Since June 2023, 182 cases have been reported across the country, of which 147 have been discharged, 31 are still hospitalized and four have died
The Peruvian government has declared a nationwide health emergency following an increase in cases of Guillain-Barré syndrome, a rare neurological disease. The emergency will last 90 days to deal with an “unusual increase” in cases, according to foreign media. According to the MercoPress news agency, 182 cases have been reported across the country since June 2023, of which 147 have been discharged, 31 are still hospitalized and four have died.
The health emergency follows a request from Peru’s Health Minister César Vásquez, who noted that an increase in the number of cases could mean “a lack of immunoglobulins” (antibodies). The exact cause of Guillain-Barre syndrome is not currently known. However, two-thirds of patients with this condition report symptoms of an infection within the previous six weeks. These bacterial or viral infections include Covid, a respiratory infection, a gastrointestinal infection or the Zika virus.
Guillain Barré syndrome – reports the National Institute of Health – is a rare disease that damages the peripheral nerves that connect the central nervous system (brain and spinal cord) with the rest of the body. It is the most common form of rapidly evolving (acute) peripheral neuropathy. The peripheral nervous system consists of sensory nerves (which send stimuli related to pain, vibration perception, touch and balance to the brain) and motor nerves (which transmit nerve impulses to the muscles that govern voluntary and involuntary movements such as breathing, heartbeat, bowel movements). In Guillain-Barré syndrome, the sheaths that cover the nerve fibers (myelin sheaths) or the nerve fibers themselves are mistakenly attacked by the body’s defense system (autoimmune reaction); this causes the slowing down, or interruption, of the transmission of nerve signals with the consequent appearance of a paralysis of the muscles often accompanied by sensory and functional alterations.
The cause of Guillain-Barré syndrome has not been identified. The disease occurs more often in adults and is slightly more frequent in males than in females. It usually appears after an infection. In two out of three cases, a few days or weeks before the onset of the syndrome, infections of the respiratory tract or gastrointestinal tract occur. Among the most frequent infections: food poisoning, mainly caused by the bacterium Campylobacter jejuni; influenza A virus; herpes virus infections (Cytomegalovirus, Epstein-Barr virus); respiratory tract infections due to Mycoplasma pneumoniae or Haemophylus influenzae.
Guillain Barre syndrome is not contagious. It is believed to be the result of an autoimmune reaction directed against the myelin sheath that surrounds the nerve or against the nerve itself; this reaction would be triggered by an infection which induces the production of antibodies directed against molecules of the nerve (autoantibodies) mistakenly mistaken for components of the infectious agent.
The disease can progress to total paralysis and respiratory failure which can endanger the person’s life. In these cases, assisted breathing and feeding via the so-called parenteral nutrition in which the administration of nutrients takes place via a peripheral vein may be necessary. There is no cure for Guillain-Barré syndrome but two types of therapeutic interventions, if performed quickly, can speed healing and reduce the duration and complications of the disease: plasmapheresis and immunoglobulin infusion.
The characteristic disturbance of the onset of Guillain-Barré syndrome is progressive weakness that can affect both legs and arms accompanied by reduced tendon reflexes of the affected limbs. Generally, the weakness initially affects the lower limbs and then spreads to the upper limbs; in a small percentage of people it manifests itself with paralysis of the upper limbs or lower limbs. The cranial nerves may also be affected resulting in weakness of the facial muscles.
Ascending muscular paralysis, that is to say that it spreads from the bottom to the top, can also involve other functions causing: difficulty in breathing; speech disorders; difficulty swallowing; heart rate changes; cardiac arrhythmias; blood pressure changes; changes in body temperature. The onset of the syndrome is generally rapid; the disturbances reach a stationary phase within 2-4 weeks and recovery usually begins within 6-8 weeks but can last several months or years. The severity and duration of the disease ranges from mild weakness, usually associated with spontaneous recovery, to total paralysis with respiratory failure.
Most people affected by the disease require hospitalization and supportive therapies: from constant monitoring of respiratory and cardiac function to the prevention of deep vein thrombosis, from the management of possible intestinal and urinary dysfunctions to the early start of physiotherapy. There is no cure for Guillain-Barré syndrome but two types of therapeutic interventions, if performed quickly, can speed healing and reduce the duration and complications of the disease: plasmapheresis and immunoglobulin infusion.
Plasmapheresis is a procedure which consists in taking blood and separating the liquid part (plasma) from the cellular part which is then reinfused into the body; its effectiveness in Guillain-Barré syndrome is due to the elimination from the blood of antibodies that contribute to damage to peripheral nerves. Intravenous infusion of high doses of immunoglobulins, containing antibodies from the blood of healthy donors, is intended to block the action of the antibodies that damage the nerves.
Pain relievers may also be given to relieve the pain, which can be very intense. Anticoagulant medicines (heparin) and the use of elastic compression stockings can be useful to prevent the formation of blood clots and facilitate the return of blood to the heart.