Newspaper articles over the last couple of days, have been highlighting the observed increase in the numbers of patients with Guillain Barre syndrome (GBS) seen in some Latin American countries over the last few weeks and in particular, Brazil. Zika is known to be associated with birth defects namely microcephaly, but now has been associated with GBS which typically affects adults.
GBS was first described in 1916 by 2 french neurologists and is rare affecting 1 to 2 patients per 100 000 per year. It has been known for some time to be an autoimmune condition triggered by virus infections, which affects the nerves supplying skeletal muscle. It was only during a Zika outbreak in the French Polynesian islands in 2013 – 2014, that the association with Zika was also made.
GBS usually affects both sides of the body a week or 2 after the viral illness, often starting in the legs and moving up the body to the arms. The trouble is that it can also affect the muscles responsible for breathing in a quarter of cases and these patients require urgent artificial ventilation in an ITU setting.
The worry of course, during outbreaks in areas where ITU beds are short, that there is nowhere to treat these patients and they inevitably die. Patients often need protracted periods of time on ventilation machines.
Treatment of GBS is mainly supportive with ventilation as necessary. Intravenous immunoglobulin and plasmapheresis have both been shown to be beneficial, but plasmapheresis in particular, is only available in specialist centres and not available in DGHs.