Fatal Guillain-Barre 68F Anzoategui Venezuela

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Doctors say upsurge in sometimes fatal paralysis condition may be linked to Zika

Cases of Guillain-Barre are on the rise in the countries hardest hit by the virus.

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Zuleidy Balza, left, sits with her mother Zulay Balza who's recovering from Guillain-Barre syndrome.

Image: Associated Press

 

THE DOCTOR TAPS Zulay Balza’s knees with a hammer and she doesn’t feel a thing. She can’t squeeze his outstretched fingers or shut her eyelids. Her face is partially paralysed.

“The weakness started in my legs and climbed upward. The face was last. After three days, I couldn’t walk,” said Balza, 49. “My legs felt like rags.”

Balza is a patient at the public University Hospital in Cucuta, at the epicentre of the Colombian outbreak of the mosquito-borne Zika virus. Only Brazil has more cases.

Two weeks ago, she came under assault by Guillain-Barre, a rare and sometimes fatal affliction that is the Western world’s most common cause of general paralysis.

Alarm over the Zika epidemic spreading across the Americas has been chiefly over birth defects, but frontline physicians believe a surge in Guillain-Barre cases may also be related.

Motor skills

The World Health Organisation says Guillain-Barre cases are on the rise in Brazil, Colombia, El Salvador, Suriname and Venezuela, all hit hard by Zika, though a link remains unproven.

The auto-immune disorder historically strikes only one or two people in 100,000. About one in 20 of those cases ends in death, and it is frightful.

“I thought my body was going to explode,” said Balza, sitting on her hospital bed and apparently over the worst.

Guillain-Barre attacks skeletal muscular nerves as if they were a foreign enemy. Fine motor skills rapidly erode, arms and legs tingle and weaken to numbness. Patients lose their balance, their speech. In rare cases, they require ventilators to stay alive.

The syndrome typically strikes after a bacterial or viral infection, such as influenza, HIV or dengue, though its cause can’t always be determined.

Zulay Balza fails to close her eyes as neurologist Jairo Lizarazo tests her facial muscles.Source: Ricardo Mazalan/AP

Dr Jairo Lizarazo, the neurologist treating Balza, has seen cases increase more than tenfold since December — 30 cases in all — in this muggy city bordering Venezuela. Like Balza, many patients never showed the characteristic symptoms of Zika — fever, rashes, joint pain and conjunctivitis. Four in five don’t.

He’s convinced the virus boosts susceptibility to Guillain-Barre.

“It’s an epidemiological association,” said Lizarazo. “We don’t know exactly how it works. But it’s there, for sure.”

Only explanation

Associated cases confirmed or suspected based on clinical evidence number in the hundreds. Guillain-Barre cases believed to be linked to the virus have killed three people in recent weeks in Colombia and health officials have attributed another three Guillian-Barre deaths in Venezuela to suspected Zika infections.

WHO said Zika has been confirmed present in apparently just one Guillain-Barre death, in the northwestern Venezuela state of Zulia in January.

Dr Maria Lucia Brito Ferreira, chief neurologist at Hospitalda Restauracao in Recife, Brazil, said she hopes to get laboratory confirmation this month that nine Guillain-Barre deaths recorded there in the past year were Zika-related.

Cases of Guillain-Barre in Colombia — about 450 annually before Zika struck — were up nearly threefold in the past month and a half.

El Salvador has reported 118 cases since November, nearly as many as previously seen in a year. “The only explanation is the Zika virus,” said Deputy Health Minister Eduardo Espinoza.

Dr. Osvaldo Nascimento, a leading Rio neurologist, estimates Brazilian cases of Guillain-Barre are up fivefold. Reporting is not compulsory, so the government’s partial figure of 1,868 cases requiring hospitalization last year is a sketchy parameter.

An upsurge in Guillain-Barre was documented in 2013 during a major Zika outbreak in French Polynesia, with a study finding cases up twentyfold. WHO said all 42 cases recorded in the Pacific archipelago tested positive for Zika as well as dengue fever, which is also currently present in Colombia, Venezuela, Brazil and other Zika-affected countries.

