GBS Cases Research Articles

Estimated incubation period for mosquito-borne disease-related Guillain-Barre syndrome

PurposeGuillain-Barre syndrome (GBS) is a rare post-infectious peripheral polyneuropathy. Following the Zika virus epidemic in 2016, the WHO called for understanding Zika associated GBS through epidemiological studies. However, the incubation period of GBS remains little known and its characterisation is needed. MethodsArticles reporting the data of lag time between the symptom onset of Chikungunya or Zika and GBS were included for pooled analysis. Maximum likelihood estimation was adopted to estimate the incubation period distribution of GBS conditioned to that of the antecedent infection. ResultsA total of 89 Chikungunya- and Zika-related GBS cases from 23 articles were identified. The incubation period distribution of GBS is lognormal distributed with the median of 13–14 days and does not depend on the antecedent infection. ConclusionsThe incubation period of GBS follows Sartwell's model. It should be useful in confirming the association between infection and GBS in epidemiologic studies as well as to assist diagnosis and prognosis such as clinically assessing respiratory failure. It is also found that viral symptoms can occur prior to neurological symptoms, suggesting that GBS may be a parainfectious disease.

Guillain-Barré Syndrome Associated With Zika Virus Infection: A Prospective Case Series From Mexico.

Background: On May 2016, anticipating the rainy season from June to October in Mexico, we expected an increase in cases of Zika virus (ZIKV) infections. With the goal of identifying cases of GBS associated with ZIKV infection, a prospective joint study was conducted by a reference center for neurological patients and the Secretary of Health in Mexico City from July 2016 to November 2016.Methods: Serum, cerebrospinal fluid, urine, and saliva were tested by RT-PCR for ZIKV, dengue virus, and chikungunya virus in patients referred from states with reported transmissions of ZIKV infection, and with clinical symptoms of GBS according to the Brighton Collaboration criteria. Clinical, electrophysiological, and long-term disability data were collected.Results: In the year 2016 twenty-eight patients with GBS were diagnosed at our institute. In five hospitalized patients with GBS, RT-PCR was positive to ZIKV in any collected specimen. Dengue and chikungunya RT-PCR results were negative. All five patients had areflexic flaccid weakness, and cranial nerves affected in three. Electrophysiological patterns were demyelinating in two patients and axonal in three. Three patients were discharged improved in 10 days or less, and two patients required intensive care unit admission, and completely recovered during follow-up.Conclusion: Our results are similar to those reported from the state of Veracruz, Mexico, in which out of 33 samples of urine of patients with GBS two had a positive RT-PCR for ZIKV. Simultaneous processing of serum, CSF, urine, and saliva by RT-PCR may increase the success of diagnosis of GBS associated to ZIKV.

Prevalence and outcomes of Guillain-Barré syndrome among pediatrics in Saudi Arabia: a 10-year retrospective study.

BackgroundGuillain-Barré syndrome (GBS) is a progressive acute form of paralysis most probably secondary to an immune-mediated process. GBS among Saudis has been seldom investigated, which leaves both clinicians and researchers with scarcity in knowledge. Therefore, this study aims to assess the prevalence and clinical prognosis of GBS among pediatrics admitted with acute paralysis at a large healthcare facility in Riyadh, Saudi Arabia.MethodsThis retrospective study reviewed patients’ medical records between 2005 and 2015. Eligible cases were children (<14 years old) admitted to the hospital complaining of acute paralysis and later diagnosed with one form or variant of GBS. Pearson’s chi-square, Fisher’s exact test, and binary logistic regression were employed to analyze the collected data.ResultsThe prevalence of GBS was 49%. The male-to-female ratio was 1.45:1. The mean ± standard deviation age was 7±3.7 years. There were 34 (69.4%) cases with progression to maximum paralysis in ≤2 weeks, while 15 (30.6%) cases occurred beyond 2 weeks. Males (n=24, 82.8%) were more likely to endure progression to maximum paralysis in ≤2 weeks after the disease onset, compared to females (n=10, 50%), P=0.014. All cases complaining of respiratory problems exhibited a progression to maximum paralysis in ≤2 weeks, compared to those with no respiratory problems, P=0.027. Residual paralysis at 60 days post disease onset was highly associated with GBS patients of age 8–14 years (n=15, 65.2%), compared to younger patients (n=8, 30.8%), P=0.016. Patients admitted in colder seasons (n=14, 63.6%) were more likely to suffer residual paralysis too, compared to those in warmer seasons (n=9, 33.3%), P=0.035. GBS cases who complained of facial weakness (n=9, 75%) and ocular abnormalities (n=10, 71.4%) were also more likely to endure residual paralysis at 60 days post disease onset, P=0.025 and P=0.03, respectively.ConclusionMale gender could be a determinant of rapid progression to maximum paralysis, while the older age group in pediatrics is expected to endure residual paralysis at 60 days post disease onset. GBS can be accounted as a rare disease, especially in pediatrics, so confirmed cases should be investigated comprehensively for research purposes.

