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Archive | December 2018

How the flu can be dangerous to your health to deadly.

As of January 2018 here is what was factual about the flu:
Flu season January 2018 was off to an early — and severe — start, with rates of hospitalizations and deaths from flu higher than what’s typical for this time of year.
December 14, 2018 by Steven Reinberg, Healthday Reporter. (HealthDay)—Flu season is getting off to a slow but steady start, a U.S. health official said Friday

As of than, only Georgia is seeing high levels of infections, but cases are being reported throughout the nation.

“Flu activity now is still fairly low, but as expected we have been seeing activity slowly increasing over the last few weeks,” said Alicia Budd, an epidemiologist at the U.S. Centers for Disease Control and Prevention.

It’s too soon to tell how bad this year’s flu season will be. “Unfortunately, we don’t have a crystal ball to know how badly we are going to fare during this flu season,” Budd said.

Peak activity can occur anytime between December and February, she said.  So we are not out of the clinch with the Flu time at its time of peak.  The most common type of flu around now is influenza A H1N1, which is accounting for about 80 percent of the flu viruses being reported, Budd said.

In addition, another A strain, H3N2, is also being seen, making up about 20 percent of the viruses reported, she said.

“H3N2 is out there, but at much lower levels than we saw last year,” Budd said. It was that strain that made flu so severe last year, when 1 million people were hospitalized and 80,000 died.

Both of these types of flu are included in this season’s flu vaccine, as well as one or two influenza B strains. This year’s vaccine seems well matched to these strains, so it will most likely be more effective than last year’s vaccine, Budd said.

Because H1N1 is the predominant flu strain around now, she thinks the vaccine’s effectiveness could be as high as 65 percent.

It’s not too late to get vaccinated, Budd said. If you haven’t gotten a flu shot, it’s time, she said. It can take up to two weeks for your body to mount a protective immune response.

The most common type of flu around now is influenza A H1N1, which is accounting for about 80 percent of the flu viruses being reported, Budd said.

But why is the flu so bad this year?

During the week that ended Dec. 30 2017 (the most recent period for which data is available), 46 states reported widespread flu activity, up from 36 states the week before, according to the U.S. Centers for Disease Control and Prevention (CDC). At this time 2017 last year, just 12 states reported widespread flu activity.

What’s more, the rate of flu hospitalizations from the beginning of October to the end of December 2017 was about 14 hospitalizations per 100,000 people, according to CDC data. The rate was highest among adults ages 65 and older, at about 57 hospitalizations per 100,000 people. At the time Jan 2017, the rate of flu hospitalizations was just 5 hospitalizations per 100,000 people.

The flu is notoriously unpredictable, with the timing, severity and length of flu season varying from year to year, according to the CDC. [6 Flu Vaccine Myths]

But the relatively harsh season the U.S. is currently having is likely related to the particular flu strains that are circulating, said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

“This year is particularly bad because it’s dominated by the H3N2 [flu strain], which tends to be more severe and causes more severe symptoms than other strains of flu,” Adalja told Live Science. Indeed, flu seasons in which the H3N2 strain predominates tend to have higher overall flu hospitalization and death rates, according to the CDC.

Officials can’t predict what the final outcome for flu season will be this year in terms of illnesses, hospitalizations and deaths, but Adalja suspects it will be a notable one.

“I don’t know what the final tally will be in this flu season, [but] I suspect it will be one of the worst ones we’ve had in recent years,” Adalja said.

Another factor that may affect the severity of a flu season is whether the flu strains included in the yearly flu shot match the ones circulating in the public. So far this year, the circulating flu strains do appear to match the flu strains that were selected for the vaccine, according to a recent CDC report.

However, to make the flu vaccine, manufacturers typically use chicken eggs to “grow” the flu virus strains. During this process, the flu strains may acquire genetic changes that make the strains slightly different from those in circulation.

“You don’t end up with the same vaccine viruses that you started with” because of these genetic changes, Adalja said. This appears to have happened with the H3N2 component of this year’s flu vaccine, according to the CDC, and the changes may lower the effectiveness of the vaccine.

