Neurological Concerns Following Viral Infections: Emerging Patterns in Guillain-Barré Syndrome (GBS)

Recent reports have raised concerns among medical professionals regarding a notable increase in Guillain-Barré Syndrome (GBS) cases post viral infections. Prominent physicians have shared their insights on various platforms, including X (formerly known as Twitter), shedding light on this unsettling trend. The surge in GBS occurrences during the current season has been noted as a recurrent phenomenon. Individuals have reported discussions with their healthcare providers, who have attributed GBS to factors such as recent COVID-19 infections or vaccination. GBS, also referred to as Guillain-Barré syndrome, is an infrequent neurological disorder characterized by the immune system's misguided attack on components of the peripheral nervous system. Typically, this ailment is triggered by bacterial or viral infections.

1. Prevalence and Clinical Characteristics

Dr. Sahil Kohli, Principal Consultant in Neurology at Max Hospital, Gurugram, underscores the rarity of GBS, emphasizing its annual incidence of one to two cases per lakh. He highlights the immune-mediated nature of GBS, noting that it exhibits a slight predisposition towards males and tends to affect children, young adults, and individuals aged 55 or older. According to Dr. Kohli, GBS manifests as an immune-mediated neuropathy linked to various antecedent events.

2. The Molecular Mechanism Behind GBS

Dr. Puja Kushwah, Senior Consultant in Neurosciences at Metro Hospitals & Heart Institute, Noida, explains the underlying mechanism of GBS. She identifies instances where the immune system's response to a prior infection or related incident interacts with similar epitopes on peripheral nerves, a phenomenon known as molecular mimicry. Dr. Kushwah points out that up to two-thirds of patients with GBS can trace the disorder back to such antecedent events. Noteworthy culprits for GBS include Campylobacter jejuni infection, Cytomegalovirus, Influenza A and B, HIV, COVID-19 Virus, and Zika virus, whereas rarer pathogens like Varicella-zoster virus, Epstein-Barr virus, herpes simplex virus, hepatitis E, chikungunya virus, and Japanese encephalitis virus also contribute to GBS development.

3. Clinical Presentation and Manifestations

Dr. Kohli elucidates the clinical manifestations of GBS, primarily characterized by the onset of weakness or pain in the lower extremities. This weakness, starting distally in the feet, progresses gradually to involve the hands. In severe cases, the respiratory system can be affected, leading to breathing difficulties and potential reliance on ventilatory support.

4. Associations with Dengue and Other Infections

Dr. Kohli highlights the autoimmune nature of GBS, often observed following infections. He underscores the prevalence of GBS in contexts such as upper respiratory infections and pneumonia-like illnesses. Notably, GBS cases are notably elevated in the current dengue-heavy scenario, presenting almost six times more frequently in dengue cases.

5. GBS in the Context of COVID-19 and Vaccination

The association between Guillain-Barré Syndrome and viral infections is underscored by Dr. Kohli, particularly emphasizing its linkage with COVID-19. He explains that GBS can arise post any viral infection, including COVID-19. The peak of the COVID-19 pandemic witnessed instances where GBS coincided with positive COVID-19 diagnoses, cementing the connection between the two.

Dr. Kushwah elaborates that GBS has been associated both with COVID-19 infection and COVID vaccines. She notes the occurrence of rare GBS cases post COVID-19 infection and highlights instances of GBS following administration of specific COVID-19 vaccines. She emphasizes that observational data suggest the risk of GBS after infection surpasses that post-vaccination.

6. Additional Triggers and Recovery Outlook

Dr. Kushwah underscores the diverse triggers of GBS, including not only viral infections and COVID vaccines but also other vaccines like influenza and meningococcal vaccinations. Moreover, certain medical procedures and conditions like surgery, trauma, bone marrow transplantation, Hodgkin lymphoma, systemic lupus erythematosus, and sarcoidosis have been associated with GBS.

Regarding recovery, Dr. Kohli offers reassuring insights, asserting that approximately 80 to 85% of individuals can experience substantial recuperation. The increase in reported GBS cases might stem from improved recognition of this treatable neuropathy. Dr. Kohli notes the effectiveness of intravenous immunoglobulin (IVIG) or plasmapheresis as potential treatments for GBS.