Guillain Barre Syndrome is uncommon type of infection which occurs mostly to individuals who were previously healthy. GBS is an acute infection that affects the peripheral nervous and in rare cases it can affect the motor or cranial nerves. GBS does not produce any warning and it is considered an inflammatory condition which can lead to progressive muscle weakness and in case a patient does not seek medical attention it can lead paralysis. It is very difficult to recognize this infection from viral infection mostly in its early stages (Willison, Jacobs & Van Doorn, 2016). It is very rare to find patients suffering from this illness in emergency departments. Inflammation of the peripheral nerves affect the legs and harms of a patient resulting into weakness, impaired function and feeling of limb paralysis which can happen with or without any pain (Ansar & Valadi, 2015). Though it is a rare infection it can affect individual of all ages. GBS is not a single infection, this is because it is made up several variations which can be differentiated by their signs and symptoms, severity and the extent of the inflammatory phase. For healthcare professionals to be in position to handle this infection, they should be familiar with the mimics and variants to effectively be able to diagnose this illness (Wijdicks & Klein, 2017). This paper focuses on signs and symptoms of GBS, prevalence, risk factor of the infection, pathophysiology, management and treatment of the illness.
In the past, Guillain Barre Syndrome was considered a single disorder, but it is now recognized as a heterogeneous disorder because it now takes several forms. The primary form with GBS takes inflammatory demyelinating polyradiculoneuropathy (van Doorn, 2013). GBS uses an antecedent infection to evoke the immune response which in turn cross-reacts with peripheral nerve components because of cross-reactive epitopes which results into an acute polyneuropathy which is directed towards the myelin or the axon of the peripheral nerve.
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Symptoms of GBS starts in the face, feet and hands of the patients and it not taken care of it spreads to legs and arms. The effects of the infection increases gradually when the symptoms travels towards the midpoint of the body. Signs and symptoms of this infection play a part in both the right and left side of the body. GBS is considered very complicated and irregular such that the motor symptoms of the infection cannot be detected (Van den Berg et al., 2014). It is very hard for the infection to affect the arms and limbs without spreading to other body parts. Some patients are reported to develop skin sensitivity to touch by intensifies by bed sheets and socks. If a patient does not seek medical attention the pain experienced from this infection can limit them form walking in which that are not capable of walking for long distances. Patients who experience signs and symptoms in their feet and ankles have high chances of experiencing pain in their fingertips as the pain continuous to spread to the knees and eventually to the wrist. According to (Oehler et al., (2014), patient with this infection are sometimes not able to differentiate between cold and hot. They can sometimes start sweating when it is extremely cold or start feeling coldness when it is hot.
A GBS patient may experience communication interruptions. This happens between what they want to do which could be of benefit to them and the ability of their body to perform the desired task. This happens because the motor nerve is responsible for movement and due to this infection it is affected and damaged which can lead to partial or complete blockage of the motor signal making an individual unable to perform some tasks because the damaged nerve system affects it capability to function properly which can lead to reduced movement and coordination of body muscles (van Doorn, 2013). The patient muscles can be damaged or twisted. In some adverse cases the tendon reflexes may get lost or diminished. According to the World Health Organization (2016), paralysis and weakening can occur to patient most common in the feet, hands and face. The paralysis is persistent and keeps on rising to the patient and it can spread to the rest of the limb (Musso, Nilles & Cao?Lormeau, 2014). Arms of the patient becomes so weak such that it becomes a problem for them to be able to lift objects. Weakness of the arms is contributed by pain and involuntary muscle contractions. Constipation is another symptom of this infection which happens due to condensed movement of the intestines.
GBS has been reported across the globe. The annual US incidence of GBS is 1 to 3 patient out of 100000 people (Willison, Jacobs & Van Doorn, 2016). The annual mean rate of patients hospitalized in US has reported to be increasing with respect to age rarely affecting young people below 15 years and highly in adult people. US military are at very high risk o been infected by this infection as compared to the general population. Incidence of GBS occurrence in the world is similar to US epidemiology without geographical clustering. AMAN and AMSON type of GBS mostly occur in the northern part of china, Mexico am Japan which makes up to 5-10% incidences of GBS reported in US. AIDP make up to 90% cases in Europe, North America and developed countries. GBS infection has been reported throughout international community across the globe (van den Berg, Bunschoten, van Doorn & Jacobs, 2013). GBS affects male mostly as compared to female with a ratio of 1.5:1. For male victims then infection is mostly common in older patients. Approximately 80% patients suffering from GBS have the capability to walk independently for 6 months of the infection and 60% of the patients are able to recover completely and attain motor strength in a period of 12 months. In 2008 epidemiology study reported a 2-12% mortality rates of patients with GBS despite ICU management.
The main cause of GBS is still unknown. However according to center for disease control and prevention (CDC) about two-thirds of individual infected by GBS develop it after they have been sick with respiratory problems or diarrhea. This suggests that people with poor immune system are at very high risk of been infected by GBS (Salmon et al., 2013). Campylobacter jejuni infection is another risk factor which is associated with GBS. This infection is the most cause of diarrhea in many countries across the globe and it is termed as a major risk factor for GBS. The bacteria of campylobacter is mostly found in undercooked food mostly poultry. Individuals suffering from HIV/AIDS are highly exposed to GBS. This happens because AIDS makes their immune system very weak making them susceptible to other infections and GBS can be one of these infections (van den Berg et al., 2013). All people are capable of getting infected by GBs but older adults and men are at very high risk of this infection. This happens to older people because as individuals age, there immune system becomes weak and they are not in position to fight infections (Nyati & Nyati, 2013). Healthcare professionals believes that viral and bacterial infection are capable of changing the way in which nerve systems reacts to peripheral nerves (Salmon et al., 2013).