Researchers are finding that yearly flu shots are typically less effective against H3N2, compared with other strains of flu. A study published in 2016 found that, from 2004 to 2015, the flu shot was only 33 percent effective against H3N2 viruses, compared with 61 percent effective against H1N1 and 54 percent effective against influenza B viruses, which are another strain. This may be because, compared with other flu viruses, H3N2 viruses are more likely to acquire genetic changes that impact the effectiveness of the vaccine, the CDC said.

Health officials still recommend a yearly flu vaccine for everyone ages 6 months and older, because it’s still the best way to prevent flu. And studies have found that, even if a person does catch the flu, their illness is milder if they’ve been vaccinated. “Even lower levels of protection” are better than none, Adalja said.

The virus can directly cause death, Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore, told Live Science in 2016. This occurs when the flu virus causes such overwhelming inflammation in a person’s lungs that they die due to respiratory failure. Severe damage to the lungs makes it impossible for enough oxygen to pass through the lung tissue into the blood, leading to death. [Flu Shot Facts & Side Effects (Updated for 2017-2018)]

When someone dies directly from the flu, it happens very quickly, Adalja added.

The flu can also kill indirectly, meaning that the virus makes a person more susceptible to other health problems, and these health problems lead to death. For example, getting sick with the flu can make certain groups of people, such as older adults and people with chronic illnesses, more susceptible to bacteria that cause pneumonia, according to the Mayo Clinic. “Pneumonia is the most serious complication” of the flu and can be deadly, the Mayo Clinic says.

When a person with the flu gets pneumonia, the pneumonia is considered a secondary bacterial infection, Adalja said. (Pneumonia can be caused by either a virus or bacteria; in the case of a secondary infection after flu, it is caused by bacteria.) Death from such secondary infections usually occurs about a week or so after the person first got sick, because it takes time for the secondary infection to set in, Adalja said.

The flu can lead to death in other ways as well. People with the flu can experience “multiple organ failure” throughout their body (in order words, multiple organs stop working properly), which can be deadly, Adalja said.

The flu can also trigger other serious complications, including inflammation of the heart, brain or muscle tissues, according to the CDC. Infection can also lead to an extreme, body-wide inflammatory response known as sepsis, which can be life-threatening, the CDC says.

The 2017–2018 flu season has been particularly harsh, partially because the predominant strain of flu that’s spreading, H3N2, tends to cause more severe symptoms than other strains, Live Science reported the month of January 2018. And although the flu strains circulating this year do match up with those covered in the season’s flu vaccine, an odd phenomenon may have occurred during the vaccine-making process inside chicken eggs. During that process, flu strains can acquire genetic changes, and this may have happened for the H3N2 component of the vaccine, Adalja said previously.

We have not reached the end of February 2019 yet, so at this point by CDC they state the following:

“Influenza activity in the United States during the 2017–2018 season began to increase in November and remained at high levels for several weeks during January–February5. While influenza A(H3N2) viruses predominated through February, and were predominant overall for the season, influenza B viruses were more commonly reported starting in March, 2018. The season had high severity with unusually high levels of outpatient influenza-like illness, hospitalizations rates, and proportions of pneumonia and influenza-associated deaths.

CDC estimates that the burden of illness during the 2017–2018 season was also high with an estimated 48.8 million people getting sick with influenza, 22.7 million people going to a health care provider, 959,000 hospitalizations, and 79,400 deaths from influenza (Table 1). The number of cases of influenza-associated illness that occurred last season was the highest since the 2009 H1N1 pandemic, when an estimated 60 million people were sick with influenza6.

The 2017–2018 influenza season was additionally atypical in that it was severe for all ages of the population5. The burden of influenza and the rates of influenza-associated hospitalization are generally higher for the very young and the very old, and while this was also true during the 2017–2018 season, rates of hospitalization in all age groups were the highest seasonal rates seen since hospital-based surveillance was expanded in 2005 to include all ages (Table 2). This translated into an estimated 11.5 million cases of influenza in children, 30 million cases of influenza in working age adults (aged 18-64 years), and more than 7.3 million cases in adults aged 65 years and older.

