India faces an outbreak of rashing paralysis

Last month, a school teacher in the western city of Pune found her six -year -old son annoying for the task.

“I had erased some words and asked him to write them. I assumed that I was angry and that is why I did not hold the pencil correctly,” Indian Express told the newspaper.

She never imagined that her fight to hold a pencil was the first sign of Guillain-Barré Syndrome (GBS)A rare disorder where the immune system attacks nerve cells, causing muscle weakness and paralysis.

In a matter of days, the child was in intensive care, unable to move his arms or legs. As his condition worsened, he lost the ability to swallow, talk and finally breathe, requiring fan support. Now he is recovering.

The child is among the 160 reported cases of GBS since the beginning of January in Pune, an education and IT center, surrounded by cities and industrial towns. There have been five death suspicions. Currently, 48 patients are in intensive care, 21 in fan and 38 have been discharged, according to official figures.

The GBS begins with tingling or numbness on the feet and hands, followed by muscle weakness and difficulty moving the joints. The symptoms worsen for two or four weeks, usually starting in the arms and legs. The reported mortality rate It varies between three and 13%, depending on the severity and quality of support for medical care.

The outbreak in Pune goes back to a pathogen called Campylobacter JejuniA main cause of food transmitted infections and the largest GBS driver worldwide. The link between the two was discovered in the 1990s in rural China, where the pathogen was common in chickens, and GBS shoots occurred all monsoon when children played in the water contaminated by chicken or ducks excrement .

GBS is not completely weird in India. Monojit Debnath and Madhu Nagappa, of the National Institute of Mental Health and Mental Neurosciences based in Bangalore (Nimhans), studied 150 patients with GBS for a period of five years between 2014 and 2019. Their findings showed that during a Third of them tested positive for Campylobacter.

More recently, shoots linked to the pathogen around the world have been informed. In the first seven months of 2023, Peru reported More than 200 suspicious cases and at least four GBS deathswhich leads the government to declare a national health emergency and strengthen public health measures. Two thirds of the cases were linked to Campylobacter.

In countries with good hygiene, fewer cases of GBS are linked to Campylobacter, and respiratory infections are a great taxpayer, experts say. There have also been other triggers. In 2015, Brazil reported a group of GBS cases linked to the Zika virus. Vaccines can rarely trigger GBS, but it was reported that a Covid vaccine was linked to a few hundreds of GBS cases in the United Kingdom In 2021.

“Campylobacter is endemic with hundreds of thousands of cases that take place all the time. It always exists in the environment,” Hugh Willison, a professor of neurology at the University of Glasgow.

However, it is not easy to develop GBS, scientists say.

There is a specific strain of Campylobacter, which has an outer layer covered with sugar, and in rare cases, its molecular structure coincides with the coating of human nerve cells.

When the patient’s immune system attacks bacteria, it can also end up directing the nerves, a process called molecular mimicry, which leads to GBS. However, a small fraction of Campylobacter strains has this nerve layer.

“In Pune, a Campylobacter strain is likely to circulate with this molecular feature, and an increase in infections with this strain, consequently, leads to a greater number of GBS cases,” says Professor Willison.

Most experts estimate that approximately one in 100 strains of Campylobacter entails the risk of GBS, and one in 100 people infected with said voltage develops GBS, which makes the general risk approximately one in 10,000.

That creates what Mr. Willison describes as a “immune roller roulette”, triggering a “acute neurological tsunami” that increases the peripheral nervous system. Once the immune response decreases, the attack decreases, but the body still needs time, medical attention and support to repair the damage.

What worsens things is that there is no cure for GB.

In GBS, the body produces antibodies against Campylobacter, which then attacks the nerves. Doctors use “plasma exchange”, a process that filters blood to eliminate harmful antibodies, along with intravenous immunoglobulin (IVIG), a therapeutic antibody derived from normal blood, to help reduce the severity of the disease.

The other challenge is that there is no unique proof to diagnose GBS. The diagnosis, doctors say, is mainly based on clinical characteristics. It is presented as a form of paralysis that can also be caused by polyomyelitis, viruses or rare neurological disease.

“The diagnosis is a constellation of clinical characteristics. The erroneous diagnosis or no late diagnosis or diagnosis can occur easily,” says Willison.

The unequal public health system of India presents a challenge, since doctors in rural areas may have difficulty diagnosing GBS. A reason, possibly, why The teams of the World Health Organization (WHO) are in PuneHe is collaborating with federal and state health workers to track, test and monitor cases, and analyze trends to support effective treatment.

The authorities say they have watched more than 60,000 houses, collected 160 water samples for the tests and asked people to drink boiled water and eat fresh and clean food, and do not have “rancid food and chicken or partially cooked lamb.”

While most GB cases worldwide come from little cooked poultry, it can also be extended through water, similar to cholera or salmonella, experts say.

Contaminated water used to wash or prepare street food makes it easier for bacteria to spread. Clearly, in Pune, a Campylobacter strain with the distinctive molecular characteristic is circulating, which affects a large number of people.

What is not clear is whether this is due to large -scale contamination of the water supply or many people who consume infected poultry. “We appeal to people who do not be scared,” says a notice of the Department of Health. But in the face of uncertainty, it is easier to say it than to do it.