Guillain-Barré Syndrome and its Causes
Guillain-Barré syndrome is a severe condition characterized by acute inflammatory polyneuropathy, leading to the degeneration of myelin sheaths that insulate nerve fibers. This syndrome manifests in various forms, with the most severe cases resulting in secondary axon degeneration.
While the precise trigger for Guillain-Barré syndrome remains unidentified, studies suggest that it may result from an immune response against nerve cells. This response typically follows an infection, with the immune system producing antibodies that inadvertently attack nerve molecules resembling the infecting agent.
Common pathogens linked to this immune response in Guillain-Barré syndrome patients include:
- Enteric viruses
- Herpes virus
- Campylobacter jejuni
- Mycoplasma spp
In some cases, the syndrome has been observed following Zika virus or Covid-19 infection.
Symptoms of Guillain-Barré Syndrome
Guillain-Barré syndrome typically manifests 5 days to 3 weeks after exposure to triggering factors such as infection, surgery, or vaccination. The syndrome's symptoms include:
- Weakness, including facial and respiratory
- Paresthesia, beginning in the legs and progressing to the arms
- Blood pressure fluctuations
- Cardiac arrhythmias
- Pupillary changes
In severe cases, the disease can result in total paralysis and respiratory failure, necessitating endotracheal intubation and mechanical ventilation. A variant of Guillain-Barré syndrome, known as Miller-Fisher syndrome or Fisher's variant, can result in ataxia, areflexia, or ophthalmoparesis.
Diagnosing Guillain-Barré Syndrome
Guillain-Barré syndrome diagnosis involves a series of clinical tests aimed at detecting infectious diseases and immune dysfunction, including tests for hepatitis and HIV. Additional diagnostic measures include electro-diagnostic tests to study nerve conduction, cerebrospinal fluid analysis, and regular measurements of forced vital capacity.
Further examination may reveal early signs of demyelination as nerve conduction velocity decreases. Severe cases may involve cervical cord compression, at which point, if associated with polyneuropathy and non-prominent bulbar involvement, an MRI should be performed.
Managing and Recovery Timeline of Guillain-Barré Syndrome
Guillain-Barré syndrome is a rapidly progressing condition, necessitating vigilant monitoring of vital signs. During the acute phase, ensuring an unobstructed airway is paramount, with assisted respiration on standby if required. Keeping the patient hydrated is crucial, and intravenous administration may be employed if oral fluid intake becomes challenging.
Heat therapy serves as an effective pain reliever and facilitates physical therapies. To prevent immobilization, passive movements should be performed on the patient, gradually transitioning to active movements. As for medical intervention, intravenous immunoglobulins serve as the primary treatment, with plasmapheresis or plasma exchanges as a fallback if the initial treatment proves ineffective.
While most patients observe substantial improvement within a couple of months, approximately 30 percent of adult patients continue to experience some degree of weakness after three years. Furthermore, between 2 to 5 percent evolve into inflammatory demyelinating polyneuropathy.
Guillain-Barré Syndrome Situation in Peru
The government of Lima has declared a 90-day nationwide health emergency following a surge in Guillain-Barré syndrome cases. From January to July, 180 patients have tested positive for the syndrome, and sadly, four lives have been lost. In response, the Ministry of Health, with the support of the Higher Institute of Health, has rolled out an action plan.
The plan's primary objective is to guarantee appropriate care for those diagnosed with the disease. It also encompasses epidemiological surveillance, investigation, and monitoring of the escalating Guillain-Barré syndrome cases. This decisive action aims to curb the spread of the illness and ensure the successful recovery of the affected individuals.
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