Our estimates of hospitalizations and mortality associated with the 2017–2018 influenza season continue to demonstrate how severe influenza virus infection can be. We estimate overall, there were 959,000 hospitalizations and 79,400 deaths during the 2017–2018 season. More than 48,000 hospitalizations occurred in children (aged < 18 years); however, 70% of hospitalizations occurred in older adults aged ≥65 years. Older adults also accounted for 90% of deaths, highlighting that older adults are particularly vulnerable to severe disease with influenza virus infection. An estimated 10,300 deaths occurred among working age adults (aged 18–64 years), an age group that often has low influenza vaccination.

What does this all mean?  Get the Influenza Vaccine for PREVENTION of the flu and Prevention of an Epidemic rising.  Help yourself and community!

References: CDC Centers for Disease Control and Prevention & Health Day

 

QUOTE FOR TUESDAY:

Influenza Pandemics: “The 1889–1890 flu pandemic, also known as Russian Flu, had a very high attack and mortality rate, causing around a million fatalitiesTotal mortality attributable to the 1918 Spanish Flu was probably around 40 million.  The “Asian Flu”, 1957–58. An H2N2 virus caused about 70,000 deaths in the United States.  First seen in China late Feb 1957 caused about 2 million deaths globally.  The “Hong Kong Flu”, 1968–69. An H3N2 caused about 34,000 deaths in the United States & killed approximately one million people worldwide .  In the spring of 2009, a novel influenza A (H1N1) virus emerged. It was detected first in the United States and spread quickly across the United States and the world. This new H1N1 virus contained a unique combination of influenza genes not previously identified in animals or people. This virus was designated as influenza A (H1N1)pdm09 virus. The (H1N1)pdm09 virus was very different from H1N1 viruses that were circulating at that time; vaccination with seasonal flu vaccines thus offered little cross-protection against (H1N1)pdm09 virus infection. While a monovalent (H1N1)pdm09 vaccine was produced, it was not available in large quantities until late November, which was after the peak of illness during the second wave had come and gone in the United States. From April 12, 2009 to April 10, 2010, CDC estimated that there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (195,086-402,719), and 12,469 deaths (8868-18,306) in the United States due to the (H1N1)pdm09 virus.* CDC estimated that between 151,700 and 575,400 people worldwide died from 2009 H1N1 virus infection during the first year the virus circulated.”

Centers for Disease Control and Prevention

Know the history (epidemics) to the present about Influenza and why the vaccine is so important, especially in preventing epidemics!

Influenza A (H1N1), Influenza A (H3N2), and one or two influenza B viruses (depending on the vaccine) are included in each year’s influenza vaccine now.

How Influenza even got started to now:

Influenza was discovered not by a direct study of the disease in humans, but rather from studies on animal diseases. In 1918, J.S. Koen, a veterinarian, observed a disease in pigs which was believed to be the same disease as the now famous “Spanish” influenza pandemic of 1918.

In the 20th century, three influenza pandemics occurred: Spanish influenza in 1918 (~50 million deaths), Asian influenza in 1957 (two million deaths), and Hong Kong influenza in 1968 (one million deaths).  The World Health Organization declared an outbreak of a new type of influenza A/H1N1 to be a pandemic in June 2009.  Influenza may also affect other wild life which are horses, chickens and birds along with the pigs. In late 1917, military pathologists reported the onset of a new disease with high mortality that they later recognized as the flu. The overcrowded camp and hospital — which treated thousands of victims of chemical attacks and other casualties of war — was an ideal site for the spreading of a respiratory virus; 100,000 soldiers were in transit every day. It also was home to a live piggery, and poultry were regularly brought in for food supplies from surrounding villages. Oxford and his team postulated that a significant precursor virus, harbored in birds, mutated so it could migrate to pigs that were kept near the front.

Influenza A virus subtype H5N1, also known as A(H5N1) or simply H5N1, is a subtype of the influenza A virus which can cause illness in humans and many other animal species.  A bird-adapted strain of H5N1, called HPAI A(H5N1) for highly pathogenic avian influenza virus of type A of subtype H5N1, is the highly pathogenic causative agent of H5N1 flu, commonly known as avian influenza (“bird flu“).  It is enzootic (maintained in the population) in many bird populations, especially in Southeast Asia.

