Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, South Korea.
Department of Neurology, Dong-A University Medical Center, Busan, South Korea.
J Peripher Nerv Syst. 2024 Mar;29(1):82-87. doi: 10.1111/jns.12614. Epub 2024 Jan 29.
Scrub typhus is an endemic disease in the fall season that occurs in a limited number of places known as the Tsutsugamushi Triangle. Peripheral neuropathy is a common complication of scrub typhus. Herein, we encountered several patients with ascending paralysis after scrub typhus infection, who were diagnosed with Guillain-Barré syndrome (GBS). We aimed to investigate the clinical and laboratory characteristics of patients who developed GBS after scrub typhus.
Patients were retrospectively recruited from six nationwide tertiary centers in South Korea from January 2017 to December 2021. Patients who had been clinically diagnosed with GBS and confirmed to have scrub typhus via laboratory examination and/or the presence of an eschar before the onset of acute limb paralysis were included. The GBS-associated clinical and electrophysiological characteristics, outcomes, and scrub typhus-associated features were collected.
Of the seven enrolled patients, six were female and one was male. The median time from scrub typhus infection to the onset of limb weakness was 6 (range: 2-14) days. All patients had eschar on their bodies. Four patients (57.1%) were admitted to the intensive care unit and received artificial ventilation for respiratory distress. At 6 months, the median GBS disability score was 2 (range, 1-4) points.
Patients with scrub typhus-associated GBS have a severe clinical presentation and require intensive treatment with additional immunotherapies. Therefore, GBS should be included in the differential diagnosis when peripheral neuropathies develop during scrub typhus treatment. Notably, scrub typhus is associated to GBS.
恙虫病是一种秋季流行的地方病，仅发生在被称为恙虫病三角的有限地区。周围神经病是恙虫病的常见并发症。在此，我们遇到了几例恙虫病感染后出现上升性瘫痪的患者，这些患者被诊断为格林-巴利综合征（GBS）。我们旨在研究恙虫病后发生 GBS 的患者的临床和实验室特征。
本研究回顾性地从韩国的六个全国性三级中心招募了 2017 年 1 月至 2021 年 12 月期间被临床诊断为 GBS 且通过实验室检查和/或急性肢体瘫痪前存在焦痂而确诊为恙虫病的患者。收集了 GBS 相关的临床和电生理特征、结局以及恙虫病相关特征。
纳入的 7 名患者中，女性 6 例，男性 1 例。从恙虫病感染到肢体无力发作的中位数时间为 6 天（范围：2-14 天）。所有患者均有身体焦痂。4 名患者（57.1%）因呼吸窘迫入住重症监护病房并接受人工通气。6 个月时，GBS 残疾评分的中位数为 2 分（范围，1-4 分）。
恙虫病相关 GBS 患者的临床表现严重，需要强化治疗和额外的免疫治疗。因此，在治疗恙虫病时出现周围神经病时，应将 GBS 纳入鉴别诊断。值得注意的是，恙虫病与 GBS 有关。