Estimation of the Incidence of Guillain-Barré Syndrome During Pregnancy in the United States.

Guillain-Barré syndrome (GBS) is an adverse event of interest after vaccination, yet few data are available for background rates during pregnancy. We confirmed 2 cases of incident GBS and estimated an incidence of 2.8 confirmed GBS cases per million person-years (95% confidence interval, 0.5-9.3), indicating rare occurrence. Our findings will help inform safety assessments of Zika vaccines in pregnant populations.

GUILLIAN BARRE SYNDROME;

Objectives: To determine the frequency of various clinical features of Guillian Barre Syndrome in patients presenting to a tertiary care hospital in Karachi. Study Design: Descriptive study. Period: July 2015 to December 2015. Setting: Tertiary care hospitals of Karachi. Material &amp; Methods: Seventy five diagnosed case of GBS who fulfill the inclusion criteria irrespective of gender included in the study after informed consent. Data was collected on preformed proforma. Detailed history, physical examination was done on each patient, diagnosis was confirmed on NCV &amp; EMGs. Data analysis procedure was done with the help of SPSS version 16. Mean±SD was calculated for age of the patient and duration of clinical features. Frequency and percentages were calculated for different clinical features. Stratification was done with respect to age, gender and duration of clinical features to control effect modifiers in the study. Results: Mean age was 43.96±14.22 (ranging from 15 to 70) years, among 75 patients 51(68%) were male &amp; 24(32%) were female, majority of patients (34) were &gt;50 years of age, 45.3% of patients had pain in extremities; pain in back was reported by 49.3%. Dysphagia in 80%, Ophthalmoplegia in 20% and Dysarthria in 16% of patients Respiratory failure was prevalent in 34.7% patients. Sinus tachycardia occurred in 49.3%, Sinus bradycardia 14.7% patients and 20% patients had urinary dysfunction. Constipation was also a predominant feature affecting 80% of patients. Conclusion: We found that GBS occurred at all ages and was more common in males. There are various clinical features of GBS along with flaccid limbs weakness clinical features observed &amp; these should be address promptly for better outcome.

The burden of infant group B streptococcal infections in Ontario: Analysis of administrative data to estimate the potential benefits of new vaccines

ABSTRACTGroup B streptococcus (GBS) is a leading bacterial cause of neonatal sepsis and meningitis in many countries as well as an important cause of disease in pregnant women. Currently, serotype-specific conjugate vaccines are being developed.We conducted an epidemiological analysis of health administrative data to estimate the burden of infant GBS disease in Ontario, Canada and combined these estimates with literature on serotype distribution to estimate the burden of disease likely to be vaccine-preventable.Between 1st January 2005 and 31st December 2015, 907 of 64320 health care encounters in Ontario in patients under 1 year old had codes specifically identifying GBS as the cause of the disease, of which 717 were under one month of age. In addition, application of epidemiological data to the remaining patients allowed us to estimate a further 2322 cases and among them 1822 were under one month of age. In the same period, 579 confirmed neonatal invasive GBS cases in patients up to one month of age were reported to public health. Depending on serotype distribution, vaccination coverage and early versus late onset disease (0–6 days and 7–90 days of age respectively), the preventable fraction ranged widely. With a vaccine that is 90% effective and 60% immunization coverage, up to 52% of early and late onset disease could be prevented by forthcoming vaccines.GBS is under-reported in Ontario. Uncertainty about the potential impact of vaccine indicates that further analysis and research may be needed to prepare for policy-decision making, including clinical validation studies and an economic evaluation of GBS vaccination in Ontario.

