While the post-Covid surge in the number of cases of Guillain-Barré syndrome (GBS) included mostly adults, the current outbreak in Pune has affected some children

With Quotes from Dr N K Venkataramana (neurosurgeon) and Dr Keni Ravish Rajiv (neurologist and head of epilepsy services)

It is always difficult to identify GBS because it does not come with an active infection.

India is grappling with a new public health concern. More than 111 people in Pune, Maharashtra have been diagnosed with Guillain-Barré syndrome (GBS), a rare neurological disorder in which a person’s immune system attacks peripheral nerves. What begins as a weakness or tingling sensation in the legs can rapidly progress to paralysis.

This is, however, not the first time India has seen a spike in cases of the GB syndrome. There were reports of people developing GBS post Covid-19 infection and some were allegedly post-vaccination.

So, how is the current scenario in Pune different?

Dr N K Venkataramana, founder chairman and chief neurosurgeon, Brains super specialty hospital, Bangalore, who handled several Guillain-Barré syndrome post Covid-19 says that this is the first time India is seeing an outbreak of GB syndrome.

“To my knowledge, we haven’t seen GB syndrome being typically labelled like this as an outbreak.”

What happened post Covid?

According to him, it is always difficult to identify GBS because it does not come with an active infection.

“It happens a little later. This is exactly what happened after people contracted Covid. Many people who got affected with Covid developed what I would call a GB-like syndrome,” he says.

“While the cases of Guillain-Barré syndrome reported post Covid-19 mimicked GB syndrome clinically, some were not Covid positive nor had symptoms whereas some had contracted SARS-CoV2 infection. Clinically, they were similar,” says Dr Venkataramana.

Following a viral or bacterial infection, there is an immunological reaction in the body that affects the nerves- this is GBS. It causes a progressive paralysis- starting from the lower limbs and then begins to ascend – involving the trunk, respiratory muscles, hands, neck muscles, etc. Occasionally, it can affect the brain as well. The Covid infection typically altered the body’s immune system, affecting blood vessels, lungs and the brain predominantly, leading to a sudden increase in strokes, heart attacks and lung failure.

Dr Keni Ravish Rajiv, senior consultant, neurology and head of epilepsy services, Aster CMI Hospital, Bangalore says that GBS is most commonly triggered by an infection with Campylobacter jejuni, a type of bacteria.

“Apart from that, E. coli, influenza viruses and even some vaccinations also can trigger GBS syndrome,” he adds.

Pediatric cases in the Pune outbreak

While GBS primarily affects adults, out of the 111 individuals diagnosed with GBS, 21 are below the age of 9 years.

This, Dr Venkataramana says, is rare.

“It is adults who are mostly affected – this time, however, children are also getting affected. This does not mean children are immune to this problem,” he says.

According to Dr Rajiv, GBS syndrome does not spare anyone based on their age. “It can involve any child or adult.”

Important to control the spread

It is important to aggressively control the spread now. “Since it is rapidly spreading, there is a possibility that this virus is a variant that is altering the immune system very rapidly, similar to Covid. I think this is a public health issue. It's a serious thing to be discussed and ensure that it doesn't spread to other parts of the country,” cautions Dr Venkataramana.

It is also important to take all precautions to see that it does not spread. These include: boiling water before drinking, avoiding raw or undercooked food and disinfecting kitchen surfaces and utensils after handling raw meat.

Important to control the spread

While there were reports of people developing Guillain-Barré syndrome post the Covid-19 infection and vaccination, India is now seeing the first outbreak of the autoimmune condition, which follows a viral or bacterial infection, in Pune. In contrast to the previous surge in cases, several children have also been affected by GBS this time.