Ahmedabad: According to the Ahmedabad Civil Hospital’s medical superintendent, the hospital has seen an increase in cases of Guillain-Barre Syndrome (GBS), a rare disorder where the immune system attacks peripheral nerves. 18 people have been diagnosed with it in the past 30 days.
Several medical practitioners say the rise in cases cannot be attributed to a single cause though GBS is often preceded by bacterial or viral infections, which also includes vector-borne diseases such as dengue and chikungunya, and viral infections such as Covid-19 or diarrhoea.
As of Monday, Dr Rakesh Joshi, medical superintendent at the ACH said that 18 were diagnosed with GBS in the past 30 days of which four are admitted in the hospital at present.
Dr Parth Patel, critical care specialist dealing with GBS cases at ACH, the largest public hospital in Gujarat, said last week, on October 18 that around 35 patients were diagnosed with GBS by then in the past 45 days. “We had the rainy season, we had Covid-19… All these have led to a rise in viral infections (prevalent) and complications due to these viral infections… that could be a reason why GBS cases are on the rise. The incidence is definitely higher than that before Covid-19. In a non-pandemic year, after monsoon, there would be 15 cases of GBS at ACH in 30-45 days.”
As of October 18, six patients with GBS were admitted at ACH, of which one was admitted for the past 45 days. Of the 35 patients admitted in the past 45 days, two died, including one who was in his early 20s. The second fatality was a patient in his 40s who died due to septic shock, according to Dr Patel.
Some of the patients had history of Covid-19 with mild symptoms or asymptomatic, said Dr Patel adding that among his GBS patients, the most dominant immediate past infection includes chikungunya or dengue or rhinitis (stuffy nose, often caused as an allergic reaction), followed by gastroenteritis.
Neurologist Dr Sucheta Mudgerikar at Apollo Hospitals in Gandhinagar says, “We see GBS every year whenever there are more viral infections, including post-monsoon period… Currently we are seeing GBS also after a cough and cold or diarrhoea, and not necessarily Covid… We are seeing a marginal rise (compared to previous years).”
Last week, Apollo Gandhinagar had four GBS patients admitted with two in their 20s, one in 50s and one in 60s with recent infection history being that of viral fever, cough and cold, and diarrhoea. The hospital on an average sees six to 10 severe cases of GBS in a year.
Being potentially life-threatening, where collapse of neck and chest muscles can close the airway, two lines of treatments are available for GBS patients — intravenous immunoglobulins (IVIg) and plasmapheresis, along with supportive care.
While a significant spike in GBS cases has not been determined yet, Dr Ravindra Lodha, honorary neurologist at Rajasthan Hospital, Ahmedabad, where three patients were admitted in a span of two days last week, says that one of the variant of IVIg) is in short supply. “Two quantitative variants of IVIg are available — one of five milligram which costs Rs 14,000 and another of 10 milligram which costs Rs 16,000 — we are seeing the cheaper variant in short supply at present. With a five-day course, the cost for a patient goes up to over two lakh rupees,” says Dr Lodha.
Dr Lodha, however, adds that GBS cases in his hospital have not seen any significant spike. “Against two to three cases in a month, we have seen four cases in October,” he says.
A study was registered with the Clinical Trials Registry of India last year to “find out the demographic, clinical features, management and outcomes of patients with GBS admitted during the Covid pandemic (March 1- August 31 2020) and compare it with one year before (March 1-Aug 31 2019)”. Two hospitals in the state — Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, in Anand and Zydus Hospitals in Ahmedabad — are part of the 43 study sites.
