Guillain – Barre syndrome associated with Helicobacter pylori isolates from rectal swabs of four patients: University of Benin Teaching Hospital Experience

Abstract

Background: A Gram-negative bacteria known as Helicobacter pylori (H. pylori) is thought to be the cause of autoimmune gastrointestinal diseases. Additionally, this pathogen has been connected to peripheral neuropathies and extra-gastrointestinal illnesses with autoimmune sequelae. H. pylori may be involved in the 30% of GBS cases that Campylobacter jejuni is blamed for. Guillain-Barré syndrome (GBS) typically has a post-infectious aetiology. The Aim of the study is to show that rectal swabs to isolate Helicobacter pylori as a cause of Guillain - Barre syndrome should be a routine instead of gastric biopsy.

Methods: The study was a Retrospective Cross Sectional Study. It involved a review of Case notes of Patients that were admitted in the Neurology Unit of UBTH from 2014-2019, been managed for Guillain-Barre syndrome associated with H. pylori infection and also a review of their Medical microbiology laboratory test records during management especially their rectal swab Microscopy, Culture and Sensitivity results. It has never been the practice of the Neurology unit to do rectal swabs for patients with Guillain - Barre syndrome, this was done by the medical microbiology unit that co-managed the patient. Patients with incomplete or missing medical data were excluded from the study.

Results: Four case series of one male and three female patients, age ranged from 7 years to 23years with the mean age of 15 ± 8 years. The most common initial symptom was weakness in the extremities which was seen in all the patients. Motor deficit involved all four limbs in all the patients. The mode of onset was progressive in all the cases and ascending. History of peptic ulcer disease was present in all four patient and H. pylori was isolated from rectal swabs from all the patients. Three (75%) of the patient showed marked improvement on commencement of Omeprazole and erythromycin, while one (25%) ,did well on amoxicillin and Omeprazole. One (25%) had complications of bilateral patchy lower limb skin exfoliation and desquamation. A case of death was recorded. On discharge complete functional recovery was noted in two (50%), while one (33%) had partial recovery.

Conclusion: This study of four case series highlights a relatively inexpensive and straightforward faecal specimen collection by rectal swab, and readily available faecal specimen compared with gastric biopsy specimen, in the laboratory diagnosis and isolation of Helicobacter pylori, a cause (among other causes) of Guillain-Barre Syndrome, which is a medical emergency in most cases. In addition Guillain-Barre Syndrome linked with H. pylori is not always a Post-infectious diseases because medications used to clear the gastrointestinal tract of Bacterial usually lead to recovery from the paralysis caused by Guillain- Barre Syndrome.