Infectious Disease Compendium

Guillain Barre Syndrome

Diagnosis

An ascending paralysis, often post infectious. Botulism, tick paralysis, West Nile encephalitis and paralytic shellfish poisoning are in the differential diagnosis.

Epidemiologic Risks

See the organism in question. Prior post vaccination GBS is NOT a risk for subsequent GBS (PubMed).

Microbiology

Campylobacter has the most significant association with subsequent development of GBS. Been a long time since the influenza vaccine was implicated.

"Infection with cytomegalovirus or Epstein–Barr virus is associated with the demyelinating Guillain– Barré syndrome, whereas C. jejuni infection is associated with the axonal Guillain–Barré syndrome and with the Miller Fisher syndrome (2012 NEJM Review)."

Shingles increases risk 20 x in the next two months (PubMed) as does acute CMV.. The incidence of CMV-GBS is between 0.6 and 2.2 cases per 1000 cases of primary CMV infection versus 0.25 to 0.65 cases per 1000 cases of Campylobacter (PubMed).

Empiric Therapy

Antibiotics are not needed. Plasmapheresis and IVIG are often given for GBS.

Pearls

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

Guillain-Barré syndrome 357.0.