Guillain Barre Syndrome is very difficult to pathogenesis and diagnose at very early stages. This happens because the sign and symptom of the infection are similar to those of other neurological infection wand they may vary from person to person. Healthcare professionals recommends the following to be done to patient infected by this disorder (McNair, 2013). Spinal tap the first method in which healthcare professionals withdraws a small amount of fluid from the patient’s lower back. Physicians then tests the fluid for a specific type of change which occurs if the person is suffering from GBS. Healthcare professionals can also use electromyography in which they insert thin needles electrodes in the muscles of the patient. Electrodes plays are very major role of measuring if nerve activities in the muscles are working properly. Nerve condition studies is the third test which healthcare professionals carry out to examine if a patient is affected by GBS (Nyati & Nyati, 2013). This test includes sticking small discs of electrodes to the body of the patients. Healthcare professionals use minor electric shocks to activate the nerve and measure how faster the signals have traveled along them. Lumber puncture is the last pathophysiology of GBS used to remove some fluids around the spinal cord through a needle which is inserted in the lower part of the spine.
In most cases patients with vital signs and symptoms of GBS are hospitalized so that healthcare professionals can carefully monitor their progress and respond to medication and treatments they are administering to them. The duration in which the patient spend in the hospital vary from days to weeks depending on how critical their health status is in. the first type of treatment which healthcare professionals can give to patients is plasma exchange in which blood is drawn and plasma which is part of the blood is removed from the patient (Cao-Lormeau et al., 2016). Healthcare professional thereafter have to place back the cells into the body. Plasma exchange is a very effective treatment method because it is capable of shortening the length and effects of GBs symptoms. The second treatment method which is recommended by healthcare professionals is immunoglobulin therapy in which the infected blood of the patient which is weak and not able to fight back infections is removed and healthy blood which has the capability of fighting infections is put in the body of the patient (Nomura, 2015).
Patients with severe GBS especially the ones experiencing respiratory problems are put on ventilators which helps them to breath. With this treatment methods most people are able to recover completely even the ones with severe GBs symptoms. However, in most cases fatigue which is a major symptom of GBS persist even after the patient has recovered. The recovery process of GBS sometimes tend to be very slow, and in severe cases this infection can leave a patient almost completely paralyzed (McNair, 2013). GBS is considered a life threatening infection because it is associated with respiratory problems which can interfere with breathing of a patient. Management of GBS involves preventing and dealing with complications such as breathing problems by providing supportive care until the symptoms of the patients begins to improve (Salmon et al., 2013).
Conclusion
Guillain Barre Syndrome is a life threatening infection across the globe. The infection affect people of all races and age. GBS is accompanied by a number of life threatening signs and symptoms which if not taken good care of can lead to death. Therefore, it is the role of healthcare professionals to ensure that they carefully monitor the progress of a patient with this infection before it results in permanent conditions like paralysis. Healthcare institutions should ensure that they have the best treatment methods in place which can be used to treat and prevent this infection. GBS can be conducted from bacterial infection called Campylobacter jejuni infection which is commonly found in undercooked food, therefore people are advised to make sure that they take food which is properly cooked to reduce chances of them been infected by this infection.
References
Ansar, V., & Valadi, N. (2015). Guillain-Barré syndrome. Primary Care: Clinics in Office Practice, 42(2), 189-193.
Cao-Lormeau, V. M., Blake, A., Mons, S., Lastère, S., Roche, C., Vanhomwegen, J., … & Vial, A. L. (2016). Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. The Lancet, 387(10027), 1531-1539.
McNair, N. D. (2013). Treatment of Guillain-Barre Syndrome. Journal of Infusion Nursing, 36(6), 397-400.
Musso, D., Nilles, E. J., & Cao?Lormeau, V. M. (2014). Rapid spread of emerging Z ika virus in the P acific area. Clinical Microbiology and Infection, 20(10), O595-O596.
Nomura, K. (2015). Treatment of Guillain-Barré syndrome. Brain and nerve= Shinkei kenkyu no shinpo, 67(11), 1397-1410.
Nyati, K. K., & Nyati, R. (2013). Role of Campylobacter jejuni infection in the pathogenesis of Guillain-Barré syndrome: an update. BioMed research international, 2013.
Oehler, E., Watrin, L., Larre, P., Leparc-Goffart, I., Lastere, S., Valour, F., … & Ghawche, F. (2014). Zika virus infection complicated by Guillain-Barre syndrome–case report, French Polynesia, December 2013. Eurosurveillance, 19(9), 20720.
Salmon, D. A., Proschan, M., Forshee, R., Gargiullo, P., Bleser, W., Burwen, D. R., … & Vellozzi, C. (2013). Association between Guillain-Barré syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis. The Lancet, 381(9876), 1461-1468.
van den Berg, B., Bunschoten, C., van Doorn, P. A., & Jacobs, B. C. (2013). Mortality in guillain-barre syndrome. Neurology, 80(18), 1650-1654.
Van den Berg, B., Walgaard, C., Drenthen, J., Fokke, C., Jacobs, B. C., & Van Doorn, P. A. (2014). Guillain–Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nature Reviews Neurology, 10(8), 469.
van Doorn, P. A. (2013). Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS). La Presse Médicale, 42(6), e193-e201.
Wijdicks, E. F., & Klein, C. J. (2017, March). Guillain-barre syndrome. In Mayo Clinic Proceedings (Vol. 92, No. 3, pp. 467-479). Elsevier.
Willison, H. J., Jacobs, B. C., & Van Doorn, P. A. (2016). Guillain-barre syndrome. The Lancet, 388(10045), 717-727.
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