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Gastroenteritis-associated Guillain–Barré syndrome on the Caribbean Island Curaçao

From the Departments of Neurology (Drs. Van Koningsveld, Ang, Jacobs, van der Meché, and van Doorn), Statistics (Dr. Schmitz), and Medical Microbiology and Infectious Diseases (Dr. Endtz), Erasmus University Medical Center Rotterdam, the Netherlands; Department of Neurology (Drs. Rico and Merkies), Sint Elisabeth Hospital, Curaçao; and Epidemiology and Research Unit (Drs. Gerstenbluth and Halabi), Medical and Public Health Service of Curaçao, the Netherlands Antilles.

Address correspondence and reprint requests to Dr. R. van Koningsveld, Department of Neurology, Erasmus University Medical Center Rotterdam, PO BOX 1738, 3000 DR Rotterdam, the Netherlands; e-mail: vankoningsveld{at}neur.azr.nl

Background: The number of patients with Guillain–Barré syndrome (GBS) who have been observed in Curaçao, the Netherlands Antilles, may be increasing. Methods: Clinical and serologic data were obtained from records of patients admitted between 1987 and 1999 and fulfilling National Institute of Neurological and Communicative Disorders and Stroke criteria for GBS. When possible, serum and stool samples were collected. The results were compared with a large Dutch epidemiologic study. Results: The authors identified 49 patients, an overall crude incidence rate (IR) in Curaçao of 2.53/100,000 inhabitants (95% CI 1.87 to 3.35) (Dutch study 1.18, rate ratio (RR) of 2.14, p < 0.001). The IR in Curaçao increased from 1.62 in 1987 to 1991 to 3.10 in 1992 to 1999, RR 5.22 (95% CI 2.48 to 10.2, p = 0.02). The IR showed a curvilinear shape within a year. In comparison with the Dutch group, patients from Curaçao had a more severe course of the disease, with a mortality rate of 23% (3.4% in the Dutch group, p < 0.001), a higher percentage of preceding gastroenteritis (p < 0.001), and less sensory involvement (p < 0.001). In 8 of 10 serum samples, evidence was found for a recent infection with Campylobacter jejuni. Conclusions: The authors found a steady increase in incidence of GBS over the years in association with a more pronounced seasonal preponderance and a more severe course. The clinical characteristics suggest a role for C jejuni.

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