Guillain-Barré Syndrome: Clusters not contagion

GBS is named after the two French neurologists who first described the condition in 1916, Georges Guillain and Jean Alexandre Barré. The doctors noticed something unusual in two soldiers who had trouble walking and moving their arms and legs.

The symptoms started with tingling in their feet and weakness in both their legs. The weakness then spread to their arms and faces. Doctors found that both soldiers had lost their reflexes. Spinal taps showed higher levels of protein in their spinal fluid with normal or low white blood cell count. This was a key clue to understanding the illness.

GBS wasn’t widely accepted right away. However, this discovery helped doctors start recognizing and treating this condition.

Even though doctors first discovered GBS over 100 years ago, it is still being closely studied. Research on the triggers, pathophysiology, and treatment modalities are ongoing. Knowing its incidence and epidemiology are important steps toward learning to manage GBS.

Guillain-Barré Syndrome incidence:

• On average, GBS affects 1 in 100,000 each year
• 20-30% of cases have severe Guillain-Barré syndrome with respiratory failure affects
• There is a 5% fatality rate
• Death after GBS predominantly occurs in the elderly and severely affected patients, especially during the recovery phase
• There is no specific age or sex predilection for developing GBS, but generally, individuals over 50 years old may be more predisposed

Notable Triggers

Respiratory and gastrointestinal infections have been identified as potential triggers for the development of GBS. Gastroenteritis caused by Campylobacter jejuni is a well-established trigger.

Additionally, infections caused by other viruses, including Zika virus and Epstein-Barr virus, have also been linked to the onset of GBS.

Here are some key examples:

1. Zika Virus Outbreak (2015–2016)

• Where: Latin America and the Caribbean (especially Brazil, Colombia, El Salvador, and Puerto Rico)
• What happened: During the Zika virus epidemic, doctors saw a sharp rise in GBS cases in areas where Zika was spreading. In some regions, GBS incidence was up to 20 times higher than usual
• Why: Zika virus is believed to directly or indirectly trigger GBS in a small percentage of infected people

2. Campylobacter-Related Outbreaks (Various Locations, Ongoing)

• Where: Worldwide
• What happened: Outbreaks of Campylobacter jejuni (a common cause of food poisoning) have led to temporary increases in GBS cases. Campylobacter jejuni leads to GBS in approximately 1 out of every 1000 cases. The 2025 outbreak in Pune, India was related to Campylobacter jejuni and contaminated water is the primary source of infection. 25 stool samples from patients with Guillain–Barré syndrome tested positive for C. jejuni
• Why: Campylobacter is one of the most frequent bacterial triggers of GBS. Not everyone who gets food poisoning from it develops GBS, but it’s a known risk factor

3. Influenza Pandemics and Flu Seasons

• Where: Worldwide
• What happened: During some flu seasons there have been increases in GBS cases
• Why: Influenza virus can trigger GBS. While flu vaccines are sometimes linked to rare cases, the flu virus carries a higher risk

People with GBS usually get symptoms that start suddenly and get worse quickly. The weakness usually begins in the legs and moves upward.

It often affects both sides of the body in the same way. Most people get their worst symptoms within 4 weeks.

The disease has a range of symptoms including:

• Tingling or “pins and needles” feeling, usually starting in the hands or feet
• Muscle weakness, often starting in the legs and moving upward (called “ascending weakness”)
• Trouble walking or moving the arms and legs
• Reduction or loss of deep tendon reflexes
• Difficulty moving the muscles of the face, including smiling or closing the eyes
• Trouble swallowing or speaking in more serious cases
• Weak neck muscles, making it hard to lift or turn the head
• Problems with breathing, which can happen if the chest muscles are affected
• Fast or irregular heartbeat, or changes in blood pressure (due to nerve damage affecting body functions)
• Loss of balance or coordination
• Pain, especially in the lower back or limbs

GBS usually happens only once, and it’s rare for it to come back (less than 10% of cases).

If symptoms keep getting worse for more than 8 weeks, doctors may look for a different diagnosis.

GBS is diagnosed by clinical examination — by looking at symptoms and checking for weak or missing reflexes during a neurological exam.

The doctor will start by doing a physical exam to check the patient’s muscles and nerves. They’ll look to see if symptoms affect both sides of the body, which is common in GBS, and how quickly the symptoms started.

In other conditions, muscle weakness might develop slowly over months, but in GBS it usually happens more quickly.

The doctor will also test reflexes, since people with GBS often lose some of them

A lumbar puncture (spinal tap) or EMG (a test that checks nerve and muscle activity) may help support the diagnosis.

These tests are helpful but should not delay starting treatment.

Blood tests to find the cause of GBS are not needed to diagnose it and should not hold up treatment.

Anyone who might have GBS should be watched closely for trouble breathing.

There is no known cure for Guillain-Barré syndrome and it is potentially life-threatening. GBS patients should be hospitalized so that they can be monitored closely

Treatments can help improve symptoms of GBS and shorten its duration. These include treatment with intravenous immunoglobulins (IVIg) and supportive care.

Immunotherapy

As an autoimmune disorder, the acute phase is usually treated with immunotherapy. This includes plasma exchange to remove antibodies from the blood or IVIg. Immunotherapy is most often effective when started within 2 weeks after the first symptoms appear.

Supportive Care & Monitoring

The patient’s breathing, heartbeat and blood pressure need to be monitored. If their ability to breathe is impaired, they are usually put on a ventilator.

All GBS patients should be monitored for complications, which can include abnormal heart beat, infections, blood clots, and high or low blood pressure.

Rehabilitation

If muscle weakness persists after the acute phase of the illness, patients may require rehabilitation services to strengthen their muscles and restore movement.

Guillain-Barré Syndrome (GBS) remains a challenging autoimmune disorder affecting the peripheral nervous system. Though rare, GBS requires prompt medical attention.

Symptoms can progress rapidly from mild tingling sensations to severe paralysis and respiratory failure. Early diagnosis through clinical examination is crucial for timely treatment and better outcomes.

Treatment includes immunotherapy treatments along with supportive care and careful monitoring. With appropriate management and rehabilitation most patients recover from GBS. However, recovery timelines can vary significantly. Some patients experience a complete recovery within weeks or months. Others may have lingering effects for years. The 5% fatality rate primarily affects elderly patients and those with severe presentations.

Ongoing research continues to explore the relationship between GBS and its various triggers, including Campylobacter jejuni, Zika virus, and influenza. Understanding these connections and improving therapeutic approaches will help medical professionals better manage this complex condition.

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

Learn more about infectious diseases on the GIDEON platform.