Campylobacter Infection as a Trigger for Guillain-Barré Syndrome in Egypt

Abstract

BackgroundMost studies of Campylobacter infection triggering Guillain-Barré Syndrome (GBS) are conducted in western nations were Campylobacter infection and immunity is relatively rare. In this study, we explored Campylobacter infections, Campylobacter serotypes, autoantibodies to gangliosides, and GBS in Egypt, a country where Campylobacter exposure is common.MethodsGBS cases (n = 133) were compared to age- and hospital-matched patient controls (n = 374). A nerve conduction study was performed on cases and a clinical history, serum sample, and stool specimen obtained for all subjects.ResultsMost (63.3%) cases were demyelinating type; median age four years. Cases were more likely than controls to have diarrhea (29.5% vs. 22.5%, Adjusted Odds Ratio (ORa) = 1.69, P = 0.03), to have higher geometric mean IgM anti-Campylobacter antibody titers (8.18 vs. 7.25 P<0.001), and to produce antiganglioside antibodies (e.g., anti-Gd1a, 35.3 vs. 11.5, ORa = 4.39, P<0.0001). Of 26 Penner:Lior Campylobacter serotypes isolated, only one (41:27, C. jejuni, P = 0.02) was associated with GBS.ConclusionsUnlike results from western nations, data suggested that GBS cases were primarily in the young and cases and many controls had a history of infection to a variety of Campylobacter serotypes. Still, the higher rates of diarrhea and greater antibody production against Campylobacter and gangliosides in GBS patients were consistent with findings from western countries.

Detection of Campylobacter species in stool specimens from patients with symptoms of acute flaccid paralysis in South Africa

“…Reports have shown, however, the incidence of GBS to increase with age, and according to Islam et al [30], C. jejuni-induced GBS incidence is lower in children. Nevertheless, results from our study coincided with that of Wierzba et al [9], mainly because AFP cases are generally observed amongst young children globally and this observation influenced the case definition of AFP patients (< 15 years) included in surveillance. Given that gastroenteritis due to C. jejuni infections are hyperendemic among young children (< 5 years) in tropical resource-poor settings, it is expected that the prevalence of C. jejuni-induced GBS would be prevalent among individuals of < 5 years of age.…”

“…Most of these studies investigating Campylobacter-induced GBS were conducted in developed countries. A study conducted in Egypt showed the frequent association of GBS with males which coincides with what is observed in developed countries [9]. However, in our study, although not statistically significant (p-value = 0.22), C. jejuni was more commonly detected in females (54%) compared to males (46%).…”

“…These findings suggest that other species of Campylobacter, although not yet recognised, may be important in the pathogenesis of GBS [14,28]. In developing countries, asymptomatic infections with Campylobacter occur due to recurrent Campylobacter infections as residents are repeatedly exposed to these pathogens [9,10]. This may partly explain the detection of species of Campylobacter from AFP patients which have not yet been documented as elicitors of GBS, such as the detection of C. coli in our study.…”

“…Campylobacter positive cases in our current study thus reflected a predominance of children and teenagers, who are individuals identified by the case definition for AFP surveillance. The study conducted in Egypt by Wierzba et al [9], showed the incidence of C. jejuni-induced GBS to be higher in children from developing countries; an observation which contrasts reports from developed countries where the prevalence of GBS is commonest among adults [16,29,30]. According to Nyati and Nyati [4], patients of any age may develop GBS.…”

“…Pathogenic features of C. jejuni influencing the development of GBS have been described, with C. jejuni infections reportedly constituting the majority of GBS cases [1][2][3][4][5]. GBS, which develops after C. jejuni infection, has been investigated and reported in a number of studies, rendering characteristics of C. jejuni strains subject to renewed interest in association with the pathogenesis of GBS [4,[6][7][8][9].…”