JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Guillain-Barré Syndrome in Louisiana
Benjamin Munley, MPH, Sean Simonson, MPH, Raoult Ratard, MD
Table 2: Comparison of Pre- and Post-rotation Test Scores Cases of Guillain Barré Syndrome (GBS) were extracted from the Louisiana Hospital Inpatient Discharge Database for the period 1999 to 2014. There were 1,996 unduplicated cases for an average of 124 cases per year and a yearly annual incidence ranging from 2.3 to 3.4 /100,000. The lack of standardized case definition may be the cause of the slight discrepancies between incidence of GBS in different countries. But in general the epidemiologic situation of GBS is fairly similar with that of other countries. There was no significant increasing trend throughout the period. There was no difference in distribution by sex but a very significant increase in older age groups. The concurrent diagnoses were infections, neurological conditions or pneumonia. In this study Campylobacter infections are described in relation with GBS.
INTRODUCTION In Louisiana, changes in specific disease trends, particularly the emergence of the Zika virus, could result in an increase in the number of Guillain-Barré Syndrome (GBS) cases captured by the state’s surveillance system. Because GBS was not a reportable condition, cases were only captured through the Louisiana Hospital Inpatient Discharge Database (LAHIDD), an aggregate database of Louisiana hospitals’discharge data which is representative of statewide hospitalizations. The objective of this article is to describe the burden of GBS in Louisiana as well as examine the trends in GBS with respect to known associated health conditions over the period of 1999-2014. History Guillain-Barré syndrome (GBS) was first described in the medical literature in 1859 by French physician Jean-Baptiste Octave Landry in a report describing 10 cases with slightly varying presentations of “ascending paralysis” and poor prognoses. In 1916, the French physicians Georges Guillain, Jean Alexandre Barré, and Andre Strohl, described two cases similar to Landry’s originals. Their article described two French soldiers with motor, reflex, and slight sensory deficits as well as muscle tenderness, alterations in nerve conduction, and unexplained increases in cerebrospinal fluid protein. The syndrome became known as Guillain-Barré Syndrome after subsequent publications did not include Landry’s or Strohl’s names.
respiratory infections, Campylobacter infections, HIV infections, surgery, certain vaccines, and certain flavivirus infections. The two most common conditions associated with GBS cases are minor respiratory infections such as pneumonia, estimated at 50% of GBS cases, and campylobacteriosis, estimated between 26%-60% of GBS cases, based on previous case-control studies using serological testing for previous campylobacter infections in GBS cases.¹,² The association between GBS and flavivirus infections is not new knowledge. Rather, one of the first articles presenting evidence of an association came in a 1994 case report detailing Japanese encephalitis virus (JEV) endemic regions in south India where 21/34 GBS cases identified had serologic evidence of a recent JEV infection.³ Of new import, however, is the strong association found between GBS and recent infection with the pandemic Zika virus. However, prior to the recent Zika pandemic, there had been no evidence of an association between GBS and the Zika virus. The first evidence to be gathered of a possible association came from a study of the Zika virus outbreak in French Polynesia where 41 of 42 GBS cases identified between October 2013 and April 2014 were found to have serologic evidence of a past Zika virus infection.⁴
Pathogenesis Hypothesis
GBS and its associations with other medical conditions
The current theory behind the associations of GBS and recent infections with certain pathogens like the genus Campylobacter and flaviviruses suggests the immune response to these pathogens creates antibodies that are also specific to epitopes
GBS is a post-infectious acute autoimmune disorder of the peripheral nervous system and has been shown to be associated with several diseases as well as certain medical treatments. Common conditions associated with GBS include: minor
J La State Med Soc VOL 170 JULY/AUG 2018 107
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