Bickerstaff's brainstem encephalitis complicating Salmonella Paratyphi A infection

First report of Bickerstaff’s brainstem encephalitis caused by Salmonella Dublin: a case report

“…In most cases of BBE, CSF protein/cell dissociation occurs within 4 weeks of disease development. However, in a small number of cases, the disease is not accompanied by elevated protein levels [ 12 , 13 , 15 – 17 ]. Brain MRI examination reveals abnormal findings in approximately one-third of BBE patients, with long T2 signal lesions in the brainstem, thalamus, cerebellum, and white matter [ 18 ].…”

Infectious and noninfectious triggers in Guillain–Barré syndrome

“…In one study, three out of 302 (1%) of patients with typhoid fever developed GBS [70] whereas in a larger African study of 959 infected patients there was no GBS [71]. Different GBS variants have been reported in association with Salmonella species, including several cases of GBS, FS and BBE [68,72,73]. Knowledge of anti-ganglioside antibody profiles in such patients is lacking and anti-GQ1b antibodies have only been identified in one patient with S. Paratyphi strain A-related BBE [73].…”

“…Different GBS variants have been reported in association with Salmonella species, including several cases of GBS, FS and BBE [68,72,73]. Knowledge of anti-ganglioside antibody profiles in such patients is lacking and anti-GQ1b antibodies have only been identified in one patient with S. Paratyphi strain A-related BBE [73]. Here, GQ1b epitope was not tested for and it remains unclear whether molecular mimicry plays a role in Salmonella-related GBS.…”

How do we identify infectious agents that trigger Guillain–Barré syndrome, Fisher syndrome and Bickerstaff brainstem encephalitis?

“…In this issue, Sheng and his co-authors have shown in their review table [1] several case reports of GBS (probably AMAN) [43,44], mild forms of FS (acute ophthalmoparesis without ataxia) [45] and BBE [46] that are associated with enteric fever, raising the possibility that enteric fever pathogens can trigger the syndromes. S. Typhi has been isolated from patients with GBS [47][48][49][50][51][52][53] or BBE [46], and S. Paratyphi A has also been isolated from a GBS patient [43].…”

“…In the current issue, Sheng and colleagues report an interesting case of Bickerstaff brainstem encephalitis (BBE) associated with Salmonella Paratyphi A infection [1]. This prompted us to revisit the nosological position of BBE and review the role of antecedent agents in BBE with a view to suggesting ways of identifying the infectious agents that can trigger this rare condition.…”