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Campylobacter bacteria is one of the well-known causes of diarrhoea in Nepal, and so it is not surprising that GB syndrome which presents with weakness of the legs is seen in Nepal. It is important to emphasise that only a small minority of patients with Campylobacter gastroenteritis suffer from GB syndrome. Obviously if we kept meticulous notes and had proper disease surveillance in place, we would indeed be able to pick up GB syndrome cases and possibly trace them to gastroenteritis outbreaks.
The weakness in both the legs can slowly creep up to the chest and face. In the chest the weakness may interfere with breathing, and hence GB syndrome patients need close monitoring. Most patients make a good recovery, but this may take months. Steroids are often prescribed, but they are useless. There are two modes of treatment: Plasmapharesis entails removal of the troublesome antibodies in the plasma by a special machine. Intravenous immunoglobulin administration is the other therapeutic method. Both are very effective, expensive, and seldom available here. We have to make sure that the patient has ventilator support if the need should arise, as just competently dealing with the symptoms is often not good enough.
Since ventilators are not available in many areas of Nepal prevention of GB syndrome becomes paramount, which means avoiding diarrhoea even though not all GB syndrome needs a trigger like campylobacter, induced diarrhoea. Indeed, GB syndrome can happen spontaneously, but there are reports that patients with the GB syndrome associated with campylobacter have a worse prognosis.
Washing hands with soap and water, drinking boiled water, treating salad with chlorine or iodine tablets dissolved in water before consumption, and avoiding restaurant food cooked the previous day and kept without refrigeration (what with power cuts) become crucial in the context of Nepal to try to avoid even that small chance of acquiring the GB Syndrome.