CDC Centers for Disease Control blog site states, “There are four types of influenza viruses: A, B, C and D. Human influenza A and B viruses cause seasonal epidemics of disease almost every winter in the United States. The emergence of a new and very different influenza A virus to infect people can cause an influenza pandemic. Influenza type C infections generally cause a mild respiratory illness and are not thought to cause epidemics. Influenza D viruses primarily affect cattle and are not known to infect or cause illness in people.

Influenza A viruses can be further broken down into different strains. Current subtypes of influenza A viruses found in people are influenza A (H1N1) and influenza A (H3N2) viruses. In the spring of 2009, a new influenza A (H1N1) virus (CDC 2009 H1N1 Flu website) emerged to cause illness in people. This virus was very different from the human influenza A (H1N1) viruses circulating at that time. The new virus caused the first influenza pandemic in more than 40 years. That virus (often called “2009 H1N1”) has now replaced the H1N1 virus that was previously circulating in humans.

Influenza B viruses are not divided into subtypes, but can be further broken down into lineages and strains. Currently circulating influenza B viruses belong to one of two lineages: B/Yamagata and B/Victoria. Unlike type A flu viruses, type B flu is found only in humans. Type B flu may cause a less severe reaction than type A flu virus, but occasionally, type B flu can still be extremely harmful. Influenza type B viruses are not classified by subtype. However, influenza B viruses do not cause pandemics.

CDC follows an internationally accepted naming convention for influenza viruses. This convention was accepted by WHO in 1979 and published in February 1980 in the Bulletin of the World Health Organization, 58(4):585-591 (1980) (see A revision of the system of nomenclature for influenza viruses: a WHO Memorandum[854 KB, 7 pages]). The approach uses the following components:

  • The antigenic type (e.g., A, B, C)
  • The host of origin (e.g., swine, equine, chicken, etc. For human-origin viruses, no host of origin designation is given.)
  • Geographical origin (e.g., Denver, Taiwan, etc.)
  • Strain number (e.g., 15, 7, etc.)
  • Year of isolation (e.g., 57, 2009, etc.)
  • For influenza A viruses, the hemagglutinin and neuraminidase antigen description in parentheses (e.g., (H1N1), (H5N1)

For example:

  • A/duck/Alberta/35/76 (H1N1) for a virus from duck origin
  • A/Perth/16/2009 (H3N2) for a virus from human origin

Getting a flu vaccine can protect against flu viruses that are the same or related to the viruses in the vaccine. Information about this season’s vaccine can be found at Preventing Seasonal Flu with Vaccination. The seasonal flu vaccine does not protect against influenza C viruses. Additionally, flu vaccines will NOT protect against infection and illness caused by other viruses that also can cause influenza-like symptoms. There are many other non-flu viruses that can result in influenza-like illness (ILI) that spread during flu season.  If people got vaccines high odds there would be less influenza spreading throughout the country you live in or globally with travelers for both pleasure and business.

  • Flu vaccines have been updated to better match circulating viruses [the B/Victoria component was changed and the influenza A(H3N2) component was updated].
  • For the 2018-2019 season, the nasal spray flu vaccine (live attenuated influenza vaccine or “LAIV”) is again a recommended option for influenza vaccination of persons for whom it is otherwise appropriate. The nasal spray is approved for use in non-pregnant individuals, 2 to 49 years old. There is a precaution against the use of LAIV for people with certain underlying medical conditions. All LAIV will be quadrivalent (four-component).”