Government funding

Antibodies for the dengue and chikungunya viruses, which are far more debilitating than Zika, are often being found in infected patients. That is making establishing a direct Zika-Guillain-Barre link more complicated.

Like Zika, both viruses are transmitted by the Aedes aegypti mosquito and could also trigger Guillian-Barre, experts say.

Source: Ricardo Mazalan/AP

Under normal circumstances, eight in 10 patients nearly fully recover from Guillian-Barre, though it sometimes takes months.

Data on Guillain-Barre is scant in most of the developing world. Of 18 countries participating in a clinical study launched by Dutch physicians in 2012, only two are in Latin America: Mexico and Argentina. Brazil just joined.

Across the region, investigators were simply unable to get government funding to participate, said Dr Ken Gorson, a Tufts University neurologist and president-elect of an international foundation that combats Guillain-Barre.

Poorer countries were ill-prepared to manage the crisis.

Colombia’s National Health Institute is overwhelmed with a weeks-long backlog in completing tests for Zika.

Deaths

The three Guillain-Barre deaths that the country’s Health Ministry attributed to Zika on5 February have not yet been confirmed by laboratory tests, said spokesman Ricardo Amortegui. Nor have the three deaths in the Venezuelan state of Lara announced last week.

One Guillian-Barre fatality in Colombia suspected of being linked to Zika was a 51-year-old man from the Caribbean island of San Andres, who died in November, said Rita Almanza, epidemiology chief in Medellin. The others were a 45-year-old man and a 41-year-old woman flown from Turbo on the Caribbean coast who died in Medellin in February.

Guillain-Barre grabbed hold of Nancy Pino in neighbouring Venezuela with devastating effect.

The 68-year retired school administrator developed fever, rashes and muscle pain while celebrating Christmas with her family in the hot lowland state of Anzoategui.

She recovered quickly. Days later, her hands and feet started to go numb. Her tongue felt like it was asleep. She stopped eating.

The family rushed her to a Caracas hospital. She could barely walk.

Bedridden, she lost the ability to talk and soon, to breathe. Doctors attached her to a respirator.

“It was so quick,” daughter Nihara Ramos said between sobs. “It was like a flame consuming her from the bottom up.”

Doctors diagnosed Guillain-Barre with a spinal tap — they assumed she had Zika earlier — and suggested that the relatives obtain immunoglobulin, an expensive treatment that pools healthy antibodies from hundreds of donors. Gorson said it costs $15,000-$45,000 in the United States.

The family, straight-jacketed by Venezuela’s economic crisis, couldn’t find or afford enough.

In less than three weeks, a woman who once bounded up seven flights of stairs to her apartment was dead.

http://www.thejournal.ie/zika-paralysis-2606558-Feb2016/?utm_source=shortlink

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Second confirmed death from Guillain-Barre syndrome

Nancy Pino died in the HUC. His family did not find 35 bottles of immunoglobulin to prevent a heart attack

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ISAYEN HERRERAJANUARY 28, 2016 - 12:01 AM

On Tuesday at 6:00 pm Nancy Pino died, 66 years old, diagnosed with Guillain-Barre since 9 January.Pino is the second person to die from this disease began to have an upturn in the country for 4 weeks, total 85 cases and is presumed to be a complication resulting zika.

Pino started having fever, rashes and muscle pain, virus-like symptoms. Three days later he was paralyzed limbs and stopped talking. She was taken to Hospital Peripheral Car and a private clinic, but not accepted for lack of supplies. The third health center where he arrived was the University Hospital of Caracas, where he was admitted to intensive care. They were asked to family 35 vials immunoglobulin to start treatment, but only found 15.

The Guillain-Barre syndrome treated with immunoglobulin was produced in the state-owned Quimbiotec, which stopped producing due to lack of foreign exchange. The family asked for help in Miraflores, where they were referred to the Autonomous Service of Pharmaceutical Elaborations (Sefar). There just brushed them 5 bottles. Another 10 containers were achieved in hospitals in the interior, but did not complete the treatment.

The first case of death from Guillain-Barre syndrome was confirmed on January 14 at the University Hospital of Maracaibo. There Jorge La Cruz, 51, was hospitalized on 9 January and died six days later. Also failed immunoglobulin.