Modification of Glasgow-Blatchford scoring with lactate in predicting the mortality of patients with upper gastrointestinal bleeding in emergency department

Background: Gastrointestinal bleeding is a commonly seen multidisciplinary clinical condition in emergency departments which has high treatment cost and mortality in company with hospital admission. Risk evaluation before endoscopy is based on clinical and laboratory findings at patient’s emergency visit. Objective: The purpose of this study is to investigate the efficacy of “Glasgow-Blatchford scale + lactate levels” to predict the mortality of patients detected with gastrointestinal bleeding in the emergency department. Methods: A total of 107 patients with preliminary diagnosis of upper gastrointestinal bleeding included in the study after approval of the ethics committee were prospectively evaluated. Glasgow-Blatchford scale scores were calculated and venous blood lactate levels were assessed. Need for blood transfusion in the follow-up, the amount of transfusion, and mortality in the next 6 months were evaluated. Results: A statistically significant difference was found in mortality rates between the lactate and Glasgow-Blatchford scale cohorts in our study (p = 0.001 and p &lt; 0.01, respectively). The mortality rate was significantly higher in the lactate(+) GBS(+) cases compared to the lactate(–) GBS(+), lactate(+) GBS(–), and lactate(–) GBS(–) cases compared to the bilateral comparisons (p = 0.004, p = 0.001, p = 0.001, and p &lt; 0.01, respectively). There was a statistically significant relationship between the rate of erythrocyte suspension replacement in the cases according to Glasgow-Blatchford scale levels (p = 0.001 and p &lt; 0.01, respectively). The incidence of erythrocyte suspension replacement was 7.393 times greater in patients with Glasgow-Blatchford scale score of 12 and above. Conclusion: Glasgow-Blatchford scale is highly sensitive to the determination of mortality risk and the need for blood transfusion in upper gastrointestinal bleeding. Glasgow-Blatchford scale with lactate evaluation is more sensitive and more significant than Glasgow-Blatchford scale alone. This significance provides us to establish “modified Glasgow-Blatchford scale.” In the future, studies which will use Glasgow-Blatchford scale supported by lactate could be increased and the results should be supported more.

Abstract P-533: PAROXYSMAL SYMPATHETIC HYPERACTIVITY IN CHILDREN REQUIRING NEUROLOGICAL CRITICAL CARE.

Aims & Objectives: To estimate the frequency of Paroxysmal Sympathetic Hyperactivity in critically ill children requiring neurological critical care and to study risk factors for development of Paroxysmal Sympathetic Hyperactivity. Methods This prospective observational study was conducted in the PICU from April to December 2016. All children (1 month - 12 years) admitted in PICU for neurological critical care were assessed for symptoms of PSH defined by episodes of at least 4 of 8 features i.e. tachycardia, hypertension tachypnea, reduced level of consciousness, muscle rigidity, hyperthermia, diaphoresis and pupillary dilation. Association of PSH with age, Glasgow Coma Scale and PRISM III score at admission and influence of PSH on mortality, duration of ventilation and PICU stay was studied. Results Out of 54 neurocritical patients admitted, 5 (9.2%) had PSH as defined by above criteria. 30(55.5%) patients showed <4 features of PSH (12 had 3 features, 11 had 2 and 7 had only one feature). Out of 5 patients of PSH, 4 had meningoencephalitis (2-viral, 1-tubercular, 1-bacterial) while one was a case of GBS. Features of PSH were present for an average of 26 days with mean of 6.9 episodes per day. Patients with PSH required longer duration of mechanical ventilation and hospital stay. Admission PRISM scores were higher in patients with PSH. Age, sex, GCS at admission and requirement of mechanical ventilation and mortality were not found to be different in patients with or without PSH. Conclusions 9.2%(5/54) patients requiring neurological critical care had PSH and they needed longer duration of ventilation as well as hospital stay.

