Search

Background: Guillain-Barré syndrome (GBS) causes acute neuromuscular weakness. Severe cases are life-threatening and many are left disabled. Intravenous immunoglobulin (IVIg) and plasma exchange (PE), along with supportive care, are the mainstays of treatment. Treatment choice is influenced by multiple factors. The clinico-epidemiological features of GBS in Australia have not been reviewed in 30 years and few studies have assessed contemporary treatment choices., Aims: To investigate the clinico-epidemiological features, choice of treatment, clinical course and outcomes of GBS patients in an Australian tertiary metropolitan hospital., Methods: A retrospective observational study was performed of GBS presentations to a tertiary hospital in Sydney, Australia, over 5 years. Clinico-epidemiological features, treatment choices, clinical course and outcomes were assessed., Results: We reviewed 46 GBS patients (54% male), average age 55 years. Antecedent infection was identified in 61%. Twenty-eight per cent had preceding immunogenic events or conditions. Acute inflammatory demyelinating polyradiculoneuropathy was the most common subtype (78%). Cerebrospinal fluid albumino-cytologic dissociation was present in 43%. Electrodiagnostic testing most frequently demonstrated demyelination (64%). Ninety-eight per cent received immunotherapy, mostly IVIg (93%). Twenty-two per cent received further treatment due to treatment-related fluctuations or lack of improvement. Thirteen per cent required ICU admission and 46% needed rehabilitation. There were no deaths or need for mechanical ventilation. Seventy-one per cent of the follow-up cohort had residual disability at 6 months, but this was generally mild., Conclusions: The clinico-epidemiological features are consistent with previous cohorts. Our experience in a large Australian tertiary centre demonstrates a clear preference for IVIg over PE., (© 2019 Royal Australasian College of Physicians.)

Purpose: To describe characteristics, incidence and outcome of patients with Guillain-Barre syndrome (GBS) admitted to ICU., Methods: We conducted a binational, retrospective, observational, epidemiological study. We compared the baseline characteristics, physiological conditions and outcomes for GBS patients with or without mechanical ventilation (MV) and of survivors and non-survivors., Results: We studied 711 patients admitted to 173 ICUs between 2005 and 2015. We found an increasing proportion of GBS admissions per year (P < 0.03). 237 patients required MV. These patients had higher APACHE III scores (47 vs 31), worse PaO 2 /FiO 2 ratio (P/F 258 v 341), a significantly longer ICU LOS (25 v 4 days) (P < 0.0001, all comparisons) and a greater incidence of pre-ICU cardio-respiratory arrest (6.7% v 1.2%). Similarly, non-survivors were 5-times more likely to have experienced a pre-ICU cardio-respiratory arrest. Overall, ICU and hospital mortality were 3.9% and 6.9%, respectively and increased to 9.7% and 14.3% in the MV group. MV patients remained in hospital for almost 40 days., Conclusion: GBS represents a small but increasing proportion of ICU admissions with one-third of patients receiving MV. Overall in-hospital mortality is relatively low but doubles if MV is needed. These observations provide important prognostic information to clinicians involved in the care of these patients., (Copyright © 2018. Published by Elsevier Inc.)

Context: Tick paralysis is a neurotoxic envenoming that mimics polio and primarily afflicts children, especially in hyperendemic regions of the Western United States of America (US) and Eastern Australia., Objective: To compare the epidemiology, clinical and electrodiagnostic manifestations, and outcomes of tick paralysis in the US versus Australia., Methods: A comparative meta-analysis of the scientific literature was conducted using Internet search engines to identify confirmed cases of tick paralysis in the US and Australia. Continuous variables including age, time to tick removal, and duration of paralysis were analyzed for statistically significant differences by unpaired t-tests; and categorical variables including gender, regional distribution, tick vector, tick attachment site, and misdiagnosis were compared for statistically significant differences by chi-square or Fisher exact tests., Results: Tick paralysis following ixodid tick bites occurred seasonally and sporadically in individuals and in more clusters of children than in adults of both sexes in urban and rural locations in North America and Australia. The case fatality rate for tick paralysis was low, and the proportion of misdiagnoses of tick paralysis as Guillain-Barré syndrome (GBS) was greater in the US than in Australia. Although electrodiagnostic manifestations were similar, the neurotoxidromes differed significantly with prolonged weakness and even residual neuromuscular paralysis following tick removal in Australian cases compared with US cases., Discussion: Tick paralysis was a potentially lethal envenoming that occurred in children and adults in a seasonally and regionally predictable fashion. Tick paralysis was increasingly misdiagnosed as GBS during more recent reporting periods in the US. Such misdiagnoses often directed unnecessary therapies including central venous plasmapheresis with intravenous immunoglobulin G that delayed correct diagnosis and tick removal., Conclusion: Tick paralysis should be added to and quickly excluded from the differential diagnoses of acute ataxia with ascending flaccid paralysis, especially in children living in tick paralysis-endemic regions worldwide.