criteria at a teaching hospital (University of Missouri Hospital) in Columbia, Mid-Missouri between 2011 and 2017.Results: Patients with coexisting neurological conditions had statistically significant delay in diagnosis of GBS [Mean (SD); 13 ± 5 vs. 9.39 ± 4.7; p = 0.03]. Patients presenting with motor + symptoms (sensory and/or autonomic, in addition to motor), compared to those with only motor symptoms had statistically significant delay in diagnosis of GBS [Mean (SD); 11.90 ± 5 vs. 8.58 ± 4; p = 0.04].Discussion: Presence of co-existing neurological conditions, and motor + symptoms can delay timely diagnosis and management of GBS.

Papillomavirus vaccination and Guillain-Barre Syndrome among girls: A cohort study in Spain

BackgroundStudies of the association of Guillain-Barré Syndrome (GBS) with papillomavirus vaccination (HPVv; scheduled from 2007) have provided contradicting results, probably due to the low frequency of this disease. We aimed at estimating that risk relative to non-vaccination among girls, by using the Spanish Primary Care Database for Pharmacoepidemiological Research (BIFAP). MethodsA cohort study of girls aged 9–18 years during 2007–2016 free of GBS or HPVv was selected and followed up to GBS diagnosis. Follow-up time was divided by time-varying HPVv exposure and confounders. Crude Incidence rates (IR per 1,000,000 person-years (py)) and adjusted Hazard Ratios (HR) of GBS were estimated anytime after vaccination compared to non-exposed periods. HRs were also estimated for the first 90 days after HPVv (risk-window) and thereafter. ResultsOut of 388,849 girls, of which 154,255 were vaccinated, 6 'confirmed' GBS cases occurred during non-exposure periods (IR of 5.83 per million person-years; 95% CI: 2.62–12.97) and 3 ‘confirmed’ cases anytime after vaccination (IR of 7.87; 95% CI: 2.54–24.39). The resulting adjusted HR anytime after vaccination was 1.24 (95% CI: 0.19–8.00). All three cases occurred after the risk window of 90 days with an HR of 1.77 (95% CI: 0.25–12.54) for post-exposure periods as compared with non-exposure. Since zero cases occurred during the risk window, no HR could be estimated for exposed periods. ConclusionsIncidences of GBS were in line with the range previously reported for young people, supporting the potential of BIFAP for performing studies on GBS. However, a lack of power may be present for quantifying the relative risk of such a rare disease after the vaccination among the study cohort, where we can only exclude an increased risk of 8-times relative to no vaccination.

Characterization of adult patients with Guillain–Barré syndrome during the arboviral infection outbreaks in Honduras

Arbovirus infections have been associated with a wide spectrum of neurological manifestations. Among these, Guillain-Barré syndrome (GBS) is one of the most common. This study describes the characteristics of GBS associated with arbovirus infections during the outbreak which occurred in Honduras from January 2016 to February 2019. This was an observational retrospective study of adult patients who were diagnosed with GBS during that time. The diagnosis of GBS was based upon the criteria first published by Asbury, et al. and subsequently revised as the Brighton Criteria. A total of 91 patients with GBS constituted the study population. RT-PCR tests for ZIKV, CHIKV, and DENV arboviruses were performed in 47 (52%) of the patients. Of the tested population, 8/47 were positive for one of the arboviruses (5/8 for ZIKV, 3/8 for CHIKV; 0/8 for DENV). The clinical profile of the eight cases with GBS and arboviral infection did not differ significantly from the GBS patients who tested negative for ZIKV and CHIKV. In the cases with GBS and ZIKV, a parainfectious onset of the disease was suggested. Although not a strikingly large number of patients with GBS and arbovirus infection were seen, the close temporal relationship in these eight cases suggests an arbovirus (ZIKV and CHIKV) etiology.

Guillain-Barre Syndrome in a Case of Typhoid Fever: an Uncommon Association

Guillain-Barre syndrome (GBS) following typhoid is extremely uncommon and only few case reports are available in literature. The importance of this case report is to highlight upon the fact that a diagnosis of GBS should always be kept in mind whenever a patient of typhoid fever develops weakness. We report a young girl with blood culture proven typhoid fever that developed this very rare neurological complication quite early in the course of the disease. Following treatment with intravenous antibiotics and intravenous immunoglobulin, she was improved.
 Bangladesh J Medicine July 2021; 32(2) : 142-144

The epidemiology of Guillain-Barré syndrome in Thailand over 13 years (2005-2017): A nationwide population-based retrospective cohort study.

There have been no published studies examining the epidemiology of Guillain-Barré syndrome (GBS) in large populations in Thailand. This study aimed to explore the incidence, patient characteristics, seasonality, treatments, and outcomes of GBS in Thailand. The National Health Security Office (NHSO) provided data on in-patient admission between fiscal year 2005 and 2017. We selected all patients with a primary diagnosis of GBS. We retrieved data regarding the total population from the Department of Provincial Administration. A total of 4521 patients with GBS were included. The median age was 42 years (IQR 22-56), and 61.5% were male. The incidence rate increased from 0.48 to 0.93 per 100 000 population over the 13 years. The incidence was increased with age and a male-to-female ratio of 1.6:1. There was seasonal variation in the rate of admission for GBS, with significantly more patients admitted in rainy vs summer (IRR 1.94, 95%CI 1.80-2.10, P < .001) and winter vs summer (IRR 1.48, 95%CI 1.36-1.60, P < .001). Treatment with IVIg increased from 4.4% to 29.6% (P < .001), whereas plasmapheresis decreased significantly from 4% to 1.32% (P=.017). The mortality rate was 3.5%. Elderly and young adults had a significantly higher mortality rate when compared to children and teenagers (P < .001 and P=.003). The incidence of GBS in Thailand was steady over 13 years and was greater in rainy and winter season. Treatment with IVIg increased while plasmapheresis decreased. Mortality was higher in elderly patients.