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Lee H, Heo N, Kwon D, Ha J. Deciphering changes in the incidence of the Guillain-Barré syndrome during the COVID-19 pandemic: a nationwide time-series correlation study. BMJ Neurol Open 2022; 4:e000378. [PMID: 36618976 PMCID: PMC9808757 DOI: 10.1136/bmjno-2022-000378] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
Background Postinfectious autoimmunity is a hallmark of Guillain-Barré syndrome (GBS), and GBS incidence closely parallels that of its immune triggers. Sociobehavioural interventions implemented during the COVID-19 pandemic have altered the infectious disease landscape. Methods This nationwide time-series correlation study analysed GBS incidence, sentinel surveillance and SARS-CoV-2 vaccination data from January 2017 to December 2021 in the National Health Insurance Service and Korean Disease Control and Prevention Agency databases. The incidence of GBS and sentinel gastrointestinal and respiratory infectious diseases during the pandemic (2020-2021) was estimated and compared with both prepandemic (2017-2019) and incidence predicted in a time-series forecasting model. Time-series correlation analysis was used to examine the temporal association between GBS, infectious triggers and SARS-CoV-2 vaccination. Results During the pandemic, the total crude cumulative incidence rate was 2.1 per 100 000 population, which is lower than the prepandemic incidence, especially in age groups of less than 60 years. Seasonality was briefly interrupted during the winter of 2021. The majority of respiratory and some gastrointestinal conditions had a lower-than-expected incidence during the pandemic. Compared with the prepandemic state, during the pandemic period a higher number of gastrointestinal pathogens (Escherichia coli, Campylobacter spp., Clostridium perfringens, Yersinia enterocolitica and enteric adenovirus) had significant, moderate-to-strong positive temporal associations with GBS. The temporal association between SARS-CoV-2 infection and GBS was not significant, but SARS-CoV-2 vaccination exhibited a strong positive temporal association with GBS in 2021. Conclusion The incidence of GBS and sentinel infectious diseases decreased to below-expected levels during the pandemic, with the former attributable to the decreased incidence of non-COVID-19 respiratory and gastrointestinal infections. The evolving incidence of autoimmune postinfectious phenomena following the pandemic needs attention.
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Affiliation(s)
- Hyunju Lee
- Division of Public Health Emergency Response Research, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, Korea
| | - Namwoo Heo
- Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yongin, Gyeonggi-do, Korea
| | - Donghyok Kwon
- Division of Public Health Emergency Response Research, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, Korea
| | - Jongmok Ha
- Infectious Disease Control Center, Gyeonggi Provincial Government, Suwon, Gyeonggi-do, Korea,Department of Neurology, Yeoncheon-gun Health Medical center, Yeoncheon-gun, Gyeonggi-do, Korea
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2
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Liang H, Cao Y, Zhong W, Ma Z, Liu J, Chen H. Miller-Fisher syndrome and Guillain-Barre syndrome overlap syndrome following inactivated COVID-19 vaccine: Case report and scope review. Hum Vaccin Immunother 2022; 18:2125753. [PMID: 36315834 PMCID: PMC9746535 DOI: 10.1080/21645515.2022.2125753] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Miller-Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome (GBS) manifesting as the triad of ataxia, areflexia, and ophthalmoplegia. With the extensive 2019 coronavirus disease (COVID-19) immunization program, cases of GBS or MFS following vaccination are increasingly being reported. A 64-y-old Chinese man presented with new-onset paresthesia of the extremities, bilateral abduction limitation, right facial palsy, areflexia of bilateral lower limbs, and left-dominant limb ataxia 12 d after the second dose of inactivated vaccine against COVID-19. Cerebrospinal fluid analysis indicated albumin-cytological dissociation and was positive for anti-GQ1b IgG and anti-GT1b IgG. Nerve conduction studies of limbs showed evidence of axonal neuropathy with reduced sensory amplitudes. Based on the clinical presentations, temporal progression of symptoms, and laboratory findings, the diagnosis of MFS-GBS overlap syndrome was made. The patient was treated with intravenous immunoglobulin and acupuncture and made a complete recovery 54 d after the onset of his initial neurological signs. To the best of our knowledge, we report the first case of MFS-GBS overlap syndrome following the inactivated COVID-19 vaccination. However, a coincidental relationship with this inactivated vaccine cannot be excluded. Although the benefits of COVID-19 vaccination largely outweigh its risk and the prognosis of MFS is generally favorable, a close surveillance of neurological complications post-COVID-19 vaccination is always necessary, considering its potentially disabling and lethal effects on vaccinated populations.