Outbreak of Guillain-Barré syndrome possibly related to prior Zika virus infection, Metropolitan Region of Recife, Pernambuco, Brazil, 2015.

to investigate the occurrence of GBS in the Metropolitan Region of Recife, PE, Brazil, 2015. this was a descriptive study using data from the Hospital Information System, National Pharmaceutical Services Management System and interviews; GBS cases were classified according to Brighton criteria and prior infection according to laboratory and clinical criteria. in 2015, the number of GBS hospitalizations had a threefold increase in comparison to 2014. We investigated 44 confirmed or probable GBS cases, of which 18 had symptoms of Zika infection up to 35 days before the occurrence of GBS, mainly rash; one case was laboratory-confirmed for Zika virus infection and one death was registered. the findings reinforce a possible relationship between GBS and Zika infection, given the absence of increased GBS occurrence in previous dengue epidemic years, absence of chikungunya transmission records, presence of clinical manifestations compatible with infection and a laboratory confirmation.

Guillain\u2013Barr\xe9 syndrome risk among individuals infected with Zika virus: a multi-country assessment

BackgroundCountries with ongoing outbreaks of Zika virus have observed a notable rise in reported cases of Guillain–Barré syndrome (GBS), with mounting evidence of a causal link between Zika virus infection and the neurological syndrome. However, the risk of GBS following a Zika virus infection is not well characterized. In this work, we used data from 11 locations with publicly available data to estimate the risk of GBS following an infection with Zika virus, as well as the location-specific incidence of infection and the number of suspect GBS cases reported per infection.MethodsWe built a mathematical inference framework utilizing data from 11 locations that had reported suspect Zika and GBS cases, two with completed outbreaks prior to 2015 (French Polynesia and Yap) and nine others in the Americas covering partial outbreaks and where transmission was ongoing as of early 2017.ResultsWe estimated that 2.0 (95% credible interval 0.5–4.5) reported GBS cases may occur per 10,000 Zika virus infections. The frequency of reported suspect Zika cases varied substantially and was highly uncertain, with a mean of 0.11 (95% credible interval 0.01–0.24) suspect cases reported per infection.ConclusionsThese estimates can help efforts to prepare for the GBS cases that may occur during Zika epidemics and highlight the need to better understand the relationship between infection and the reported incidence of clinical disease.

Epidemiology of invasive group B streptococcal disease in infants from urban area of South China, 2011\u20132014

BackgroundGroup B Streptococcus (GBS) is a leading cause of morbidity and mortality in infants in both developed and developing countries. To our knowledge, only a few studies have been reported the clinical features, treatment and outcomes of the GBS disease in China. The severity of neonatal GBS disease in China remains unclear. Population-based surveillance in China is therefore required.MethodsWe retrospectively collected data of <3 months old infants with culture-positive GBS in sterile samples from three large urban tertiary hospitals in South China from Jan 2011 to Dec 2014. The GBS isolates and their antibiotic susceptibility were routinely identified in clinical laboratories in participating hospitals. Serotyping and multi-locus sequence typing (MLST) were also conducted for further analysis of the neonatal GBS disease.ResultsTotal 70 cases of culture-confirmed invasive GBS infection were identified from 127,206 live births born in studying hospitals, giving an overall incidence of 0.55 per 1000 live births (95% confidence interval [CI] 0.44–0.69). They consisted of 49 with early-onset disease (EOD, 0.39 per 1000 live births (95% CI 0.29–0.51)) and 21 with late-onset disease (LOD, 0.17 per 1000 live births (95% CI 0.11–0.25)). The incidence of EOD increased significantly over the studying period. Five infants (4 EOD and 1 LOD) died before discharge giving a mortality rate of 7.1% and five infants (7.1%, 2 EOD and 3 LOD) had neurological sequelae. Within 68 GBS isolates from GBS cases who born in the studying hospitals or elsewhere, serotype III accounted for 77.9%, followed by Ib (14.7%), V (4.4%), and Ia (2.9%). MLST analysis revealed the presence of 13 different sequence types among the 68 GBS isolates and ST-17 was the most frequent sequence type (63.2%). All isolates were susceptible to penicillin, ceftriaxone, vancomycin and linezolid, while 57.4% and 51.5% were resistant to erythromycin and clindamycin, respectively.ConclusionsThis study gains the insight into the spectrum of GBS infection in south China which will facilitate the development of the guidance for reasonable antibiotics usage and will provide evidence for the implementation of potential GBS vaccines in the future.

