Immunopathological studies suggest that the target of immune attack is different in the subtypes of Guillain‐Barré syndrome (GBS). In acute motor axonal neuropathy (AMAN), the attack appears directed against the axolemma and nodes of Ranvier. In acute inflammatory demyelinating polyneuropathy (AIDP), the attack appears directed against a component of the Schwann cell. However, the nature of the antigenic targets is still not clear. We prospectively studied 138 Chinese GBS patients and found that IgG anti‐GD1a antibodies were closely associated with AMAN but not AIDP. With a cutoff titer of greater than 1:100, 60% of AMAN versus 4% of AIDP patients had IgG anti‐GD1a antibodies; with a cutoff titer of greater than 1:1,000, 24% of AMAN patients and none of the AIDP patients had IgG anti‐GD1a antibodies. In contrast, low levels of IgG anti‐GM1 antibodies (>1:100) were detected in both the AMAN and the AIDP forms (57% vs 35%, NS). High titers of IgG anti‐GM1 (>1:1,000) were more common in the AMAN form (24% vs 8%, NS). Serological evidence of recent Campylobacter infection was detected in 81% of AMAN and 50% of AIDP patients, and anti‐ganglioside antibodies were common in both Campylobacter‐infected and noninfected patients. Our results suggest that IgG anti‐GD1a antibodies may be involved in the pathogenesis of AMAN. Ann Neurol 1999;45:168–173
Fluoroquinolone-resistant
Campylobacter jejuni
has been observed worldwide and is now being seen in the United States. Among patients in our health-care system in Pennsylvania, fluoroquinolone-resistant
C. jejuni
were not observed from 1982 to 1992; however, resistance increased to 40.5% in 2001. Resistance to erythromycin remains at a low level (<5%).
Influenza vaccines contain structures that can induce anti-GM(1) antibodies after inoculation into mice. Further research into influenza vaccine components that elicit anti-ganglioside responses and the role played by these antibodies (if any) in vaccine-associated GBS is warranted.
GM 1 -and GD 1a -like ganglioside mimicry in Campylobacter jejuni lipooligosaccharide (LOS) is considered to be involved in the pathogenesis of Campylobacter-induced Guillain-Barré syndrome (GBS). Compared with gastroenteritis-related isolates, GBS-related C. jejuni isolates were strongly associated with the expression of GD 1a -like mimicry. The presence of a few genes involved in LOS ganglioside mimicry, cst-II, cgtA, and cgtB, was also associated with GBS-related strains. GD 1a -like epitope expression may be an important virulence phenotype associated with the risk of developing GBS following campylobacter infection.
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.
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