Management and Progression of Guillain-Barre Syndrome in a Resource-limited Setting: A Multicenter Study in the University Hospitals of Ouagadougou, Burkina Faso

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Résumé

Introduction: Guillain-Barre syndrome (GBS) faces many diagnostic and therapeutic challenges in sub-Saharan Africa, negatively impacting patient prognosis. The aim of this study was to describe the therapeutic and evolutionary modalities of GBS in the university hospitals of Ouagadougou, Burkina Faso. Patients and methods: This was a descriptive cross-sectional study with prospective data collection, conducted in the university hospitals of Ouagadougou (Yalgado Ouedraogo, Tengandogo, Bogodogo) from March 2018 to May 2022.
Patients aged ˃ 16 years admitted for GBS according to the modified Brighton criteria were included. Clinical severity at the time of admission and at the end of hospitalization was assessed using the GBS Disability Score (GBSDS). Socio-demographic, clinical, therapeutic, and in-hospital progression data were analyzed.

Results: A total of 79 patients were consecutively hospitalized for GBS, with a mean age of 38 years and a male-to-female ratio of 1.25. The mean time to admission was 22 days. The clinical picture consisted of hypo- or areflexic tetraparesis/plegia (100%) with respiratory muscle deficit (44.3%), cranial nerve involvement (58.2%), dysautonomia (55.7%), and albumin-cytological dissociation (100%). ENMG showed demyelinating and axonal forms in 57.6% and 42.4% of cases, respectively. At the plateau phase, 36% and 21% of patients had very severe deficits (Guillain-Barre Syndrome Disability Score (GBSDS 4)) and respiratory distress (GBSDS 5), respectively. Corticosteroid therapy (58.2%) and intravenous immunoglobulins (IVIg) (6.8%) were the specific therapies used. Infectious complications (41.8%), particularly inhalation pneumonia (27.8%), acute respiratory distress (13.9%), and cardiac dysautonomia complications (6.3%), were the most common hospital complications. Eighteen patients (22.8%) were transferred to intensive care, mainly due to the onset of respiratory distress (13.9%). At the end of hospitalization, the hospital mortality rate was 22.8%, with acute respiratory distress (44.4%) and dysautonomic cardiac arrest (16.7%) being the most common immediate causes of death.

Conclusion: In Burkina Faso, GBS is confronted with delays in patient admission, low availability and access to IVIG and EP, and high hospital mortality. Early admission and improved access to emergency immunotherapy and intensive care beds in ASS will help improve the prognosis for patients with GBS.

Mots-clés

GBS, Corticosteroid Therapy, Intravenous Immunoglobulins, Hospital Mortality, Respiratory Distress, Burkina Faso