Guillain–Barré syndrome initially manifesting as motor weakness, urinary dysfunction and hyperreflexia: Case report and literature review

AbstractBackgroundGuillain–Barré syndrome (GBS) is an acute inflammatory neuropathy characterized by areflexic quadriparesis. Urinary dysfunction has been known to occur in approximately 25% of GBS patients during the clinical course and usually emerges during peak motor weakness. According to the diagnostic criteria for GBS, bladder dysfunction at onset makes the diagnosis of GBS rather doubtful. We report here a rare case of GBS that initially manifested as motor weakness with urinary dysfunction and hyperreflexia.Case presentationA 66‐year‐old Japanese man experienced mild weakness in his hands that extended to the entire upper extremities the following day. At the same time, he started experiencing difficulty voiding. On the fourth day after the onset of weakness, he was admitted to Saitama Medical Center, Kawagoe, Japan, because of an inability to stand up without support. Neurological examination revealed moderate generalized weakness, hyperreflexia, and poor urinary volume and flow. Early in hospitalization, his deep tendon reflexes gradually decreased and ultimately he became areflexic. A nerve conduction study indicated the axonal form of GBS. He was treated with immunoadsorption plasmapheresis, followed by two sessions of intravenous immunoglobulin G treatment. The motor weakness and urinary dysfunction gradually ameliorated, and he was discharged and transferred for rehabilitation on hospital day 47.ConclusionsThe present case suggests that urinary dysfunction in GBS might not necessarily occur during peak motor weakness, but could start at onset. Physicians should consider GBS in differential diagnosis of patients presenting with initial symptoms of motor weakness and urinary dysfunction.

A case of a recurrent GBS

Background: Guillain-Barré syndrome is an acquired polyradiculo-neuropathy, often preceded by an antecedent event. It is a monophasic disease but a recurrence rate of 1–6 % is documented in a subset group of patients.Case presentation: Thirty-five-years-old female with past history of near complete recovery following Guillain-Barré syndrome 17 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AMAN variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 1 weeks during recurrent episode revealed albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery.Conclusion: Recurrence of Guillain-Barré syndrome can occur in a subset of patients with Guillain-Barré syndrome even after many years of asymptomatic period. Most patients with recurrent GBS respond favourably to treatment with plasmapheresis or IVIG.Bangladesh Crit Care J September 2017; 5(2): 135-138

Zika Virus Epidemic in the Dominican Republic, 2016

BackgroundThe first cases of Zika (ZIKV) in the Americas were reported in Easter Island, Chile in 2014. The epidemic spread to Brazil and Central America in 2015. We describe the extent and distribution of the countrywide ZIKV epidemic in the Dominican Republic.MethodsThe DR Ministry of Health (MoH) instituted active surveillance, monitoring and mandatory reporting of suspected cases of ZIKV in 2015 through the National System of Epidemiologic Surveillance (SINAVE). In the pre-epidemic period, the MoH conducted active search and blood testing of suspected cases in communities rumored to have cases of the disease. During the epidemic, the MoH conducted weekly monitoring of all cases of febrile exanthems, flaccid paralysis and meningitis, and also conducted rapid surveys in highly populated areas to identify local outbreaks. Data from SINAVE was exported and analyzed using SAS.ResultsA total of 5226 cases ZIKV were reported to the MoH from January 2016 to December 2016 (figure). Cases were 74% female, of whom 1275 (33%) were pregnant. Most of the cases (51%) were diagnosed in the age group of 20 to 39, and did not differ by gender. The majority (58%) of cases were reported from a metropolitan area. Almost all cases (82%) were treated in the outpatient setting, while 17% were hospitalized. Only 3 patients died and 95% had an uncomplicated course. There were 285 cases of Guillain BarrŽ Syndrome (GBS; Figure), with the epidemic curve showing a peak 2–4 weeks following the peak of the epidemic. Compared with patients with suspected ZIKV (n = 1054), those with GBS were more likely to be male (47% vs. 19%, P < 0.001), aged ≥40 years (53% vs. 19%, P < 0.001),, more likely to have complications (18% vs. 6%, P < 0.001) and comorbidity (2% vs. 0.2%, P = 0.04) Seventeen (6%) of confirmed GBS cases resulted in death.FigureCases of Zika and GBS, Dominican Republic, 2016ConclusionThe DR reported one of the largest ZIKV outbreaks in the Americas. The epidemic started early in 2016 and had all but subsided by May 2017. Although most cases had an uncomplicated course, incidence of GBS was high.Disclosures All authors: No reported disclosures.

