### Diagnosis An ascending paralysis, often post-infectious. [[Botulism]], tick paralysis, West Nile [[encephalitis]], and [[Paralytic Shellfish Poisoning]] are in the differential diagnosis. ### Epidemiologic Risks See the organism in question. Prior post-vaccination GBS is NOT a risk for subsequent GBS. [^1] It has a long time since the [[Influenza]] [[Vaccine]] was implicated and the risk of GBS is greater from the disease than the [[Vaccine]]. Rarely occurs after bacterial [[Meningitis]]. [^2] ### Microbiology *[[Campylobacter]]* has the most significant association with subsequent development of GBS. > "Infection with [[Cytomegalovirus]] or Epstein--Barr virus is associated with the demyelinating Guillain-- Barré syndrome, whereas C. jejuni infection is associated with the axonal Guillain--Barré syndrome and with the Miller Fisher syndrome." [^3] Shingles increases risk 20 x in the next two months [^4] as does acute [[Cytomegalovirus]]. The incidence of [[Cytomegalovirus]]-GBS is between 0.6 and 2.2 cases per 1000 cases of primary [[Cytomegalovirus]] infection versus 0.25 to 0.65 cases per 1000 cases of [[Campylobacter]]. [^5] Chikungunya, West Nile and Zika Virus have all caused GBS. Perhaps Cat Scratch. [^6] [[COVID]]: > "GBSs prevalence was estimated at 15 cases per 100,000 SARS‐CoV‐2 infections. [[COVID]]‐19 appears to be associated with an increased likelihood of GBSs and with demyelinating GBSs variants in particular." [^7] ### Empiric Therapy Antibiotics are not needed. Plasmapheresis and IVIG are often given for GBS. ### Puswhisperers [Trying to tie one disease to another](http://www.pusware.com/PW5/TryToTie.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop595.mp3) ### Rationalizations [^1]: Baxter R, Lewis N, Bakshi N, Vellozzi C, Klein NP; CISA Network. Recurrent [[Guillain-Barre Syndrome]] following vaccination. Clin Infect Dis. 2012 Mar;54(6):800-4. doi: 10.1093/cid/cir960. Epub 2012 Jan 19. PMID: 22267712. [^2]: Ding L, Chen Z, Sun Y, Bao H, Wu X, Zhong L, Zhang P, Lin Y, Liu Y. Guillain-Barré syndrome following bacterial [[Meningitis]]: a case report and literature review. BMC Neurol. 2018 Dec 17;18(1):208. doi: 10.1186/s12883-018-1211-4. PMID: 30558576; PMCID: PMC6296051. [^3]: https://www.nejm.org/doi/pdf/10.1056/NEJMra1114525 [^4]: Lehmann HC, Hartung HP. [[Varicella]]-zoster virus: another trigger of Guillain-Barré syndrome? Clin Infect Dis. 2010 Sep 1;51(5):531-3. doi: 10.1086/655137. PMID: 20642352. [^5]: Orlikowski D, Porcher R, Sivadon-Tardy V, Quincampoix JC, Raphaël JC, Durand MC, Sharshar T, Roussi J, Caudie C, Annane D, Rozenberg F, Leruez-Ville M, Gaillard JL, Gault E. Guillain-Barré syndrome following primary [[Cytomegalovirus]] infection: a prospective cohort study. Clin Infect Dis. 2011 Apr 1;52(7):837-44. doi: 10.1093/cid/cir074. PMID: 21427390. [^6]: Zakhour R, Mancias P, Heresi G, et al. Transverse Myelitis and Guillain-Barré Syndrome Associated with Cat-Scratch Disease, Texas, USA, 2011. _Emerging Infectious Diseases_. 2018;24(9):1754-1755. doi:10.3201/eid2409.180008. [^7]: Palaiodimou L, Stefanou MI, Katsanos AH, Fragkou PC, Papadopoulou M, Moschovos C, Michopoulos I, Kokotis P, Bakirtzis C, Naska A, Vassilakopoulos TI, Chroni E, Tsiodras S, Tsivgoulis G. Prevalence, clinical characteristics and outcomes of Guillain-Barré syndrome spectrum associated with [[COVID]]-19: A systematic review and meta-analysis. Eur J Neurol. 2021 Oct;28(10):3517-3529. doi: 10.1111/ene.14860. Epub 2021 Apr 28. PMID: 33837630; PMCID: PMC8250909.