Nepali Times
Life Times
GB syndrome


In June 2011 there were reports of patients from Yuma County, Arizona, USA with Guillain Barre (GB) Syndrome. This ailment is very well known to Nepali doctors, partly because of its close association with gastroenteritis (diarrhoea). Yuma County had been an outbreak of diarrhoea caused by a bacteria called Campylobacter jejuni, the commonly implicated microorganism in immunologically triggering GB syndrome after a few days to weeks.

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.

1. sukha
what a nonsense article...who cares whether they have a case of GB syndrome in remote US town...and who cares whether it's caused by CJ or not..

dear editor, what is the point of this article? who are the target audience?
if this article is published for the sake of people living in Yuma.. then it is fine...u have heart of gold... but, if u r catering common nepali...i dont find a thing which is interesting.. and if this article is for the medicos.. then there are better books and articles..

a complete waste of time.. space and enticement...

2. hange
sukha, the point of this article is to talk about treatment of a disease that is prevalent in Nepal.  Did you even bother to read the whole article or did you just read the first sentence about Yuma?

If you call sage advice on how to avoid this disease in Nepal useless, then it is indeed useless.  Contrary to what you have stated, the article is not for medicos: it's for common people to learn how to prevent, detect, and treat this scourge.  Frankly, your comment was a complete waste of time and space.  Enticement?  Perhaps you would be best served by learning how to write as well as how to read.

3. Ashok
Thank you for the informative article. GB syndrome bears a personal relevlance to me and my family as my first cousin succumbed to the disease in Nepal few years ago. Within a matter of few weeks, he turned to a bed ridden, ventilator supported patient from a hale and hearty, healthy lad and finally passed away. I have often wondered whether he would have survived had he not been in Nepal and have not really found any convincing answers. From Pokhara, he was referered to TU hospital in KTM and it seemed like the particula disease was a complete enigma to the doctors themselves, let alone us the family members who had never heard of it. I also often feel, more than treatment, the doctors who were supposed to treat him, experimented ways of treating GB syndrome by using various medications and hoping for the best.

4. heyprabhu
Well said "hange".

If you want to criticise something, do it respectfully, like an intellectual that you consider yourself to be.

5. sukha

@hange� thanks for making me to get back to the drawing board

the article really hits me� yah, plz believe me�it lucidly explains the treatment, management and prevention of GB syndrome�this is such a important  and common public health issue in the country...thanks for bringing it out�

Now, it is time to write about other problems associated with diarrhea.. like Escherichia coli O157:H7 infection, hemolytic uremic syndrome, irritable bowel syndrome, secondary lactose intolerance� and�

The published picture showing a hand with tendons and muscles also helps to understand the benefit of hand washing in the prevention of GB syndrome�

This article is really a cracker�

Sometimes,  I wish I was in the payroll of the board to write comments�

6. Excellent article as always!
Sukha, let me tell you I being a doctor in one of the busiest hospitals in the capital, come across too many cases of GB. I believe that the general public should be made aware of GB. I must say Dr. Basnyat has yet again done a fine job in delivering the message with his lucid style of writing. And who says he doesn't write about other common and prevailing diseases on the column, haven't you been reading the previous ones? If not be sure to read the upcoming ones....I'm sure there is much more to come!
Hey Sukha don't give yourself too much Dukha and blabber nonsense making a fool out of yourself!

7. Thomas

I for one thought the article was very appropriate for the general public in Nepal, as well as for Nepali doctors, as it would raise awareness of a syndrome that presents as a mystery ailment to many professionals as well as laymen.  About 10 years ago a relative in Nepal was struck with GB syndrome, and the treatments prescribed by a number of doctors at several Kathmandu hospitals ranged from innocuous but unnecessary to downright dangerous.  When the family presented the primary care physician with detailed information from overseas about GB and how the symptoms being seen were a perfect match for the syndrome, the response was to ridicule the patient for having the temerity to suggest they might know more than the doctor about this particular condition.  It helped our relative immensely to know the prognosis for their condition, and enabled them to avoid medication that might have made the situation much worse, and Dr. Basnyat's article will hopefully have similar and much broader effects.

This article was also beneficial to this reader for the information provided on the link between GB syndrome and diarrhoea.

(11 JAN 2013 - 17 JAN 2013)