A rare case of fulminant GBS mimicking brain death with clinical recovery

A 28-year-old male patient admitted with an acute onset areflexic quadriparesis requiring mechanical ventilation within 24 h of admission. The clinical findings of absent motor response and loss of brainstem reflexes mimicked a “brain death” pattern. MRI brain and spine were normal. Nerve conduction studies were suggestive of early acute inflammatory demyelinating polyneuropathy and cerebrospinal fluid (CSF) showed albumino-cytological dissociation. Electroencephalographic (EEG) showed 5–6 Hz generalized slowing. He was treated with 2 cycles of intravenous immunoglobulins (0.4 gm/kg) for 5 days starting on day 1 and 19. Extensive work up was done to rule out other causes of acute flaccid areflexic quadriparesis with multiple cranial nerve involvement. Five sessions of plasma exchange (50 mL/kg) were carried out between day 45 to 55. He showed gradual recovery after being in “locked in” state for almost 55 days. At 9 months post on-set the patient has regained bulbar function and has MRC grade 3/5 power in all four limbs. Other published cases with a similar admission pattern were reviewed. The prognosis is usually very poor as most of the patients died or remained severely disabled.

Prenatal Tdap immunization and risk of maternal and newborn adverse events.

Many countries recommend combined tetanus toxoid, reduced diphtheria toxoid and acellular pertussis immunization (Tdap) during pregnancy to stimulate transplacental transmission of pertussis antibodies to newborns. The immune system can be altered during pregnancy, potentially resulting in differing immunization risks in pregnant women. The safety of widespread Tdap immunization during pregnancy needs to be established. Our objective was to assess whether prenatal Tdap immunization was associated with adverse birth outcomes, and to evaluate the effect of timing of Tdap administration on these outcomes. We identified pregnancies at delivery in a large insurance claims database (2010-2014). Tdap immunization was categorized as optimal prenatal (27+weeks), early prenatal (<27weeks), postpartum (≤7days post-delivery), or none. Medical claims were searched to identify maternal adverse immunization reactions (e.g. anaphylaxis, fever, Guillian-Barre syndrome [GBS]), adverse birth outcomes (e.g. preeclampsia/eclampsia, premature rupture or membranes, chorioamnionitis) and newborn outcomes (e.g. respiratory distress, pulmonary hypertension, neonatal jaundice). Women with optimal or early prenatal Tdap were compared to those not immunized in pregnancy, using propensity score-weighted log-binomial regression and Cox proportional hazards models to estimate risk ratios (RR) and hazard ratios (HR). We identified 1,079,034 deliveries and 677,075 linked newborns; 11.5% were immunized optimally and 2.3% immunized early. There were 1 case of post-immunization anaphylaxis, and 12 cases of maternal encephalopathy (all post- delivery); there were no cases of GBS. Optimally-timed immunization was associated with small increased relative risks of: chorioamnionitis [RR=1.11, (95% CI: 1.07-1.15), overall risk=2.8%], and postpartum hemorrhage [RR=1.23 (95% DI: 1.18-1.28), overall risk=2.4%]; however, these relative increases corresponded to low absolute risk increases. Tdap was not associated with increased risk of any adverse newborn outcome. Overall, prenatal Tdap immunization was not associated with newborn adverse events, but potential associations with chorioamnionitis consistent with one previous study and postpartum hemorrhage require further investigation.

Disease burden and antimicrobial resistance of invasive group B streptococcus among infants in China: a protocol for a national prospective observational study

