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GUILLIAN BARRE SYNDROME IN ETHIOPIAN PATIENTSZenebe Melaku,Guta Zenebe,Abera Bekele,2005,Ethiop Med J,43

Introduction

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

Methodology

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

Results

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%) ,

axonal (19.1%),mixed(25.5%)

Results….

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)&not 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

illness

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)

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