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There have been previous epidemics of GBS in India – in 2019, at least one child died in the north of the country (file photo)
Last month, a teacher from the city of Pune in the west of Pune found her six -year -old son upset by homework.
“I had erased a few words and asked him to write them. I supposed he was angry and that is why he did not hold the pencil correctly,” she said in the Indian Express newspaper .
She never imagined that her struggle to hold a pencil was the first sign of Guillain-Barré syndrome (GBS), a rare disorder where the immune system attacks nerve cells, causing muscle weakness and paralysis.
In a few days, the boy was in intensive care, unable to move his arms or legs. As his condition gets worse, he has lost the ability to swallow, speak and finally breathe, requiring fan support. He is now recovered.
The boy has been among around 160 cases reported from GBS since the beginning of January in Pune, a Center for Education and Computer Science, surrounded by industrial cities and villages. There were five suspicious deaths. Currently, 48 patients are in intensive care, 21 on fan and 38 have been released, according to official figures.
The GBS begins with tingling or numbness in the feet and hands, followed by muscle weakness and a difficulty in moving the joints. Symptoms aggravate over two to four weeks, usually starting in the arms and legs. The mortality rate reported varies between three and 13%, depending on the severity and quality of health care support.
The Pune epidemic is attributed to a pathogen called Campylobacter Jejuni, a main cause of food infections, and the largest GBS driver in the world. The link between the two was discovered in the 1990s in rural China, where the pathogen was common in chickens, and GBS epidemics occurred with each monsoon while children played in contaminated water by chicken or duck excrement.
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The Pune epidemic is attributed to a pathogen called Campylobacter jejuni
The GBS is not entirely rare in India. Monojit Debnath and Madhu Nagappa, of the National Institute of Mental Health and Neuroscience (Nimhans), based in Bangalore, studied 150 GBS over a period of five years between 2014 and 2019. Their results have shown that more than a third of They were positive for Campylobacter.
More recently, epidemics related to the pathogen have been reported from around the world. During the first seven months of 2023, Peru reported more than 200 suspicious cases and at least four SGB deaths, which prompted the government to declare a national emergency emergency and to strengthen public health measures . Two -thirds of the cases were linked to Campylobacter.
In countries with good hygiene, fewer cases of GBS are linked to Campylobacter, respiratory infections being a major contributor, say experts. There were also other triggers. In 2015, Brazil reported a group of GBS cases linked to the Zika virus. Vaccines can rarely trigger GBS, but a cocovated vaccine would have been linked to a few hundred CBS in the United Kingdom in 2021.
“Campylobacter is endemic with hundreds of thousands of cases that take place all the time. There is still in the environment,” said Hugh Willison, professor of neurology at the University of Glasgow.
However, it is not easy to develop the GBS, say scientists.
There is a specific strain of Campylobacter, which has an external layer covered with sugar, and in rare cases, its molecular structure corresponds to the coating of human nerve cells.
When the patient’s immune system attacks bacteria, it can eventually target the nerves – a process called molecular mimicry – leading to the GBS. However, a small fraction of the campylobacter strains has this nerve layer.
“In Pune, a campylobacter strain with this molecular characteristic is likely to circulate, and an increase in infections by this strain therefore led to a higher number of GBS cases,” said Professor Willison.
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A poultry farm near Pune – on a global scale, many cases of GBS have been linked to eating poorly cooked poultry
Most experts believe that around Campylobacter strains over 100 include the risk of GBS, and one in 100 infected by such a tension develops the GBS, which makes the overall risk of approximately one in 10,000.
This creates what Mr. Willison describes as an “immunological Russian roulette”, triggering an “acute neurological tsunami” which crosses the peripheral nervous system. Once the immune response is the attack on the end, the attack decreases – but the body still needs time, medical care and support to repair damage.
What aggravates things is that there is no remedy for the GBS.
In the GBS, the body produces antibodies against Campylobacter, which then attack the nerves. Doctors use “plasma exchange”, a process that filters blood to eliminate harmful antibodies, as well as intravenous immunoglobulin (IVIG), a therapeutic antibody derived from normal blood, to help reduce the seriousness of the disease .
The other challenge is that there is no single test to diagnose the GBS. The diagnosis, according to doctors, is mainly based on clinical characteristics. It presents itself as a form of paralysis which can also be caused by polio, rare viruses or neurological diseases.
“The diagnosis is a constellation of clinical characteristics. An erroneous diagnosis or no late diagnosis or diagnosis can occur easily,” explains Mr. Willison.
The uneven public health system of India has a challenge, as doctors in rural areas may have trouble diagnosing the GBS. One of the reasons, perhaps, why teams from the World Health Organization (WHO) are in Pune, is to collaborate with federal and state health workers to trace, test and monitor cases and analyze trends for support effective treatment.
Pune Municipal Corporation
Special hospital services are installed in PUNE for GBS patients
Authorities say they have monitored more than 60,000 houses, taken 160 water samples for tests and asked people to drink boiled water and eat fresh and clean foods, and not have “stunned food and partially cooked chicken or sheep ”.
Although most cases of GBS in the world come from the undercuding poultry, it can also spread in water, similar to cholera or salmonella, according to experts.
The contaminated water used to wash or prepare street food allows bacteria to propagate easily. Obviously, in Pune, a campylobacter strain with the distinctive molecular characteristic circulates, affecting a large number of people.
What is not clear is if it is due to large -scale contamination of water supply or many people consuming infected poultry. “We call upon people not to panic,” said an opinion from the Ministry of Health. But faced with uncertainty, it is easier to say than to do.