 

PMC U.S. National Library of Medicine (National Institutes of Health) states, “the announcement in 2005 that a virus causing fatal influenza during the great influenza pandemic of 1918–1919 had been sequenced in its entirety [], in the laboratory of co-author JKT, has prompted renewed interest in the 1918 virus. The ongoing H5N1 avian influenza epizootic, and the possibility that it might also cause a pandemic [], increase the importance of understanding what happened in 1918. However, in reviewing the scientific approach to unlocking an old puzzle, it is important to note that the sequencing of the 1918 virus took place after more than century of exhaustive and sometimes disheartening efforts to discover the cause of influenza (Figure 1). Indeed, the influenza search not only pre-dated the great pandemic of 1918, but also attracted the efforts of some of the greatest researchers of the 19th and 20th centuries. Along the way, the new fields of bacteriology and virology were advanced, and a productive marriage between microbiology, epidemiology and experimental science began. In describing here the 10-year effort (1995–2005) to sequence the genome of the 1918 pandemic influenza virus, we attempt also to place it within this important historical perspective.”

Influenza virus C is a genus in the virus family Orthomyxoviridae, which includes the viruses that cause influenza.  Nearly all adults have been infected with influenza C virus, which causes mild upper respiratory infections. Cold-like symptoms are associated with the virus including fever (38-40ᵒC=100.4 to 104F), dry cough, rhinorrhea (nasal discharge), headache, muscle pain, and achiness. The virus may lead to more severe infections such as bronchitis and pneumonia.  Lower tract complications are rare.  There is no vaccine against influenza C virus.

The species in this genus is called Influenza C virus. Influenza C viruses are known to infect humans and pigs.

Influenza D viruses primarily affect cattle and are not known to infect or cause illness in people.

QUOTE FOR MONDAY:

“1. Choose age appropriate toys by reading the age label on the toy. For children younger than 3, avoid toys with small parts, which can cause choking. In particular avoid deflated or broken balloons, small parts or small balls.  2. Scooters and other riding toys – Riding toys, skateboards and in-line skates go fast, and falls could be deadly. Helmets & safety gear always WEAR.  3.)Whether marketed for children or adults, building and play sets with small magnets should also be kept away from small children (prevents magnets from being swallowed). ”

On Safety (onsafety.cpsc.gov)

Safe Toys and Gift National Month

Bebé mordiendo juguete

Toys and games are tons of fun for kids and adults. Whether your kids are working on a puzzle, playing with building blocks or even inventing their own games, here are a few things to think about to help them stay safer and have a blast.

The Hard Facts

In 2011, 188,400 children under the age of 15 years were seen in emergency departments for toy-related injuries. That’s 516 kids every day. More than a third of those injured were children 5 and under.

Toys are the treasures of childhood. But if you’re not careful, toys can be hazardous, too.

According to the U.S. Consumer Product Safety Commission (CPSC), more than 250,000 toy-related injuries were treated in U.S. hospital emergency rooms in 2015. Of those, about one-third involved kids under 5.

To keep your child safe, follow these guidelines when choosing toys.

  • Pick age-appropriate toys. Most toys show a “recommended age” sticker, which can be used as a starting point in the selection process. Be realistic about your child’s abilities and maturity level when choosing an age-appropriate toy. Toys that have projectiles, for example, are never suitable for a child under age 4 – and even some 6-year-olds aren’t mature enough to handle them. Likewise, if your 3-year-old still puts everything into her mouth, wait a little longer to give her toys and games with small parts and pieces.
  • Consider your child’s age when purchasing a toy or game. It’s worth a second to read the instructions and warning labels to make sure it’s just right for your child.
  • Choose toys that are well-made. Used toys passed down from older relatives or siblings or bought at yard sales can be worn or frayed, which can sometimes be dangerous. Check all toys – new or used – for buttons, batteries, yarn, ribbons, eyes, beads, and plastic parts that could easily be chewed or snapped off. Make sure a stuffed animal’s tail is securely sewn on and the seams of the body are reinforced. Parts on other toys should be securely attached. Make sure there are no sharp edges and the paint is not peeling.   Before you’ve settled on the perfect toy, check to make sure there aren’t any small parts or other potential choking hazard.
  • Think big. Until your child turns 3, toy parts should be bigger than his mouth to prevent the possibility of choking. To determine whether a toy poses a choking risk, try fitting it through a toilet paper roll. If a toy or part of a toy can fit inside the cylinder, it’s not safe.  Keep a special eye on small game pieces that may be a choking hazard for young children. While these kinds of games are great for older kids, they can pose a potential danger for younger, curious siblings.
  • Make sure your child is physically ready for the toy. For example, parents of older kids may buy a bike one size too big so as not to have to buy a new bike the next year. This tactic can lead to serious injury if a child doesn’t have the physical skills to control the bigger bike.
  • Skip the balloons. They may be cheerful party decorations and fun to bounce around, but latex balloons are the main cause of toy-related choking fatalities in children. When ingested, uninflated balloons (or pieces of burst balloons) can form a tight seal in a child’s airway and make it impossible to breathe.
  • Don’t pick heavy toys. Could your child be harmed if it fell on her? If so, pass.

