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From the Department of Neurology (Drs. Koga, Yuki, and Hirata), Dokkyo University School of Medicine, Tochigi; and Department of Tumor Immunology (Dr. Tai), Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
Address correspondence and reprint requests to Dr. Michiaki Koga, Department of Neurology, Yamaguchi University School of Medicine, Minami-Kogushi 1-1-1, Ube, Yamaguchi 755-8505, Japan; e-mail: kogamrk{at}par.odn.ne.jp
Objective:— To examine the association between Miller Fisher syndrome (MFS) and antecedent Haemophilus influenzae infection.
Background:— Little is known about agents in prior respiratory tract infection of MFS, whereas antecedent upper respiratory symptoms are frequent. H. influenzae is a major pathogen that can cause human respiratory tract infection.
Methods:— The authors used ELISA to detect serum antibody against the bacterium in 70 consecutive patients with MFS and 110 with Guillain–Barré syndrome (GBS).
Results:— Serum anti–H. influenzae IgG and IgM antibody activities were significantly higher in the MFS group than in age- and sex-matched patients with other neurologic diseases (n = 62) and normal control subjects (n = 82). The GBS group showed no significant increase in any class of antibody activities compared with control groups. Serologic evidence of recent infection was found in five (7%) of the patients with MFS and two (2%) of 110 patients with GBS, all of whom had a history of antecedent respiratory tract infection. They frequently showed ophthalmoplegia, but other neurologic features were not remarkable. Serum anti-GQ1b IgG antibody that had cross-reactivity with GT1a ganglioside was detected in six of these seven patients. Thin-layer chromatography with immunostaining showed that serum IgG from H. influenzae–seropositive patients with high anti-GQ1b and anti-GT1a IgG antibody titers bound to the lipopolysaccharide fraction extracted from the type b H. influenzae serostrain. These bands were also stained by anti-GT1a monoclonal antibody (GMR11), indicating that the lipopolysaccharide bears the GT1a epitope.
Conclusions:— These findings point to H. influenzae being an agent associated with MFS. Epitopic overlap between H. influenzae and human nerve tissue may be involved in the development of MFS much as GBS is associated with Campylobacter jejuni enteritis.
This article has been cited by other articles:
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  J Schessl, M Koga, K Funakoshi, J Kirschner, W Muellges, A Weishaupt, R Gold, and R Korinthenberg Prospective study on anti-ganglioside antibodies in childhood Guillain-Barre syndrome Arch. Dis. Child., January 1, 2007; 92(1): 48 - 52. [Abstract] [Full Text] [PDF]
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 M Koga, S Koike, K Hirata, and N Yuki Ambiguous value of Haemophilus influenzae isolation in Guillain-Barre and Fisher syndromes J. Neurol. Neurosurg. Psychiatry, December 1, 2005; 76(12): 1736 - 1738. [Abstract] [Full Text] [PDF]
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 M. Koga, M. Gilbert, J. Li, S. Koike, M. Takahashi, K. Furukawa, K. Hirata, and N. Yuki Antecedent infections in Fisher syndrome: A common pathogenesis of molecular mimicry Neurology, May 10, 2005; 64(9): 1605 - 1611. [Abstract] [Full Text] [PDF]
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M. Koga, N. Yuki, K. Hirata, M. Morimatsu, M. Mori, and S. Kuwabara Anti-GM1 antibody IgG subclass: A clinical recovery predictor in Guillain-Barre syndrome Neurology, May 13, 2003; 60(9): 1514 - 1518. [Abstract] [Full Text] [PDF]
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 H. J. Willison and N. Yuki Peripheral neuropathies and anti-glycolipid antibodies Brain, December 1, 2002; 125(12): 2591 - 2625. [Abstract] [Full Text] [PDF]
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M Koga, H Yoshino, M Morimatsu, and N Yuki Anti-GT1a IgG in Guillain-Barre syndrome J. Neurol. Neurosurg. Psychiatry, June 1, 2002; 72(6): 767 - 771. [Abstract] [Full Text] [PDF]
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 Does Haemophilus influenzae Infection Lead to Miller Fisher Syndrome? Journal Watch Neurology, December 6, 2001; 2001(1206): 7 - 7. [Full Text]
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