First GBS death in state recorded in Solapur

The number of cases of Guillain-Barre Syndrome in Pune have risen to over a hundred, and on Sunday, Maharashtra reported the first death from the rare neurological disorder. A 40-year-old man died in Solapur, state health department said on Monday. The deceased, a native of Solapur, worked in Singhagad area of Pune and had gone back to Solapur after reporting severe gastrointestinal distress.

Guillain-Barre Syndrome (pronounced Gee-luhn-Baa Syndrome) or GBS is a rare autoimmune condition in which the immune system attacks the peripheral nerves. It leads to symptoms such as numbness, tingling, and muscle weakness that can, in many cases also lead to muscular paralysis. But it can be preceded by gastrointestinal infection as in the case of the deceased man.

According to Dr Sanjeev Thakur, dean of Solapur Government Medical College the patient was on and off ventilator support since January 18, and the clinical post mortem, prima facie, suggests GBS. “We have sent samples of the patients, including cerebrospinal fluid (CSF) to the National Institute of Virology, to understand the cause of death” he added.

Of the 101 patients accounted for so far by the Pune health department, 56 patients are in general ward, while 41 patients are admitted to the ICU. Of these 41 ICU patients, 25 are on oxygen support and 16 patients are on ventilator support. Four patients have been discharged.

Most of these cases are reported from along the Sinhgad road which gets its water supply through local wells or from Khadakwasla dam--in both cases the water is not treated, said officials from Pune Municipal Corporation. Following the surge of GBS cases, a Rapid Response Team set up by the municipality has undertaken surveillance of around 2.5 lakh homes along the most affected areas. As part of the house-to-house survey, 25,578 houses have been surveyed during which 146 cases of Acute Diarrhoea and Dysentery (ADD) have been identified, said the officials. Most of these residents come from middle class backgrounds with access to proper sanitation. The PMC water supply department had sent 283 water samples for testing, of which 182 were found potable, and 1 was found unfit for drinking. Additionally, the Public Health Department too sent 21 water samples for testing of which three were found potable and six were found unfit for consumption. Reports for another 12 water samples are awaited.

IN addition to the water samples, 23 blood samples and 73 human stool samples were sent to the National Institute of Virology (NIV), Pune. Of these 12 tested positive for Noro virus and bacterial testing also revealed positive results for Campylobacter jejuni in three human stool samples, while 12 samples were negative, and 39 reports are still pending.

Possible cause

Exposure to campylobacter jejuni (C. jejuni) bacteria is one of the most common triggers for GBS, say experts. The Union ministry of health and family welfare has constituted a seven-member team to help the state in managing the cases.

“The purpose of this team will be to work on the case definition by extensively scanning the available data. The chronology, history, clinical symptoms etc. need to be looked into to see if the cases are being correctly diagnosed,” said a senior expert, requesting anonymity. He also stressed that GBS is not an infectious disease.

According to US Centre for Disease Control, nearly one in 1000 cases of GBS is normally linked to C. Jejuni. The severity of GBS can range from very mild to severe, and as per multiple studies cases associated with C. Jejuni are usually severe.

In a 2023 paper published in ‘Springer Open’, the authors said that Campylobacter jejuni is the single most common organism found associated with GBS. “Campylobacter jejuni infection is a frequent preceding illness in GBS patients, although it may be asymptomatic…” “Preceding infections occur in around two-third of GBS cases, especially an upper respiratory tract infection or gastroenteritis… Other infectious agents include cytomegalovirus, Epstein–Barr virus, Mycoplasma pneumoniae, and Haemophilus influenza…,” they added.

Dr Manjari Tripathi, head, neurology department, AIIMS, Delhi, said GB Syndrome occurs sporadically; it doesn’t occur in an endemic manner or in clusters. “Dying due to GB syndrome is very rare in modern times because of the available medical resources. The odd thing in the Pune situation is that there is a cluster of cases which tells us there is some endemic source of this infection happening— whatever the infection is,” said Tripathi. “The source needs to be located so that people living in that cluster near that source can be removed. The commonest sources are usually water as well as food; therefore, water and food hygiene in these areas needs to be checked.”

Dr Pradyumna Oak, director, neurology, Nanavati Max Super Speciality Hospital, Mumbai, said timely medical assistance is important as the symptoms progress over 2-4 weeks. “The exact reason of the recent outbreak of GBS is yet to be ascertained but considering the quantum of cases, a food or waterborne infection such as Campylobacter jejuni can be the possible cause. Whether the cases continue to rise will depend on how soon the cause of these infections can be located and effective preventive efforts can be made to control outbreaks,” said Oak adding that his hospital treats about two to three cases of GBS every month.

Containment steps

Private practitioners in Pune have been asked to notify suspected GBS cases, and a general advisory has also been issued for public to boil water, to eat fresh food, and to keep cooked and raw food items separately.

Public health minister Prakash Abitkar visited the affected areas in Pune on Monday and told the media, “We are taking concrete steps to ensure contaminated water is not provided in these areas. Today, only one case has been reported from the most affected area of Sinhgad road.”

Suresh Annapure, joint commissioner, FDA, Pune Region, said, they had started an inspection of eateries in the affected areas, including asking them to submit reports of water testing. FDA officials are also looking at possibility of contaminated chicken and mutton. However, Dr Ankush Parihar, deputy commissioner, animal husbandry department, Pune district, said, “GBS is not a condition caused by zoonotic diseases. The source of contamination is likely to be water. Foods like chicken and mutton are traditionally cooked at high temperature that could kill bacterial contamination,” he said.