Top Tip:

  1. After play time is over, use a bin or container to store toys for next time. Make sure there are no holes or hinges that could catch little fingers.

QUOTE FOR THE WEEKEND:

 

“Most people recover fully from even the most severe cases of Guillain-Barré syndrome.  Severe cases of Guillain-Barré syndrome are rare, but can result in near-total paralysis.”

World Health Organization

 

Part III Guillain Barre Syndrome (GBS)

                                         

Medical Management: Patients with Guillain-Barre syndrome will be hospitalized initially (medical emergency). It is important to monitor the individual s respiration carefully. If breathing problems are severe he/she may be placed in an ICU (intensive care unit) and put on a ventilator. According to the National Health Service, the two main initial treatment options for Guillain-Barre syndrome are intravenous immunoglobulin, which is safer and easier to give, or plasmapheres (plasma exchange).

How is Guillain-Barré syndrome diagnosed?

The initial signs and symptoms of GBS are varied and there are several disorders with similar symptoms.  Therefore, doctors may find it difficult to diagnose GBS in its earliest stages.

Physicians will note whether the symptoms appear on both sides of the body (the typical finding in Guillain-Barré syndrome) and the speed with which the symptoms appear (in other disorders, muscle weakness may progress over months rather than days or weeks). In GBS, deep tendon reflexes in the legs, such as knee jerks, are usually lost. Reflexes may also be absent in the arms. Because the signals traveling along the nerve are slow, a nerve conduction velocity test (NCV, which measures the nerve’s ability to send a signal) can provide clues to aid the diagnosis. There is a change in the cerebrospinal fluid that bathes the spinal cord and brain in people with GBS. Researchers have found the fluid contains more protein than usual but very few immune cells (measured by white blood cells). Therefore, a physician may decide to perform a spinal tap or lumbar puncture to obtain a sample of spinal fluid to analyze. In this procedure, a needle is inserted into the person’s lower back and a small amount of cerebrospinal fluid is withdrawn from the spinal cord. This procedure is usually safe, with rare complications.

Key diagnostic findings include:

  • Recent onset, within days to at most four weeks of symmetric weakness, usually starting in the legs
  • Abnormal sensations such as pain, numbness, and tingling in the feet that accompany or even occur before weakness
  • Absent or diminished deep tendon reflexes in weak limbs
  • Elevated cerebrospinal fluid protein without elevated cell count.This may take up to 10 days from onset of symptoms to develop.
  • Abnormal nerve conduction velocity findings, such as slow signal conduction
  • Sometimes, a recent viral infection or diarrhea.

How is Guillain-Barré treated?

There is no known cure for Guillain-Barré syndrome. However, some therapies can lessen the severity of the illness and shorten recovery time. There are also several ways to treat the complications of the disease.

Because of possible complications of muscle weakness, problems that can affect any paralyzed person (such as pneumonia or bed sores) and the need for sophisticated medical equipment, individuals with Guillain-Barré syndrome are usually admitted and treated in a hospital’s intensive care unit.

Acute care

There are currently two treatments commonly used to interrupt immune-related nerve damage. One is plasma exchange (PE, also called plasmapheresis); the other is high-dose immunoglobulin therapy (IVIg). Both treatments are equally effective if started within two weeks of onset of GBS symptoms, but immunoglobulin is easier to administer. Using both treatments in the same person has no proven benefit.

