Cluster of Fulminant Guillain–Barre Syndrome in Maharashtra from June to October 2023: Multicentric Survey

Guillain-Barre syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy, often triggered by an infection.The disease typically reaches a nadir by 4 weeks, followed by slow recovery. [1,2]Most patients have favorable outcomes, and long-term disability is seen in less than 5%. [1]Many case series of GBS have been reported from India. [3][4][5][6] A rise in GBS cases has been observed after certain bacterial or viral outbreaks, for instance, following post Zika virus outbreak in South America, 2016, Campylobacter jejuni outbreak in Peru, 2018-19 and during the COVID-19 pandemic, in Western India, 2021. [6][7][8] [Figure 1a, Table 1].We describe a rise in fulminant GBS with poor outcomes during the annual monsoon of 2023 in adults (>18 years) from the state of Maharashtra [Figure 1b].We included adult patients diagnosed as GBS (Brighton's criteria) with a fulminant course, which we defined as limb weakness (Medical Research Council grade 0-1/4) rapidly progressing to respiratory muscle weakness requiring ventilatory support in less than 48 h of symptom onset.Thirty-two such patients were identified from 17 centers across Mumbai, Pune, Aurangabad, and Nagpur from July to October 2023.The median age was 45 years with the interquartile range being 15-88 years, and 80% of them were males [Table 1].Of the patients, 82% reported antecedent events, with fever being the most common (62%).Seventy-eight percent presented with rapidly ascending quadriparesis, and cranial nerve involvement was observed in more than 90% of cases [Table 1].