An Outbreak of Guillain-Barre Syndrome with Respiratory Failure in Joypurhat, Bangladesh, 2018

Abstract

We describe an investigation to identify the causative agent and risk factors for a cluster of Guillain-Barre Syndrome (GBS) reported in northern Bangladesh, November 2018. Medical record review and verbal autopsies were conducted. We actively searched for and interviewed other GBS cases in the hospital to gather demographic and clinical information. Blood samples were collected for serological testing for campylobacter and molecular testing for dengue, Zika, and Chikungunya and stool samples for poliovirus. We identified 13 GBS patients of which eight were males. The case fatality rate was 23%. We found development of respiratory muscle paralysis in 10 patients; three had rapid involvement within 48 hours and eventually died in the acute progressive phase without mechanical ventilation support. Serological tests confirmed the presence of antibodies against Campylobacter jejuni in three of seven patients. All other tests were negative. The high case fatality rate was due to rapid onset of respiratory muscle paralysis. We recommend establishing a surveillance system to timely capture and report GBS patients and to enhance investigation capacity. We also recommend that sufficient quantity of mechanical ventilators be present in peripheral tertiary hospitals.

Keywords:  Guillain-Barre Syndrome, GBS, respiratory muscle paralysis, mechanical ventilation, Bangladesh, fatality