High risk and low prevalence diseases: Guillain-Barré syndrome

Neurological Performance and Clinical Outcomes Related to Patients With Oropouche-Associated Guillain-Barré Syndrome

BACKGROUND AND AIMS

A recent study reported that Oropouche virus (OROV) infection may play a role in the etiology of Guillain-Barré syndrome. We aimed to identify the neurological performance, disease-modifying therapies, and clinical outcomes related to patients with Oropouche-associated Guillain-Barré syndrome admitted to the critical care unit.

METHODS

This was an analysis of 210 patients diagnosed with Guillain-Barré syndrome and suspicion of Oropouche viral infection admitted to the critical care units from June 2024 to September 2024 using the national administrative healthcare data. OROV was identified by reverse-transcriptase-polymerase-chain-reaction. Patients with Guillain-Barré syndrome and Oropouche infection were compared with those without Oropouche infection in terms of demography features, neurological performance, disease-modifying therapies, and clinical outcomes.

RESULTS

Most patients had a severe disease. Mechanical ventilation was required in 28.6%. Overall mortality rate was 14.3%. The median time from onset of weakness to intensive care unit discharge, and the median time from hospital admission to intensive care unit discharge was 18 days (IQR: 13-24.3 days) and 13 days (IQR: 9-19 days), respectively. Oropouche viral infection was detected in 43 (20.5%) patients. There were no differences among patients with and without Oropouche viral infection regarding general characteristics, neurological performance, disease-modifying therapies, and outcomes. After adjusting for confounders in multivariate logistic regression analysis, Oropouche viral infection (OR: 1.94; 95% CI: 0.72-5.20; p = 0.189) was not related to increased mortality.

INTERPRETATION

Oropouche viral infection does not modify the clinical course, disease severity, and outcomes of patients with Guillain-Barré syndrome.

Miller Fisher Syndrome as a Stroke Mimic: A Case Report

Guillain-Barre syndrome (GBS) is a heterogeneous autoimmune disorder characterized by peripheral neuropathy, often triggered by preceding infections or vaccinations. It encompasses several clinical variants, including the rare Miller Fisher Syndrome (MFS), distinguished by ophthalmoplegia, ataxia, and areflexia. Diagnosis is challenging due to varied presentations and potential overlap with other neurological conditions. We present a case of a 42-year-old male initially suspected to have a stroke when he presented with unilateral loss of sensation and dysarthria. He was later diagnosed with MFS after his condition progressed and he developed generalized weakness, ophthalmoplegia, ataxia, and areflexia. Despite initial stability, his condition deteriorated, requiring intensive care. Early recognition and treatment, such as intravenous immunoglobulin (IVIg) and plasmapheresis, are critical for improving outcomes in GBS and its variants. This case underscores the importance of clinical suspicion and appropriate diagnostic strategies in managing these complex neurological disorders.

High risk and low prevalence diseases: Botulism

INTRODUCTION

Botulism is a serious condition that carries with it a high rate of morbidity and mortality.

OBJECTIVE

This review highlights the pearls and pitfalls of botulism, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

DISCUSSION

Botulism is a neuromuscular disorder caused by toxin production of clostridium species bacteria and is a challenging diagnosis that mimics several other conditions. Children account for the majority of patients, with a foodborne source most common, followed by wound sources, typically from intravenous drug injection. Classically, patients with botulism develop bilateral cranial nerve palsies and symmetric, bilateral, descending paralysis. However, patients may initially present with vague symptomatology, such as weakness and dry mouth, which can make diagnosis challenging. A careful history elucidating exposures such as intravenous drug use or consumption of non-commercial canned products can help differentiate botulism from other disorders causing neuromuscular weakness. If suspected, the Centers for Disease Control should be notified to mobilize antitoxin for treatment as soon as the diagnosis is suspected even prior to confirmatory testing. Antibiotics should be avoided in these patients, as they can potentiate toxin release, unless there is a concomitant infection requiring antibiotic therapy. Patients with botulism can develop respiratory compromise requiring emergent airway management. Prolonged neuromuscular blockade from botulism will lead to a variety of symptoms that require comprehensive intensive care unit level care.

CONCLUSION

An understanding of botulism and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease.

Healthy blood, healthy brain: a window into understanding and treating neurodegenerative diseases

Our limited understanding of complex neurodegenerative disorders has held us back on the development of efficient therapies. While several approaches are currently being considered, it is still unclear what will be most successful. Among the latest and more novel ideas, the concept of blood or plasma transfusion from young healthy donors to diseased patients is gaining momentum and attracting attention beyond the scientific arena. While young or healthy blood is enriched with protective and restorative components, blood from older subjects may accumulate neurotoxic agents or be impoverished of beneficial factors. In this commentary, we present an overview of the compelling evidence collected in various animal models of brain diseases (e.g., Alzheimer, Parkinson, Huntington) to the actual clinical trials that have been conducted to test the validity of blood-related treatments in neurodegenerative diseases and argue in favor of such approach.

An updated review on Guillain-Barré syndrome: Challenges in infection prevention and control in low- and middle-income countries

Guillain-Barré syndrome is a rare condition that can be potentially life-threatening. Guillain-Barré syndrome does not have a definitive etiological agent. It is a syndrome that can arise from multiple factors, including various infectious diseases and immunizations. The severity of Guillain-Barré syndrome is exacerbated by these variables, especially in low-income and middle-income countries where healthcare systems are already constrained and struggle to meet the demands of other diseases. The primary aim of our article is to comprehensively examine the life-threatening nature and intensity of Guillain-Barré syndrome by assessing its etiology, progression, and prevalence in low- and middle-income nations while also considering global trends. Furthermore, we proposed the implementation of standard and efficacious treatment and diagnostic resources that are readily accessible and successful in affluent nations and should also be readily accessible in impoverished nations without any unnecessary delay. Our study also emphasized the epidemiological data with molecular epidemiological analysis and the utilization of artificial technology in low- and middle-income nations. The goal was to decrease the incidence of Guillain-Barré syndrome cases and facilitate early detection.