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Affiliation(s)
- Hao Liang
- Department of Acupuncture, Heilongjiang Academy of Traditional Chinese Medicine, Harbin, China
| | - Yuanbo Cao
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Zhong
- Department of Rheumatology and Immunology, Affiliated Qiqihar Hospital, Southern Medical University, Qiqihar, China
| | - Zhenwang Ma
- Department of Acupuncture, Heilongjiang Academy of Traditional Chinese Medicine, Harbin, China
| | - Jia Liu
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China,Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China,CONTACT Jia Liu Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Hong Chen
- Department of TCM Geriatric, Heilongjiang Academy of Traditional Chinese Medicine, Harbin, China,Department of TCM Geriatric, Southern Medical University, Guangzhou, China,Hong Chen Department of TCM Geriatric, Heilongjiang Academy of Traditional Chinese Medicine, Harbin, China
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3
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Dourado Junior MET, Sousa BFD, Costa NMCD, Jeronimo SMB. Cytomegalovirus infection in Guillain-Barré syndrome: a retrospective study in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:607-611. [PMID: 34468494 DOI: 10.1590/0004-282x-anp-2020-0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/28/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is currently the most common cause of acute flaccid paralysis worldwide. Risk factors for GBS include previous viral or bacterial infections or vaccination. Recently, an outbreak of Zika virus led to an outbreak of GBS in Latin America, mostly in Brazil, concomitant to continuous circulation of dengue virus serotypes. However, there is no study about cytomegalovirus (CMV) infection as a risk for GBS in Brazil. OBJECTIVES In this study, we report a series of cases of GBS with the aim of determining the prevalence of CMV and the characteristics associated with the infection. METHODS A cohort of 111 GBS cases diagnosed between 2011 and 2017 in Natal, northeastern Brazil, was studied. Presence of CMV IgM antibodies was determined by means of electrochemiluminescence. The analysis was performed considering CMV infection status and the clinical outcome. RESULTS We found seroprevalence of 15.3% (n = 17) for CMV. CMV patients were younger (26 vs. 40; p = 0.016), with no apparent gastrointestinal (p = 0.762) or upper respiratory infections (p = 0.779) or sensory loss (p = 0.03). They presented more often with a classic GBS sensorimotor variant (p = 0.02) and with a demyelinating pattern in electrophysiological studies (p < 0.001). CONCLUSION In Brazil, the clinical-epidemiological profile of GBS associated with CMV infection is similar to that described in other countries. Better understanding of the relationship between infectious processes and GBS is a key component of the research agenda and assistance strategy for global health initiatives relating to peripheral neuropathic conditions.
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Affiliation(s)
- Mario Emilio Teixeira Dourado Junior
- Universidade Federal do Rio Grande do Norte, Centro de Ciências da Saúde, Departamento de Medicina Integral, Natal RN, Brazil.,Universidade Federal do Rio Grande do Norte, Instituto de Medicina Tropical do Rio Grande do Norte, Natal RN, Brazil
| | - Bruno Fernandes de Sousa
- Universidade Federal do Rio Grande do Norte, Centro de Ciências da Saúde, Departamento de Medicina Integral, Natal RN, Brazil
| | - Nathaly M Coelho da Costa
- Universidade Federal do Rio Grande do Norte, Centro de Biociências, Departamento de Bioquímica, Natal RN, Brazil
| | - Selma Maria Bezerra Jeronimo
- Universidade Federal do Rio Grande do Norte, Instituto de Medicina Tropical do Rio Grande do Norte, Natal RN, Brazil.,Universidade Federal do Rio Grande do Norte, Centro de Biociências, Departamento de Bioquímica, Natal RN, Brazil.,Intituto Nacional de Ciências e Tecnologia de Doenças Tropicais, Natal RN, Brazil
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Mihajkoska E, Poceva Panovska A, Brezovska K, Pendovska M, Taravari A, Suturkova L. The role of antibodies to peripheral nerve antigens in pathogenesis and laboratory evaluation of immune-mediated neuropathies. MAKEDONSKO FARMACEVTSKI BILTEN 2021. [DOI: 10.33320/maced.pharm.bull.2021.67.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Detection of antiganglioside autoantibodies and their association with clinically defined subtypes implicate an autoimmune mechanism of peripheraland cranial nerve damage in peripheral neuropathies.
Increased titer of antibodies that react with human peripheral nerve antigens have been reported in patients with motor neuropathy including Guillain-Barré syndrome,chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy and sensory motor neuropathy. This study represents review of the data related to increased titers of anti-glucoconjugate antibodies in different autoimmune neuropathies and their correlation with existence of structural homology between bacterial and glycoconjugated structures, as a basis for understanding the immune pathological response to glycoproteins and glycolipids present in the human peripheral nerve as target antigens in autoimmune neuropathies.
Evaluation of presence and increased level of autoantibodies against peripheral nerve antigens could be an important parameter in laboratory evaluation, diagnosis and prognosis of autoimmune neuropathies and contribute in more efficient therapeutic approaches in treatment of these pathological conditions.
