Aug 5, 2013

What causes Guillain-Barré syndrome?

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Paralysis after diarrhoea? Guillain-Barré syndrome in Bangladesh
Guillain-Barré syndrome is a rare nervous system disorder, usually triggered by an acute respiratory or intestinal infection. It is frequently severe and results from nerve damage caused by the body’s own immune defences. Two to three weeks after a viral or bacterial infection, some people may have trouble walking. Guillain-Barré syndrome (GBS) causes muscle weakness, loss of reflexes, and numbness or tingling in the arms, legs, face, and other parts of the body, and may rapidly progress to complete paralysis. The mortality is usually between 2 and 7%, and one in five patients will have some form irreversible residual limb weakness or other permanent nervous system disorders.

What causes Guillain-Barré syndrome?
The cause of the Guillain-Barré syndrome is slowly being unravelled and much progress has been made during the last decade. Guillain-Barré syndrome is an autoimmune disease. As the immune system produces antibodies to fight the infection, it may also attack the patient’s own tissues as though they were foreign substances, damaging the covering (myelin sheath) of the peripheral nerves and sometimes the nerve fibres. The resulting nerve damage leads to tingling and numbing sensations, muscle weakness, and paralysis.
A variety of infections have been associated with GBS, of which Campylobacter jejuni – a bacterial infection frequently causing diarrhoea– is among the most common linked.

 Guillain-Barré syndrome in Bangladesh
After the eradication of polio, the Guillain-Barré syndrome is now the most frequent cause of acute flaccid paralysis in Bangladesh.
ICDDR,B in collaboration with Dhaka Medical College Hospital and others has just completed the first systematic study of non-polio acute paralysis undertaken in the country. The results of this preliminary study suggest that possibly up to 3500 patients get Guillain-Barré syndrome each year – an incidence 2 to 3 times higher than in the rest of the world.
It is a serious debilitating disease, and hospital treatment is often needed. Mortality in the study group was 14%, and almost half of patients were still unable to walk independently after one year.
We found that almost 60% of these cases are caused by Campylobacter. This is double the figures observed worldwide. It appears that only particularly virulent Campylobacter types are responsible for a large number of these GBS cases.
Unlike in the rest of the world the disease is being seen in young adults (20 years old on average), compared to a typical mean age of 50 to 55 years in developed countries.
There is still much to be known and understood about this critical but unexplored condition causing paralysis in Bangladesh. Further research is required to find:
  • the exact prevalence and health burden of the disease in the population
  • more data on other preceding infections (the other 40% of cases)
  • risk factors for GBS, both host-related and microbe-related, and
  • more data on other diseases (e.g. diarrhoea) associated with Campylobacter in Bangladesh.
The ultimate goal is to develop new interventions to prevent or better treat Guillain-Barré syndrome in low-income developing country settings.
For more information on Guillain-Barré syndrome research in Bangladesh, contact Dr Hubert P. Endtz.

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