Guillain-Barré syndrome (GBS) is a disorder in which the body’s immune response, typically to an infection, causes nerve damage. The syndrome is rare, affecting about one to two people in 100,000 each year. It can present as a very mild case of brief weakness to devastating paralysis, affecting the muscles that allow a person to breathe on their own. Fortunately, most people eventually recover from even the most severe cases of Guillain-Barré, although some are left with some level of weakness. Guillain-Barré syndrome is not contagious.
However, according to the CDC, outbreaks of associated pathogenic viruses and bacteria, including Campylobacter, can lead to clusters of people with Guillain-Barré syndrome. About one in every 1,000 reported Campylobacter illnesses leads to Guillain-Barré syndrome. As many as 40 percent of cases in the United States are thought to be triggered by Campylobacter infection.
Guillain-Barré syndrome initially causes weakness and “pins and needles” sensations that begin in the legs. These symptoms can progress up the body and become more severe, leading to paralysis of the arms and legs. There may be weakness of the face muscles, of the muscles that enable a person to swallow, or of the muscles in charge of moving the eyes. Breathing muscles may be involved, and 10-30% of patients with Guillain-Barré syndrome will need a ventilator to breathe. Blood pressure or heart rate can vary from high to low, often unexpectedly, and the patient may not be able to empty their bladder or may be constipated. Pain in the back, arms, or legs is common.
Hemolytic uremic syndrome was first described in 1955, but it was not known to be secondary to Escherichia coli (E. coli) infections until 1983. HUS is now recognized as a cause of acute kidney failure in infants and young children. Adolescents and adults are also susceptible, as are the elderly, who often have severe disease and are at significant risk of death from the disease. The bowel inflammation that occurs prior to the onset of HUS is generally referred to as the “prodrome.”
During the prodromal phase of HUS, the initial diagnosis is often acute surgical abdomen, acute appendicitis, or ulcerative colitis. After several days of diarrhea, thrombocytopenia, hemolytic anemia (secondary to the destruction of red blood cells), and acute kidney injury converge to form the trilogy that defines HUS. Physical findings on admission to the hospital may include lethargy, abdominal tenderness, blood spots or skin hemorrhages (purpura), swelling, or dehydration.
Features on admission that portend a severe or fatal outcome include coma, rectal prolapse, decreased or absent urine output, or an elevated white blood cell count (WBC)—one greater than 20 x 10^9/L (i.e. greater than 20,000 per liter). Children with HUS average about two weeks in the hospital, with a range of three days to three months. Approximately two-thirds require dialysis during the acute phase of the disease. Adults with HUS are typically in the hospital longer because their course of illness tends to be more severe.
There is no effective therapy for HUS—it cannot be stopped with medications or other therapies. Instead, treatment is supportive, which includes meticulous attention to fluid and electrolyte balance—the cornerstone of survival.
Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract. The hallmark symptoms of IBS are abdominal pain and altered bowel habits. Abdominal pain is usually crampy in nature, but character and sites can vary. In some patients, the pain is relieved by defecation but, in others, defecation may worsen the pain. Additional symptoms may include bloating, straining at stools, and a sense of incomplete evacuation.
Altered bowel habits range from constipation to diarrhea, or alternating diarrhea and constipation. The symptoms of IBS may be daily but, more frequently, are episodic. Symptoms may be triggered by specific foods or by stress. Often, however, no specific triggers can be identified. It is estimated that 10-15% of the Western population has symptoms consistent with IBS, although most (75-80%) never seek medical care.
Although researchers and clinicians have not yet identified any actual anatomic changes, it is likely that some people with IBS have dysregulation in the motor function (also called “motility” or “peristalsis”) of their gastrointestinal tracts. Others develop visceral hypersensitivity, an increased sensation in response to stimuli. For example, persons with IBS will experience pain with distension of a balloon in the rectum at a smaller volume than that experienced in people without IBS. Finally, for some people, IBS affects their gut microbiome or causes intestinal inflammation, dyspepsia (i.e. indigestion), or gastroparesis (i.e. a condition in which stomach emptying is delayed, resulting in nausea, vomiting, early satiety, and weight loss).
Reactive arthritis (ReA) is joint inflammation that occurs after a bacterial infection originating outside the joints (“extra-articular”). These infections are either gastrointestinal (e.g., Salmonella, Campylobacter, Yersinia, Shigella, and sometimes E. coli) or urogenital (most commonly Chlamydia trachomatis, but also Neisseria gonorrhea and Mycoplasma).
Typically, symptoms last for 3-5 months, and most resolve by a year. However, 15-20% may involve a more chronic persistent arthritis, with joint damage and deformity in some. Those who are HLA-B27 positive are more likely to have a worse course, as are those who have hip involvement, those who do not respond to nonsteroidal anti-inflammatory drugs (NSAIDs), and those who have elevated inflammatory markers (i.e., ESR greater than 30).Acute ReA occurs several days or weeks after the antecedent infection. It is typically monoarticular (involving one joint) or oligoarticular (involving just a few joints, usually less than six). The lower extremities are most commonly involved, but it can also involve the arms and spine. A small subset of patients with ReA may have two additional symptoms: conjunctivitis (redness and eye pain) and urethritis (burning and pain with urination).