Keywords: anti-glycoconjugate antibodies, anti-ganglioside antibodies, peripheral nerves, autoimmune neuropathies
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Affiliation(s)
- Evgenija Mihajkoska
- Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Ana Poceva Panovska
- Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Katerina Brezovska
- Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Marija Pendovska
- University Clinic for Hematology, Ss. Cyril and Methodius University in Skopje, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
| | - Arben Taravari
- Universiy Clinic for Neurology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 50 Divizija 6, 1000 Skopje, Republic of North Macedonia
| | - Ljubica Suturkova
- Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Mother Theresa 47, 1000 Skopje, Republic of North Macedonia
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Kuwabara S, Misawa S. Chronic Inflammatory Demyelinating Polyneuropathy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1190:333-343. [DOI: 10.1007/978-981-32-9636-7_21] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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6
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Kim JE, Kim JK, Park KM, Kim Y, Yoon DY, Bae JS. Top-100 cited articles on Guillain-Barré syndrome: a bibliometric analysis. J Peripher Nerv Syst 2018; 21:329-338. [PMID: 27616001 DOI: 10.1111/jns.12188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/24/2016] [Accepted: 09/07/2016] [Indexed: 01/28/2023]
Abstract
Since the first description of Guillain-Barré syndrome (GBS) 100 years ago, the concept of this syndrome has changed remarkably. The purpose of our study was to identify and characterize the most-cited articles that have contributed to advancing the understanding of GBS. Based on the database of Journal Citation Reports, we selected 554 journals that were considered as potential sources of reports on studies related to clinical neurology and general medicine. The Web of Science search tools were used to identify the most-cited articles relevant to GBS or other variants in the selected journals. Of the selected articles, 18 were review articles and the remainder were original articles or included only a few case series. Among the original articles, 13 described basic research associated with immunological pathogenesis involving anti-ganglioside antibodies. Most of the original studies (42/64, 66%) published after 1990 evaluated anti-ganglioside antibodies that mediated axonal GBS or Miller Fisher syndrome, with only a small number of the papers involving electrodiagnostic medicine (n = 4). Our bibliometric analysis has yielded a detailed list of the top-100 cited articles in the field of GBS.
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Affiliation(s)
- Jee-Eun Kim
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Jong Kuk Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Versace V, Campostrini S, Tezzon F, Martignago S, Kofler M, Saltuari L, Sebastianelli L, Nardone R. Atypical Electrophysiological Findings in a Patient with Acute Motor and Sensory Axonal Neuropathy. Front Neurol 2017; 8:594. [PMID: 29167658 PMCID: PMC5682302 DOI: 10.3389/fneur.2017.00594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/23/2017] [Indexed: 11/13/2022] Open
Abstract
Guillain–Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy with acute onset and rapid clinical worsening; early diagnosis and immunomodulating therapy can ameliorate the course of disease. During the first days, however, nerve conduction studies (NCSs) are not always conclusive. Here, we describe a 73-year-old man presenting with progressive muscular weakness of the lower limbs, ascending to the upper limbs, accompanied by distal sensory disturbances. Neuroimaging of brain and spine and NCSs were unremarkable; cerebrospinal fluid analysis revealed no albuminocytologic dissociation. Based on typical clinical features, and on positivity for serum GD1b-IgM antibodies, GBS with proximal conduction failure at multiple radicular levels was postulated, and a standard regime of intravenous immunoglobulin was administered. Four weeks later, the patient presented with flaccid tetraparesis, areflexia, and reduction of position sense, tingling paresthesias, and initial respiratory distress. Repeat NCS still revealed almost normal findings, except for the disappearance of right ulnar nerve F-waves. A few days thereafter, the patient developed severe respiratory insufficiency requiring mechanical ventilation for 2 weeks. On day 50, NCS revealed for the first time markedly reduced compound muscle action potentials and sensory nerve action potentials in all tested nerves, without signs of demyelination; needle electromyography documented widespread denervation. The diagnosis of acute motor and sensory axonal neuropathy was made. After 3 months of intensive rehabilitation, the patient regained the ability to walk with little assistance and was discharged home. In conclusion, normal NCS findings up to several weeks do not exclude the diagnosis of GBS. Very proximal axonal conduction failure with late distal axonal degeneration should be taken into consideration, and electrodiagnostic follow-up examinations, even employing unusual techniques, are recommended over several weeks after disease onset.
