Embed Size (px)
GUILLIAN BARRE SYNDROME IN ETHIOPIAN PATIENTSZenebe Melaku,Guta Zenebe,Abera Bekele,2005,Ethiop Med J,43
GBS-acute inflammatory demyelinating polyradiculoneuropathy
Epidemiology: Incidence-Worldwide average annually 0.4-
1.7/100,000 popn. Race-no selection -in US blacks<<whites Etiology-unclear -usually associated with antecedent
triggering agent(infection commonly) -HIV implicated
Introduction… Pathogenesis-generally accepted
that an immune mediated process Clinical & pathologic features—
generally similar worldwide Mortality- markedly in developed
nations (20%2-3%) due to plasma exchange & intensive respiratory & cardiovascular care
Background information There was no study in Ethiopia b/r this &
published African studies were few. Black lion hospital;a 30 hospital serving
the whole country of >70 million people in the capital of Ethiopia,Addis Ababa,is selected for the study.
All GBS suspected patients other than children are admitted to internal medicine wards & MICU.
Objective of the study To describe clinical characteristics &
outcome of GBS in Ethiopian patients.
Definition used for diagnosis Based on the national institute of
Neurological & communicative disorders & stroke diagnostic criteria:
1-Progressive weakness of >1 limb due to neuropathy
2-Areflexia or hyporeflexia 3-Duration of progress <4 weeks 4-Absence of sharp sensory level on the
trunk 5-Absence of other causes of acute
neuropathy 6-<50 mononuclear leukocytes/mm3 in CSF
Study period-sept.1992-sept.2001 Study population-all patients admitted with
diagnosis of GBS Target population-those who met the specified
dxic criteria Study type-descriptive retrospective study Sampling-convenient sampling Data collection-clinical & laboratory information
from hospital records transferred into structured data sheet.
Data analysis-Epi info stat.software version 6.04
95 patients admitted with diagnosis of GBS.81 met the dxic criteria.
Sex- 55.6% M & 44.4% F Age range-13-75yrsmean34.4yrs -71.6% are <40yrs -most in age gp.30-39(37.9%)
Results… C/F--Antecedent event (58.1%)URTI(30.9%),Diarrhea (23.5%),Antecedent hx of
vaccination (3.7%anti-rabies vaccine in all cases) At the end of 1st&2nd wk~80%& 90% of pts respectively
had developed max.weakness CN palsies-commonest-facial diplegia(30.9%) -9th&10th CN involvement in(12.3%) -multiple CN palsy(12.3%) Autonomic dysfun.-BP,tachycardia,sphinicter
dysfucnction,rhythm d/o & sweating more common. EMG was done for 47 patients. Demyelinating (55.3%) ,
70.3% of 27 patients for whom serology for HIV was done were seropositive
C/f similar for both HIV+&-pts except the higher frequency of CSF pleocytosis,need for ventilatory support & mortality among HIV+
Results Specific Rx (IV Ig)given only for five(6.2%) of
the patients. None received plasmapheresis or steroids. Mortality–21/81pts(25.9%)-main causes of
death:resp.failure(4),pneumonia(5),UTI with uncontrolled sepsis(2)& sudden cardiac arrest(5)¬ specified(5).
Outcome on discharge-64.2% had partial to complete recovery.
-9.8% discharged with no change
Discussion Comparison with African studies Similar in:-higher male sex -lower mean age -time interval from onset to
maximum weakness -longer duration from onset to
admission(lack of accessibility to medical facilities)
-higher % of HIV+ -HIV+GBSinitial AIDS defining
Discussion Different in: -higher antecedent infection than
that of Tanzania& Nigeria and ~Kenya -higher mortality than Nigeria(better
intensive care).~to Tanzania & Kenya report.
-higher frequency of cranial nerve involvement
Comment Strength:-pioneer study in Ethiopian set up &
adds up to few African studies. -the selected 30
teaching hospital is better in terms of patient flow & chart registry
-the study used standard diagnostic criteria
-peaks out important defects that lead to delayed presentation,management & bad outcome
-stimulates & leaves background for future studies.
Comment Weak points: retrospective study - may miss potential candidate due to
improper registry or other reason. - may make data inadequate as to standard.
(eg-only 27 patients were found to be screened for HIV)
- the sample size is inadequate to give validated statistical analysis. (larger prospective study is needed)