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Epicenter of a Guillain Barré outbreak (?!)

In recent weeks, there has been an alarming increase (to the tune of seeing a case number in the past few weeks that it would normally take an entire calendar year to reach) in cases of presumed Guillain Barré Syndrome (GBS; an acute immune-mediated polyneuropathy) in our region of Guatemala, the department of Suchitepéquez.

Of the now nearly 70 cases detected, all have been from our department or have a history of having visited Suchitepéquez recently.

We have seen two patients at our center in the last couple of weeks with presentations consistent with GBS- ascending weakness + diminished/absent reflexes. The treatments for GBS with the most evidence to support their use are: intravenous immunoglobulin (IVIG) and plasma exchange. We are actively replenishing our stock of IVIG as the current outbreak does not show immediate signs of slowing.

While the investigation of the folks at the Ministry of Health (in conjunction with the CDC) is ongoing, the most likely culprit thus far appears to be consumption of contaminated water and/or food. Many of the patients suffering from GBS in the current outbreak have tested positive for campylobacter.

As UpToDate points out: "Campylobacter. jejuni gastroenteritis is the most common precipitant of GBS."

For our part, we will continue to wash our hands, cook our food well, and distribute water filters in order to prevent the spread of disease. Simultaneously, we will offer patients presenting to our center with symptoms consistent with GBS with the very best care possible- prompt diagnosis, supportive care- including mechanical ventilatory support if indicated, and evidence-based use of IVIG.

Thank you for joining us in a somewhat surprising (or, perhaps unsurprising?) epidemiological battle.

Your support continues to positively impact the health and lives of our neighbors- the rural poor of Guatemala.

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