On 21 January President of the IVSS, Carlos Rotondaro, committed to health activists in two months to reach 4,000 units immunoglobulin the country. 
 
Pregnant guessing.  In Concepción Palacios Maternity two women with similar symptoms to those of zika . Their blood samples were sent to the National Institute of Hygiene and confirmation is expected.Another woman in the same place diagnosed with malaria.

Another complication that can arise from the virus is the birth of children with microcephaly (malformation that causes the head of a child is smaller than normal) to mothers who acquired the disease within 3 months of pregnancy. In Venezuela, there are three women in evaluation for malformation in babies.

Several US airlines have offered flight changes or refunds of tickets to pregnant women who had planned to travel to Caribbean and Latin American countries affected by the virus, including Venezuela

http://www.el-nacional.com/sociedad/Van-fallecidos-Guillain-Barre_0_786521565.html

 

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Venezuelans Are Almost Defenseless in the Face of Zika

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By Alicia Hernández

February 19, 2016 | 3:35 pm

Nancy Pino should never have died of Guillain-Barré syndrome.

When the 66-year-old Venezuelan first sought medical help after her legs began to feel numb in early January there was still plenty of time to save her. Even as the symptoms began spreading to her hands, and then the rest of her body, doctors said she would almost certainly have recovered with the right medication.

The problem was that neither the clinic, nor the subsequent hospitals she went to, had the 45 daily doses she was told she needed. Her family went on a desperate search, even traveling to the city of Barquisimeto 225 miles from their home in Caracas, but they could only find enough for 15 doses.

Related: Basic Medications and Breast Implants in Short Supply in Deepening Venezuela Crisis

And with every passing day Pino's condition worsened.

"She could not say a word during her last days," said Carlos González, a childhood friend who was close to the family throughout. "But we thought she understood us because she would make gestures with her eyes."

Eventually Pino fell into a coma. She died on January 26, fifteen days after she first went to see a doctor.

Guillain-Barré syndrome, often referred to as GBS, is an autoimmune disorder that attacks the nerves of its victims and causes creeping paralysis. Most patients eventually make a full recovery if they receive adequate treatment, usually injections of immunoglobulin that neutralize the unbalanced actions of the patient's own immune system.

Suddenly, this very rare illness which tends to be triggered by a viral or bacterial infection, has become of major concern throughout Latin America.

This is because doctors are noticing cases they suspect are linked to the Zika virus epidemic currently spreading through the continent via the Aedes aegypti mosquito, which also carries Dengue Fever and Chikungunya.

Those infected with Zika are often asymptomatic or suffer from only mild fever and discomfort.

Related: Venezuelans at Risk as Country's Ailing Healthcare System Deteriorates

The reason why the virus has been declared a global health threat by the World Health Organization, is the existence of evidence linking it to a hike in the number of babies born with abnormally small heads in Brazil. There is now also rising concern about a potential link with GBS that, unlike microcephaly, is already being noted in other countries beyond the epidemic's epicenter in Brazil.

Venezuelans face a particularly worrying situation in the face of Zika, that appears to be spreading through the country very quickly.

This is partly because of the limited amount of information provided to the public by the authorities about the virus, as well as the widespread distrust with which official data is usually seen. The country's economic crisis also ensures there are hardly any tests available to help determine the scale of the epidemic and the intensity of the risks. Chronic shortages of medication, insect repellent, and contraception, are also turning worry into terror for many.

So far the data provided by Venezuelan officials on the Zika epidemic has been scant, sometimes contradictory, and always vague.

President Nicolás Maduro said earlier this month that there were 5,221 cases of possible Zika infections in Venezuela, of which 319 were confirmed. He mentioned 68 "complications" but gave no details about what these were.

Independent experts believe the number of infections is much higher. The Venezuelan Society of Public Health, a well-regarded medical NGO, estimates that the number of infections may be approaching half a million.

So far the local authorities have reported eight deaths associated with Guillain-Barré this year, though local media has reported up to 22. In 2012, the autoimmune disorder reportedly killed 32 people in Venezuela.

Related: Latin America Responds to the Zika Virus With Soldiers, Repellent, and Pregnancy Warnings

Venezuelan doctors, meanwhile, say they are noticing the increase in their clinics.

