Guillain-Barré syndrome in southern China: retrospective analysis of hospitalised patients from 14 provinces in the area south of the Huaihe River

Abstract

ChiCTR-RRC-17014152.

Regional variation of Guillain-Barré syndrome

“…The association between preceding C. jejuni infection and axonal GBS is related to the induction of cross-reactive antibodies to gangliosides (Willison et al, 2016). A recent retrospective study indicated a relatively high frequency of the demyelinating subtype (49%) and lower frequency of the axonal subtype (19%) in Southern China (Liu et al, 2018), while previous studies from Northern China from the 1990s reported the axonal subtype in 65% of GBS patients (Ho et al, 1995). It is unknown whether this variation represents a regional difference within China or a change in GBS spectrum over time in parallel to changes in exposure to infections, especially with C. jejuni (Baker et al, 2012;Liu et al, 2018).…”

“…A recent retrospective study indicated a relatively high frequency of the demyelinating subtype (49%) and lower frequency of the axonal subtype (19%) in Southern China (Liu et al, 2018), while previous studies from Northern China from the 1990s reported the axonal subtype in 65% of GBS patients (Ho et al, 1995). It is unknown whether this variation represents a regional difference within China or a change in GBS spectrum over time in parallel to changes in exposure to infections, especially with C. jejuni (Baker et al, 2012;Liu et al, 2018). Future serological studies will investigate the role of preceding infections, and immune responses to these infections, to explain the regional differences.…”

“…Comparison of previous studies conducted in single countries suggests that the variation of GBS may be influenced by factors related to the geographical origin of patients, such as endemic infections or unusual epidemics like the recent GBS peaks related to Zika virus (Cao-Lormeau et al, 2016;Parra et al, 2016). These studies illustrate a wide variability in prevalence of clinical variants and electrophysiological subtypes of GBS between regions, suggesting that sensorimotor and demyelinating GBS predominate in Europe and North America, whereas pure motor and axonal GBS are more frequent in Asian and South American countries (Lyu et al, 1997;Hadden et al, 1998;Bogliun et al, 2004;Hughes and Cornblath, 2005;Islam et al, 2010;Sekiguchi et al, 2012;Kuwabara and Yuki, 2013;Mitsui et al, 2015;Willison et al, 2016;Liu et al, 2018). However, these single country studies had different study designs, inclusion criteria and definitions of GBS variants (Ho et al, 1995;Hadden et al, 1998).…”

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“…Studies have shown that GBS was preceded by infections in 40%–70% of the reported cases 31. In one Asian setting, preceding infections were prevalent in 34.9% of the GBS cases,27 a much lower figure than that reported in this setting (69.4%). Recipients of vaccines such as the varicella zoster virus vaccine were at higher risk for the demyelinating subtypes of GBS 32.…”

“…Epidemiological studies of GBS in Asia are few and it is speculated that there are geographical differences with regards to the various types of GBS 25. For instance, the prevalence of AIDP in two Far Eastern settings was 20/30 (66.7%)26 and 324/661 (49%),27 much higher than that reported in this setting as 18/49 (17.9%). The average age of children who complained of GBS in this setting was 8.59±4.99 years, which was slightly higher than that reported in the literature 28.…”