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From the Departments of Neurology (Drs. Jacobs, van der Meché, and van Doorn, and M.A. de Klerk), Immunology (Dr. Jacobs), and Virology (Dr. Rothbarth), Erasmus University, Rotterdam; the Department of Trial and Statistics (Dr. Schmitz), Dr. Daniel den Hoed Cancer Center, Rotterdam; and the Department of Immunology and Infectious Diseases (Dr. Herbrink), Diagnostic Centre SSDZ, Delft, The Netherlands.
Address correspondence and reprint requests to Dr Jacobs, Department of Neurology, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
Objectives: To determine which antecedent infections are specifically associated with the Guillain-Barré syndrome (GBS).
Background: Infections with many agents have been reported preceding GBS. Some infections are related to specific clinical and immunologic subgroups in GBS. Most agents were reported in case reports and uncontrolled small series of GBS patients only, and their relation to GBS and its subgroups remains unclear.
Methods: A serologic study for 16 infectious agents in 154 GBS patients and 154 sex- and age-matched controls with other neurologic diseases. Acute phase, pretreatment samples were used from clinically well-defined GBS patients. The seasonal distribution of serum sampling in the GBS and control group was the same.
Results: Multivariate analysis showed that in GBS patients, infections with Campylobacter jejuni (32%), cytomegalovirus (13%), and Epstein-Barr virus (10%) were significantly more frequent than in controls. Mycoplasma pneumoniae infections occurred more often in GBS patients (5%) than in controls in univariate analysis. Infections with Haemophilus influenzae (1%), parainfluenza 1 virus (1%), influenza A virus (1%), influenza B virus (1%), adenovirus (1%), herpes simplex virus (1%), and varicella zoster virus (1%) were also demonstrated in GBS patients, but not more frequently than in controls. C. jejuni infections were associated with antibodies to the gangliosides GM1 and GD1b and with a severe pure motor form of GBS. Cytomegalovirus infections were associated with antibodies to the ganglioside GM2 and with severe motor sensory deficits. Other infections were not related to specific antiganglioside antibodies and neurologic patterns.
Conclusions: Recent infections with C. jejuni, cytomegalovirus, Epstein-Barr virus, and M. pneumoniae are specifically related to GBS. The variety of infections may contribute to the clinical and immunologic heterogeneity of GBS.
Supported by grants from the Prinses Beatrix Fonds (no. 90-3161 and 95-0519) and the Willem H. Kröger Stichting (no. 92-011).
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H. P. Endtz, C. W. Ang, N. van den Braak, B. Duim, A. Rigter, L. J. Price, D. L. Woodward, F. G. Rodgers, W. M. Johnson, J. A. Wagenaar, et al. Molecular Characterization of Campylobacter jejuni from Patients with Guillain-Barre and Miller Fisher Syndromes J. Clin. Microbiol., June 1, 2000; 38(6): 2297 - 2301. [Abstract] [Full Text]
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W.-L. van der Pol, L. H. van den Berg, R. H. M. Scheepers, J. G. van der Bom, P. A. van Doorn, R. van Koningsveld, M. C. L. van den Broek, J. H. J. Wokke, and J. G. J. van de Winkel IgG receptor IIa alleles determine susceptibility and severity of Guillain-Barre syndrome Neurology, April 25, 2000; 54(8): 1661 - 1665. [Abstract] [Full Text] [PDF]
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C. W. Ang, B. C. Jacobs, A. H. Brandenburg, J. D. Laman, F. G. A. van der Meche, A. D. M. E. Osterhaus, and P. A. van Doorn Cross-reactive antibodies against GM2 and CMV-infected fibroblasts in Guillain-Barre syndrome Neurology, April 11, 2000; 54(7): 1453 - 1458. [Abstract] [Full Text] [PDF]
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R. Van Koningsveld, P. A. Van Doorn, P. I. M. Schmitz, C. W. Ang, and F. G. A. Van der Meche Mild forms of Guillain-Barre syndrome in an epidemiologic survey in the Netherlands Neurology, February 8, 2000; 54(3): 620 - 620. [Abstract] [Full Text] [PDF]
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C. W. Ang, N. Yuki, B. C. Jacobs, M. Koga, P. A. Van Doorn, P. I. M. Schmitz, and F. G. A. Van Der Meche Rapidly progressive, predominantly motor Guillain-Barre syndrome with anti-GalNAc-GD1a antibodies Neurology, December 1, 1999; 53(9): 2122 - 2122. [Abstract] [Full Text] [PDF]
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H.-P. HARTUNG Infections and the Guillain-Barre syndrome J. Neurol. Neurosurg. Psychiatry, March 1, 1999; 66(3): 277 - 277. [Full Text]
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M. Gilbert, M.-F. Karwaski, S. Bernatchez, N. M. Young, E. Taboada, J. Michniewicz, A.-M. Cunningham, and W. W. Wakarchuk The Genetic Bases for the Variation in the Lipo-oligosaccharide of the Mucosal Pathogen, Campylobacter jejuni. BIOSYNTHESIS OF SIALYLATED GANGLIOSIDE MIMICS IN THE CORE OLIGOSACCHARIDE J. Biol. Chem., January 4, 2002; 277(1): 327 - 337. [Abstract] [Full Text] [PDF]
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