"Before, we would only have one or two reported cases [of GBS] for each 100,000 patients," Zolia Moros, from the Venezuelan Institute for Scientific Research, told VICE News. "Now we are getting one out of every 1,000 patients infected with Zika."

At the same time, although Venezuela has not reported any increase in microcephalic births, Doctor Ana Teresa Serrao, a gynecologist obstetrician in the Caracas Metropolitan Clinic, believes she is seeing an increase of prenatal problems that might be related to the virus.

Sarrao said that she had noticed a sudden spike in women miscarrying during the third month of their pregnancies soon after saying they had symptoms of Zika.

"It might be for the same reason why some more advanced pregnancies develop microcephaly," she said. "The body defends itself with antibodies and the fetus suffers the consequences."

The doctor said her clinic did not have the resources to buy the tests required to see if her hunch is correct.

If doctors like Serrao are confused and concerned, pregnant women in Caracas are even more so.

One day Kristy Sánchez's body began to itch, her eyes turned red, and her hands and feet became swollen. She had just entered her 26th week of pregnancy.

When the symptoms worsened Sánchez went to the doctor who treated her with anti-allergic medication that did not help. Now, she said, she has "no doubt" that she had Zika and is very frightened that her baby has been affected.

"My gynecologist advised me to stay calm, because there's nothing we can do if something happened to the fetus," the expectant mother said. "I knew nothing about Zika and its symptoms. I thought it was Dengue, so I let it pass."

Officials in several Latin American countries have advised women to postpone getting pregnant until the Zika epidemic is brought under control.

Even the Pope Francis answered a question this week on Zika during his flight back to the Vatican after visiting Mexico that suggested the Catholic church does not have a problem with contraception in this case.

Related: The Zika Virus Is Spreading Through the Americas Very Quickly

"To avoid pregnancy is not an absolute evil. In some cases, like this one… it is clear," he told reporters on his plane. "I would call on doctors to do everything they can to find a vaccine that can protect people against the mosquitos that spread this illness."

Venezuelan government has not said anything about these issues, or even launched any kind of information campaign on the potential risks and what to do about them. And, some note, birth control and family planning is not an easy thing to achieve in Venezuela anyway because of the chronic shortages that limit access to contraceptive pills and condoms.

But probably the most obvious way that Venezuela's economic crisis is impacting the way people are dealing with Zika in their everyday lives is the near impossibility of finding chemical repellent.

Sánchez said she is injecting herself with vitamin B12 and using an old repellent her mother happened to have kept from the days "when you could still buy it."

Yirley, who is five months pregnant, is relying on a natural option made from citronella.

"It's effective and it's better than nothing," she said. "It's been a while since I last bought traditional repellent."

Juan and Griselda said they burn egg cartons to keep the insects away.

"We also do aromatic smoke, but they still bite us," the couple said in the doorstep of their zinc and brick home in the poor barrio of Brisas de Petare in eastern Caracas. The neighborhood does not have running water, so residents depend on tanker trucks that visit the area once every week to fill buckets and barrels that then turn into potential breeding grounds for the mosquitos.

The government has sent out fumigation teams in some areas, such as in Brisas de Petare, but what is so terrifying for many in Venezuela and throughout the region is how much infection, and its potential consequences, still comes down to luck.

Rafael Rodríguez, who lives in the coastal state of Vargas, knows that his 25-year-old daughter Marian is still alive because of luck.

He said the first sign that something was wrong was when she stopped peeing for 24 hours. After that her hands began going numb.

The family took her to seven different clinics and hospitals, but none had infectologists that could treat her until she was finally admitted at a clinic in eastern Caracas where the doctors told him she had Guillain-Barré syndrome following on from an asymptomatic case of Zika.

"I will thank the doctor for the rest of my life, because she acted well and quickly," Rodríguez said. "But had this happened after, she would not have been able to receive treatment, because the clinic only had enough to treat 15 patients when my daughter was admitted."

Marian is still in a wheelchair, but is expected to make a full recovery.

Related: Here's What You Should Know About the Zika Virus

Follow Alicia Hernandez on Twitter @por_puesto

https://news.vice.com/article/venezuelans-are-almost-defenseless-in-the-face-of-zika