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Relationship of bacterial strains to clinical syndromes of Campylobacter-associated neuropathies

From the Department of Neurology and Research Institute for Neuroimmunological Diseases (K.K., M.K., M.O., K.H., N.Y.), Dokkyo Medical University School of Medicine, Tochigi, Japan; Department of Microbiology (M.T.), Tokyo Metropolitan Institute of Public Health, Tokyo, Japan; and Institute for Biological Sciences (J.L., M.G.), National Research Council Canada, Ottawa, Ontario, Canada.

Address correspondence and reprint requests to Dr. N. Yuki, Department of Neurology and Research Institute for Neuroimmunological Diseases, Dokkyo Medical University School of Medicine, Kitakobayashi 880, Mibu, Shimotsuga, Tochigi 321-0293, Japan; e-mail: yuki{at}dokkyomed.ac.jp

Background: Clinical and serologic studies suggest that Guillain–Barré syndrome (GBS) and atypical GBS with preserved muscle stretch reflexes (MSRs) form a continuous spectrum as well as do Fisher syndrome (FS), FS/GBS overlap, Bickerstaff brainstem encephalitis (BBE), BBE/GBS overlap, acute ophthalmoparesis (AO), ataxic GBS, and acute oropharyngeal palsy.

Objective: To clarify the spectrum of neurologic disorders that occur subsequent to Campylobacter jejuni enteritis.

Methods: We recruited patients with various neurologic conditions and from whom C jejuni was isolated. Bacterial features were investigated.

Results: Diagnoses for the patients from whom C jejuni was isolated were GBS (n = 90), FS (n = 22), MSR-preserved GBS (n = 10), FS/GBS (n = 6), BBE (n = 1), BBE/GBS (n = 2), AO (n = 3), ataxic GBS (n = 1), and acute oropharyngeal palsy (n = 3). Isolates from MSR-preserved GBS were similar to those of GBS in serotype (HS:19), genotype (lipo-oligosaccharide [LOS] locus class A or B, cst-II genotype [Thr51]), and GM1 or GD1a epitope expression on LOS. FS/GBS overlap, BBE, BBE/GBS overlap, AO, ataxic GBS, and acute oropharyngeal palsy isolates were similar to those of FS in serotype (HS:2 or HS:4-complex), genotype (LOS locus class A or B, cst-II genotype [Asn51]), and GQ1b epitope expression on LOS.

Conclusions: The bacterial findings support the proposal that Guillain–Barré syndrome (GBS) and muscle stretch reflex–preserved GBS comprise a continuous spectrum as well as do Fisher syndrome (FS), FS/GBS overlap, Bickerstaff brainstem encephalitis (BBE), BBE/GBS overlap, acute ophthalmoparesis, ataxic GBS, and acute oropharyngeal palsy.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the November 28 issue to find the title link for this article.

*These authors contributed equally to this work.

Supported in part by grants from the Uehara Memorial Foundation to M.K.; the Naito Foundation to M.K.; Dokkyo Medical University School of Medicine to M.K. (no. 2005-01-2); the Mizutani Foundation for Glycoscience to N.Y.; a grant for Scientific Research (B) (KAKENHI 16390254 to N.Y.) from the Ministry of Education, Culture, Sports, Science and Technology of Japan; Research Grants on Measures for Intractable Diseases (1724360 and 17243601 to N.Y.) from the Ministry of Health, Labor and Welfare of Japan; and a grant from the Human Frontier Science Program (RGP0038/2003-C to M.G. and N.Y.).

Disclosure: The authors report no conflicts of interest.

Received May 10, 2006. Accepted in final form August 9, 2006.

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