Antecedent infections in Guillain‐Barré syndrome: a single‐center, prospective study

Abstract

ObjectiveTo investigate the spectrum of antecedent infections in Chinese patients with Guillain‐Barré syndrome (GBS) and analyze the infections‐related clinical phenotypes locally.MethodsA prospective case‐control study of 150 patients diagnosed with GBS and age‐ and sex‐matched neurological and healthy controls was performed to investigate recent infections of 14 pathogens serologically and collect the clinical data during a follow‐up of 12 months.ResultsIn total, 53% of patients with GBS had a positive serology for recent infection, including Campylobacter jejuni (27%), influenza A (17%) and B (16%), hepatitis A virus (5%), dengue virus (3%), cytomegalovirus (3%), Epstein–Barr virus (3%), Mycoplasma pneumoniae (2%), herpes simplex virus (2%), varicella‐zoster virus (1%), and rubella virus (1%). Serology for infections of hepatitis E virus, Haemophilus influenzae, and Zika virus was negative. There was a higher frequency of C. jejuni, influenza A, influenza B, and hepatitis A virus infections in GBS patients than both the neurological and healthy controls. C. jejuni infection was more frequent in younger GBS patients and was associated with antibodies against GM1, GalNAc‐GD1a, and GM1:galactocerebroside complex. Influenza B infection was associated with a pure motor form of GBS.Interpretation C. jejuni, influenza A, influenza B, and hepatitis A virus serve as the most common cause of antecedent infections in GBS locally. Influenza B‐related GBS may represent a pure motor phenotype. Differences in the infectious spectrum worldwide may contribute to the geographical clinical heterogeneity of GBS.

COVID-19–Associated Bifacial Weakness with Paresthesia Subtype of Guillain-Barré Syndrome

“…Although ubiquitous, HSV infection has been reported as an extremely rare antecedent to GBS. [18][19][20][21][22] Whether in our case the GBS was directly caused by COVID-19, the COVID-19-associated systemic inflammatory response unmasked or exacerbated an HSV-mediated GBS, or the patient simply manifested unfortunately timed coexisting disease processes remains unknowable. However, we note prior immunologic research by Ziganshin et al 19 that demonstrated an increased risk of GBS triggering in simultaneous polyviral infection, including HSV, which might have important implications for the pathoetiology of GBS in our patient.…”

Facing acute neuromuscular diseases during COVID-19 pandemic: focus on Guillain–Barré syndrome

“…There are two major subtypes, based on electrophysiological and pathological features, i.e., acute inflammatory demyelinating polyneuropathy (AIDP), and acute motor/sensorimotor axonal or demyelinating neuropathy (AMAN/AMSAN/ AMSAD) [36,37,[41][42][43]. At present, a wide range of anti-nerve autoantibodies directed at proteins and glycolipids, including GM1, GM1b, GD1a, GalNAc-GD1a, and GQ1b, are considered responsible for immunopathology of AIDP, AMAN and Miller Fisher (MFS) syndrome [36,37,41,[44][45][46][47]. Albuminocytologic dissociation is reported in 2/3 cases in the first week after onset of symptoms, and the frequency of anti-ganglioside antibodies is highly dependent on GBS subtype [38,41].…”

“…Campylobacter jejuni (C. jejuni) is the predominant antecedent infection, found in 25-50% of adult patients [38,41]. The original rationale rising from animal models was that a molecular mimicry exists between specific microbial proteins and peripheral nerve glycolipids leading to an innocent bystander attack against the myelin or the axon [41,46,47]. Lipo-oligosaccharides on the C. jejuni outer membrane may elicit the production of antibodies that cross react with gangliosides on peripheral nerves [36,37,41].…”

Influenza-associated Fulminant Myocarditis Complicated by Guillain-Barré Syndrome

“…The most frequently identified infectious agent associated with subsequent development of GBS is Campylobacter jejuni, which, combined with cytomegalovirus and Mycoplasma pneumoniae, is observed in approximately 70% of patients with GBS (2). In addition, influenza viruses can also cause both myocarditis and GBS (3,4).…”