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From the Departments of Pathology and Laboratory Medicine (I.N., H.U.) and Neurology (A.K.A.), University of Pennsylvania School of Medicine, Philadelphia; Instituto Nacional de Pediatria (P.A.B., A.G.R., P.R., A.G.B., L.M.C., M.R.P.), Mexico City, Mexico; Department of Neurology (C.L., D.C., J.W.G., G.M.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Hospital Pediatrico Legaria (L.G.P., J.C.P., M.R.), Mexico City, Mexico; Department of Neurology (J.V., H.J.W.), University of Glasgow, Scotland; and Centers for Disease Control and Prevention (C.F.), Atlanta, GA.
Address correspondence and reprint requests to Dr. I. Nachamkin, University of Pennsylvania School of Medicine, 3400 Spruce Street, 4th Floor Gates Building, Philadelphia, PA 19104-4283 nachamki{at}mail.med.upenn.edu
Background: Guillain-Barré syndrome (GBS) is an acute, immune-mediated flaccid paralysis frequently associated with Campylobacter infection. Of two predominant GBS subtypes, a demyelinating subtype (acute inflammatory demyelinative polyneuropathy [AIDP]) predominates in the United States and Europe, and axonal subtype (acute motor axonal neuropathy [AMAN]) is the predominant form in China. Previous clinical studies suggested that AMAN also occurs in Mexican children. The purpose of this study was to describe the subtypes of GBS in children from Mexico City.
Methods: We prospectively studied 121 children admitted to two pediatric hospitals in Mexico City from 1996 to 2002. Clinical histories were obtained, electrophysiologic studies were performed to determine GBS subtype, and microbiologic studies were performed.
Results: Of the 121 children, 46 had AMAN and 32 had AIDP. The male to female ratio was 1.3 for AMAN cases (mean age = 6.3) and 3.0 for AIDP cases (mean age = 7.0). There was a strong seasonal distribution of AMAN cases in July to September. Children with AMAN, but not AIDP, had worsening of illness during hospitalization as judged by peak severity scores. Vomiting was more likely in AIDP (28.1%) vs AMAN (6.5%) (p = 0.012) and diarrhea was more common in AMAN (32.6%) than AIDP (12.5%) (p = 0.06). IgG anti-GM1 antibody titers were higher in patients with AMAN vs AIDP (p = 0.067). Anti-GD1a antibodies were equally present in both groups. Anti GQ1b titers were higher in AMAN vs AIDP (p = 0.009). Campylobacter antibody responses were positive in 44.1% of patients with AMAN and 37.0% of patients with AIDP. Twenty patients (14 = AMAN, 6 = AIDP) had positive stool cultures for C jejuni. Two serotypes, HS:19 and HS:41, accounted for 6 of 10 Campylobacter isolates available for serotyping from these cases.
Conclusions: This study confirms that acute motor axonal neuropathy is an important Guillain-Barré syndrome subtype in Mexican children, is associated with diarrhea, and occurs seasonally.
GLOSSARY: AIDP = acute inflammatory demyelinative polyneuropathy; AMAN = acute motor axonal neuropathy; AMSAN = acute motor sensory axonal neuropathy; GBS = Guillain-Barré syndrome; HS = heat stable; INP = Instituto Nacional de Pediatria; HPL = Hospital Legaria.
Supplemental data at www.neurology.org
Editorial, see page 1647
e-Pub ahead of print on September 26, 2007, at www.neurology.org.
Deceased.
Supported in part by a grant from the National Institutes of Health, NS-31528.
Disclosure: The authors report no conflicts of interest.
Presented in part at the 9th International Workshop on Campylobacter, Helicobacter and Related Organisms, E-12; Aarhus, Denmark; September 6–10, 2003.
Received February 16, 2007. Accepted in final form April 17, 2007.
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