BackgroundGroup B Streptococcus (GBS) is a cause of neonatal sepsis, pneumonia, and meningitis that can lead to neurological sequelae in infants less than 3 months of age. The GBS disease burden is not known in China, therefore it cannot receive major attention. The main objectives of this study are the evaluation of the incidence of neonatal GBS infection, GBS case-fatality ratio, its serotypes and genotypes, bacterial resistance, clinical treatment and outcomes in China.MethodsWe are conducting a nation-wide, population-based, multi-center, prospective, observational cohort study in China from May 2016 to December 2017. Eighteen large urban tertiary care hospitals from 16 provinces were selected that cover the eastern, southern, western, northern and central regions of China. Meanwhile, we retrospectively collected data and GBS strains from January 2015 to April 2016 from selected hospitals. The incidence rate per 1000 live births will be defined as the total number of confirmed GBS cases born in the selected hospitals divided by the number of live births in the hospitals during the study period. All GBS cases detected in selected hospitals will be used to calculate the case-fatality ratio and for the typing analysis. GBS isolates will be serotyped using the Strep-B-Latex® rapid latex agglutination test for serotyping of Group B streptococci. Multi-locus sequence typing (MLST) will be performed by sequencing the internal fragments of seven house-keeping genes. Antimicrobial susceptibility will be tested per interpretive standards established by the Clinical and Laboratory Standards Institute. The presence of the common resistance genes ermA, ermB, mefA, tetI, tetO and tetM will be tested by PCR.DiscussionWe are conducting the first national study to estimate the invasive GBS disease burden and antimicrobial resistance of GBS among infants in China. Study findings will provide important evidence for improving clinical practice to ensure timely diagnosis of GBS disease and decisions for preventive measures. Surveillance of antimicrobial resistance will promote the rational use of antimicrobials.Trial registrationThe study was retrospectively registered at http://clinicaltrials.gov on June 13, 2016. It was granted a registration number of “NCT02812576”.

Guillain-Barre Syndrome: A Case Report

Guillain-Barre syndrome is an autoimmune disorder which is caused by the body's immune system resulting in the damaging of peripheral nervous system. However immune system starts to destroy the myelin sheath (which surrounds the axon of many peripheral nerve), and will not able to transmit the signal effectively after getting damaged that may result in painful sensation leading to muscle weakness. GBS can also probably be an outcome of viral ( Cytomegalovirus ) or bacterial infection ( Campylobacter jejuni ). The virus and bacteria are likely to change the nature of the nervous system in such a way that the immune system cannot recognize the cells as its own and can allow some immune cells (lymphocytes and macrophages) to attack myelin and leading to destruction of the myelin sheath. Here a case of GBS in 50 year old women with past medical history of paresthesia was reported .According to medical literature the incidence of GBS is very rare syndrome. The patient was diagnosed with GBS with lumbar puncture that indicated albuminocytogical dissociation, a characteristic of GBS. The patient was managed with anticoagulant, anticonvulsant, anti-arrhythmic, digestive enzyme, nitrogen mustard- alkylating agent , chemoprotectant, antiemetic, PPI, gastro protectative agent along with plasmapheresis. The importance of correct diagnosis by the physician and the subsequent management is reviewed.

GBS with Bilateral plantar extensor – A case report

GBS is an immune mediated polyradiculoneuropathy classically characterized by acute symmetrical ascending lower motor type weakness and areflexia. But sometimes, in axonal variants of GBS, reflexes are preserved or exaggerated. We report a case of GBS with bilateral extensor plantar response during the course of the disease. A 36- year-old male presented with acute quadriplegia with asymmetrical muscle weakness and extensor plantar response. Sensory, bowel and bladder function was intact. He was treated with intravenous methylprednisolone daily for 5 days without improvement. NCS revealed AIDP and AMAN variants of GBS. So, in any patient presenting with acute quadriplegia with extensor plantar response, GBS should be considered as differential diagnosis.&#x0D; Bangladesh Journal of Neuroscience 2015; Vol. 31 (1): 42-44

Stabbing Yourself in the Heart: A Case of Autoimmunity Gone Awry.

Within internal medicine, cardiac and neurologic pathology comprises a vast majority of patient complaints. Physicians and advanced-care practitioners must be highly educated and comfortable in the evaluation, diagnosis, and management of these entities. Chest pain accounts for millions of annual visits to the emergency room with pericarditis diagnosed in approximately four percent of patients with nonischemic chest pain. Guillain-Barre Syndrome is autoimmune polyneuropathy that often results in transient paralysis. Simultaneous diagnosis of both entities is a rare but described phenomenon. Here, we present a clinical case of GBS associated pericarditis. A fifty-five-year-old man with history of renal transplant presented with lower extremity weakness and urinary incontinence. Physical exam and diagnostic studies confirmed Guillain-Barre Syndrome. Patient subsequently developed stabbing chest pain with clinical presentation and electrocardiogram consistent with pericarditis. The patient was successfully treated for both diseases. This case highlights that although infrequent, internal medicine care providers must be cognizant of this correlation to ensure timely diagnosis and treatment.