Pune has 101 confirmed Guillain-Barré Syndrome cases, with 16 in critical condition. Officials suspect contamination from Campylobacter jejuni bacteria and norovirus, urging vigilance as investigations continue into the outbreak’s cause and spread
Published Jan 28, 2025 | 7:00 AM ⚊ Updated Jan 28, 2025 | 9:39 AM
GBS
Maharashtra is currently grappling with a significant outbreak of Guillain-Barré Syndrome (GBS), particularly in Pune, where the number of reported cases has surged to 101 as of January 27, 2025. This includes 73 confirmed cases earlier in the week, with 14 patients on ventilators and the first suspected death attributed to the syndrome recently reported.
The first suspected GBS-related death in Maharashtra involved a Pune-based chartered accountant who exhibited symptoms such as diarrhea and muscle weakness before succumbing to respiratory complications after hospitalisation.
Pune has recorded 101 confirmed cases, with 16 patients in severe condition, requiring ventilator support. The outbreak is affecting both children and the elderly, prompting health officials to urge the public to remain vigilant and adhere to health guidelines.
Of the total cases, 68 are male and 33 are female, with patients ranging in age from under nine to their seventies. Most cases have been reported in areas under the Pune Municipal Corporation and its surrounding regions.
Health officials suspect that the outbreak may be linked to contaminated water and food, with the presence of Campylobacter jejuni bacteria and norovirus identified in some patients. Investigations are ongoing to determine the exact cause and contain the spread of the syndrome.
“Guillain-Barre Syndrome (GBS) is a neurological disease in which the immune system attacks the peripheral nerves,” Consultant Neurologist and Stroke Physician Dr Shobha N of Bengaluru’s Manipal Hospital told South First.
Imagine your body’s nerves as wires that help your brain talk to your muscles. In Guillain-Barre Syndrome, the body’s defence system gets confused and starts attacking these nerves, as if fighting an enemy.
When this happens, the nerves can’t do their job properly, which leads to problems.
“When infections attack our body, our immune system creates antibodies to fight off the infecting agents. Sometimes, these same antibodies meant for viruses end up attacking our own nervous system. This is what’s known as an autoimmune disease. The unusual antibodies produced by the person’s own body end up harming the nerves, leading to GBS,” said Consultant Neurologist at Hyderabad’s Apollo Hospital, Dr Sudhir Kumar.
“There are two common infections that can lead to the occurrence of GBS. One is a viral infection, often resembling a viral fever and affects the upper respiratory tract. The second type is a diarrheal disease,” Dr Kumar told South First.
“Demyelinating type of GBS is more common. Axonal type is less common, which is further classified into motor, sensory or mixed motor + sensory types, depending on the types of nerves affected,” he added.
There are some unusual types of GBS, where only the cranial nerves (those connected to the head) are affected. Tests on how the nerves work show two main types: One where the protective covering of the nerves is harmed (called demyelinating), and another where the nerve fibres are damaged (called axonal).
“There can also be cases where both types of damage occur together. This is what takes place in GBS,” said Dr Kumar.
According to Dr Shobha, the symptoms typically start with a person feeling weak, like they can’t move their muscles well. Sometimes, they might feel tingly or numb in their arms and legs.
In severe cases, they might even have trouble walking or moving their body, which then progresses to the upper limbs.
Dr Kumar added that the weakness typically begins in the legs, and patients might find it hard to walk or get up from the sitting position. Climbing stairs can be challenging. Within a day or so, the weakness can extend to their hands, making it difficult to do things like picking up objects, dressing, or eating.
“Cranial nerves are typically the facial nerves that can be involved. Patients can develop difficulty in swallowing and breathing,” said Dr Shobha.
“Around the third or fourth day without treatment, moving becomes even tougher. They might struggle to change positions in bed or turn from side to side. If left untreated, swallowing and speaking become problematic around the fourth day. In severe cases, breathing becomes difficult, and some patients even need a ventilator,” said Dr Kumar,
This progression usually takes a few days, but in very serious cases, it can happen in just two or three days. In other cases, it might take up to seven days for these symptoms to appear.
The most critical symptom is the paralysis of respiratory muscles. Once patients need a ventilator, it can take quite a while for them to recover.
However, the good news is that GBS is treatable, but early diagnosis and treatment are crucial.
Diagnosing GBS involves a few steps. When a patient reports symptoms like weakness that progresses quickly, beginning in the legs and moving to the hands, it gives us a hint.
“We then perform nerve conduction studies, which involve stimulating the nerves in the hands and legs and measuring their responses on a computer. This test takes around 30 minutes and can often be enough to make a diagnosis,” said Dr Kumar.
He added that in some cases, doctors might also conduct a lumbar puncture. “This procedure helps us examine the cerebrospinal fluid (CSF). In GBS cases, we usually find that the protein levels in CSF are high, while cell counts are normal or only slightly elevated,” he said.
“This is important because it helps us distinguish GBS from conditions like encephalitis (brain fever), where both CSF cell count and protein levels tend to be high. In GBS, only the protein levels are elevated, and CSF may appear normal or only slightly raised,” he added.
There are two main types of treatment approaches for GBS, said the doctors.
“To help treat Guillain-Barre Syndrome, doctors use a method called immunotherapy. This could mean getting special proteins called intravenous immunoglobulin (IVIG) through a vein,” said Dr Shobha.
IVIG involves giving patients an injection of a special type of protein through an infusion. This process takes around five days. “The goal of IVIG is to eliminate the abnormal antibodies from the bloodstream,” said Dr Kumar.
The second treatment method is known as plasmapheresis. “It involves removing the patient’s abnormal plasma (which contains those troublesome antibodies) and replacing it with fresh plasma obtained from other sources,” he added.
Both of these treatments are widely accepted as standard for GBS, and it’s crucial to start them early.
“When treatment begins promptly, around 95 percent of the people tend to recover. However, if treatment is delayed or not administered for some reason, the situation can turn dire, with a mortality rate of 30-50 percent,” said Dr Kumar.
“This underlines the importance of early treatment of GBS. It’s a disease where treatment can make a significant positive difference, and not treating it can have severe consequences.
During the rainy season, there tends to be an increase in cases of Guillain-Barre Syndrome.
“This is because most cases of GBS are post-infection. Common antecedent infections are respiratory-tract infections and diarrheal diseases. Incidences of these infections generally rise during monsoons,” said Dr Shobha.
GBS can occur after various infections, not limited to just the monsoon season.
“With the Covid-19 pandemic, we’ve seen a notable number of individuals recovering from Covid-19 also experiencing GBS. The immune system fights the virus with antibodies, but in some cases, these antibodies can damage the nerves, leading to GBS. This post-viral occurrence applies not just to Covid-19 but to other viral infections and even vaccinations,” said Dr Kumar.
He added that the risk of GBS after vaccination was relatively low. For instance, GBS might occur in about one case out of 10,000-15,000 vaccinations. This risk remained consistent across various vaccines, including Covid-19 vaccines. “It’s important to note that the effects of vaccines are usually seen within the first couple of weeks after vaccination, similar to the timeline of viral infections,” he said.
(Edited by Ananya Rao)