In the process of plasma exchange, a plastic tube called a catheter is inserted into the person’s veins, through which some blood is removed. The blood cells from the liquid part of the blood (plasma) are extracted and returned to the person. This technique seems to reduce the severity and duration of the Guillain-Barré episode. Plasma contains antibodies and PE removes some plasma; PE may work by removing the bad antibodies that have been damaging the nerves.

Immunoglobulins are proteins that the immune system naturally makes to attack infecting organisms. IVIg therapy involves intravenous injections of these immunoglobulins. The immunoglobulins are developed from a pool of thousands of normal donors. When IVIg is given to people with GBS, the result can be a lessening of the immune attack on the nervous system. The IVIg can also shorten recovery time. Investigators believe this treatment also lowers the levels or effectiveness of antibodies that attack the nerves by both “diluting” them with non-specific antibodies and providing antibodies that bind to the harmful antibodies and take them out of commission.

Miller-Fisher syndrome that is a rare, acquired nerve disease that is considered to be a variant of Guillain-Barré syndrome, is also treated with plasmapheresis and IVIg.

Anti-inflammatory steroid hormones called corticosteroids have also been tried to reduce the severity of Guillain-Barré syndrome. However, controlled clinical trials have demonstrated that this treatment is not effective.

Supportive care is very important to address the many complications of paralysis as the body recovers and damaged nerves begin to heal. Respiratory failure can occur in GBS, so close monitoring of a person’s breathing should be instituted initially. Sometimes a mechanical ventilator is used to help support or control breathing. The autonomic nervous system (that regulates the functions of internal organs and some of the muscles in the body) can also be disturbed, causing changes in heart rate, blood pressure, toileting, or sweating. Therefore, the person should be put on a heart monitor or equipment that measures and tracks body function. Occasionally GBS-related nerve damage can lead to difficulty handling secretions in the mouth and throat. In addition to the person choking and/or drooling, secretions can fall into the airway and cause pneumonia.

Rehabilitative care

As individuals begin to improve, they are usually transferred from the acute care hospital to a rehabilitation setting. Here, they can regain strength, receive physical rehabilitation and other therapy to resume activities of daily living, and prepare to return to their pre-illness life.

Complications in GBS can affect several parts of the body. Often, even before recovery begins, caregivers may use several methods to prevent or treat complications. For example, a therapist may be instructed to manually move and position the person’s limbs to help keep the muscles flexible and prevent muscle shortening. Injections of blood thinners can help prevent dangerous blood clots from forming in leg veins. Inflatable cuffs may also be placed around the legs to provide intermittent compression. All or any of these methods helps prevent blood stagnation and sludging (the buildup of red blood cells in veins, which could lead to reduced blood flow) in the leg veins. Muscle strength may not return uniformly; some muscles that get stronger faster may tend to take over a function that weaker muscles normally perform—called substitution. The therapist should select specific exercises to improve the strength of the weaker muscles so their original function can be regained.

Occupational and vocational therapy help individuals learn new ways to handle everyday functions that may be affected by the disease, as well as work demands and the need for assistive devices and other adaptive equipment and technology.

What is the long-term outlook for those with GBS?

Guillain-Barré syndrome can be a devastating disorder because of its sudden and rapid, unexpected onset of weakness—and usually actual paralysis. Fortunately, 70% of people with GBS eventually experience full recovery. With careful intensive care and successful treatment of infection, autonomic dysfunction and other medical complications, even those individuals with respiratory failure usually survive.

Typically, the point of greatest weakness occurs days to at most 4 weeks after the first symptoms occur. Symptoms then stabilize at this level for a period of days, weeks, or, sometimes months. Recovery, however, can be slow or incomplete. The recovery period may be as little as a few weeks up to a few years. Some individuals still report ongoing improvement after 2 years. About 30 percent of those with Guillain-Barré have residual weakness after 3 years. About 3 percent may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack. About 15 percent of individuals experience long-term weakness; some may require ongoing use of a walker, wheelchair, or ankle support. Muscle strength may not return uniformly.

Ongoing fatigue, pain, and other annoying sensations can sometimes be troublesome. Fatigue is best handled by pacing activities and providing time for rest when fatigue sets in. Those with Guillain-Barré syndrome face not only physical difficulties, but emotionally painful periods as well. It is often extremely difficult for individuals to adjust to sudden paralysis and dependence on others for help with routine daily activities. Individuals sometimes need psychological counseling to help them adapt. Support groups can often ease emotional strain and provide valuable information.

QUOTE FOR FRIDAY:

May 18, 2018 – The exact cause of GuillainBarre syndrome isn’t known. … In AIDP, the most common form of GuillainBarre syndrome in the U.S., the nerves‘ protective covering (myelin sheath) is damaged. The damage prevents nerves from transmitting signals to your brain, causing weakness, numbness or paralysis.

MAYO CLINIC

Part II Guillain-Barré syndrome GBS

Understanding how nerve damage occurs:

Various ideas have been proposed to explain how GBS develops. One explanation is known as the “molecular mimicry/innocent bystander” theory. According to this explanation, molecules on some nerves are very similar to or mimic molecules on some microorganisms. When those microbes infect someone, the immune system correctly attacks them. And if the microbe and myelin look similar, the immune system makes a mistake and attacks the myelin.

Different mechanisms may explain how the molecular mimicry concept may work.  When Guillain-Barré syndrome is preceded by a viral or bacterial infection, it is possible that the infecting agent has changed the chemical structure of some nerves. The immune system treats these nerves as foreign bodies and mistakenly attacks them. It is also possible that the virus makes the immune system itself less discriminating and no longer able to recognize its own nerves. Some parts of the immune system—special white blood cells called lymphocytes and macrophages—perceive myelin as foreign and attack it. Specialized white blood cells called T lymphocytes (from the thymus gland) cooperate with B lymphocytes (that originate in bone marrow) to produce antibodies against the person’s own myelin and damage it.

In some forms of GBS, antibodies made by the person to fight a Campylobacter jejuni bacterial infection attack axons in the motor nerves. This causes acute motor axonal neuropathy, which is a variant of GBS that includes acute paralysis and a loss of reflexes without sensory loss. Campylobacter infections can be caused by ingesting contaminated food or from other exposures. The infected person’s body then makes antibodies against Campylobacter. Some Campylobacter molecules resemble molecules in the person’s nerve axons, so when the person’s antibodies fight the Campylobacter bacteria they also attack the look-alike axons. This slows nerve conduction and causes paralysis. Scientists are investigating various GBS subtypes to find why the immune system reacts abnormally in this syndrome and other autoimmune diseases.

What disorders are related to GBS?

Guillain-Barré syndrome is one of several disorders involving weakness due to peripheral nerve damage caused by the person’s immune system. While GBS comes on rapidly over days to weeks, and the person usually recovers, other disorders develop slowly and can linger or recur.

The most common type of GBS seen in the United States is acute inflammatory demyelinating polyneuropathy (AIDP). In AIDP, the immune response damages the myelin coating and interferes with the transmission of nerve signals. In two other types of Guillain-Barré syndrome, acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN), the axons themselves are damaged by the immune response.

Miller-Fisher syndrome is a rare, acquired nerve disease that is a variant of Guillain-Barré syndrome. It is characterized by abnormal muscle coordination with poor balance and clumsy walking, weakness or paralysis of the eye muscles, and absence of the tendon reflexes. Like GBS, symptoms may follow a viral illness. Additional symptoms include generalized muscle weakness and respiratory failure. Most individuals with Miller Fisher syndrome have a unique antibody that characterizes the disorder.

Related peripheral nerve disorders with slow onset and persisting or recurrent symptoms include chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy. CIDP features weakness that can recur, repeatedly, over the course of years. Multifocal motor neuropathy typically affects many different muscles in a small part of a limb or limbs. Usually the symptoms are more severe on one side of the body.

Stay tune for Part III on GBS regarding how its diagnosed and the Rx including rehab.

QUOTE FOR THURSDAY:

“Key Facts:

-Guillain-Barré syndrome (GBS) is a rare condition in which a person’s immune system attacks the peripheral nerves.

-People of all ages can be affected, but it is more common in adults and in males.

-Most people recover fully from even the most severe cases of Guillain-Barré syndrome.

World Health Organization

 

 

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