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Affiliation(s)
- Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Stefania Campostrini
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Frediano Tezzon
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Sara Martignago
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Markus Kofler
- Department of Neurology, State Hospital Hochzirl, Zirl, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy.,Department of Neurology, State Hospital Hochzirl, Zirl, Austria
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.,Department of Neurology, Christian Doppler Medical Center, Paracelsus Private Medical University of Salzburg, Salzburg, Austria
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8
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Pyun SY, Kang MR, Lee JY, Kuk KJ, Oh SI, Bae JS. Early discrimination of sensorimotor Guillain-Barré syndrome into demyelinating or axonal subtype by automated nerve excitability testing. J Peripher Nerv Syst 2017; 22:85-91. [DOI: 10.1111/jns.12208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 01/25/2023]
Affiliation(s)
- So Young Pyun
- Department of Neurology; National Police Hospital; Seoul Korea
| | - Mi-Ri Kang
- Department of Neurology; Busan Paik Hospital, Inje University College of Medicine; Busan Korea
| | - Ju Young Lee
- Department of Neurology, Kangdong Sacred Heart Hospital; Hallym University College of Medicine; Seoul Korea
| | - Kim Jong Kuk
- Department of Neurology; Dong-A University College of Medicine; Busan Korea
| | - Seong-Il Oh
- Department of Neurology; Busan Paik Hospital, Inje University College of Medicine; Busan Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital; Hallym University College of Medicine; Seoul Korea
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9
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O'Hara GA, Fitchett JRA, Klein JL. Campylobacter bacteremia in London: A 44-year single-center study. Diagn Microbiol Infect Dis 2017. [PMID: 28629878 DOI: 10.1016/j.diagmicrobio.2017.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Campylobacter species are a well-recognized but rare cause of bloodstream infection. METHODS Here we reviewed 41 cases of Campylobacter bloodstream infection occurring at a single center in London over 44years, comprising 0.2% of all recorded episodes during this time period. RESULTS Patients had a mean age of 46years and, contrasting with previous reports, nearly 50% of our patients did not have significant comorbidities. Ciprofloxacin resistance increased over the study period with 35% of isolates overall being resistant compared with only 3% exhibiting macrolide resistance. Despite a minority of patients receiving appropriate empirical antibiotic therapy, overall mortality was only 7%. CONCLUSION Campylobacter bacteremia remains a rare but significant cause of morbidity with a low associated mortality. Underlying immunosuppressive conditions are common but by no means universal. In our setting, macrolides would be favored as empirical agents to treat suspected Campylobacter enteritis, including cases with associated bacteremia.
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Affiliation(s)
- Geraldine A O'Hara
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | | | - John L Klein
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
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Ziganshin RH, Ivanova OM, Lomakin YA, Belogurov AA, Kovalchuk SI, Azarkin IV, Arapidi GP, Anikanov NA, Shender VO, Piradov MA, Suponeva NA, Vorobyeva AA, Gabibov AG, Ivanov VT, Govorun VM. The Pathogenesis of the Demyelinating Form of Guillain-Barre Syndrome (GBS): Proteo-peptidomic and Immunological Profiling of Physiological Fluids. Mol Cell Proteomics 2016; 15:2366-78. [PMID: 27143409 PMCID: PMC4937510 DOI: 10.1074/mcp.m115.056036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/27/2016] [Indexed: 01/06/2023] Open
Abstract
Acute inflammatory demyelinating polyneuropathy (AIDP) - the main form of Guillain-Barre syndrome-is a rare and severe disorder of the peripheral nervous system with an unknown etiology. One of the hallmarks of the AIDP pathogenesis is a significantly elevated cerebrospinal fluid (CSF) protein level. In this paper CSF peptidome and proteome in AIDP were analyzed and compared with multiple sclerosis and control patients. A total protein concentration increase was shown to be because of even changes in all proteins rather than some specific response, supporting the hypothesis of protein leakage from blood through the blood-nerve barrier. The elevated CSF protein level in AIDP was complemented by activization of protein degradation and much higher peptidome diversity. Because of the studies of the acute motor axonal form, Guillain-Barre syndrome as a whole is thought to be associated with autoimmune response against neurospecific molecules. Thus, in AIDP, autoantibodies against cell adhesion proteins localized at Ranvier's nodes were suggested as possible targets in AIDP. Indeed, AIDP CSF peptidome analysis revealed cell adhesion proteins degradation, however no reliable dependence on the corresponding autoantibodies levels was found. Proteome analysis revealed overrepresentation of Gene Ontology groups related to responses to bacteria and virus infections, which were earlier suggested as possible AIDP triggers. Immunoglobulin blood serum analysis against most common neuronal viruses did not reveal any specific pathogen; however, AIDP patients were more immunopositive in average and often had polyinfections. Cytokine analysis of both AIDP CSF and blood did not show a systemic adaptive immune response or general inflammation, whereas innate immunity cytokines were up-regulated. To supplement the widely-accepted though still unproven autoimmunity-based AIDP mechanism we propose a hypothesis of the primary peripheral nervous system damaging initiated as an innate immunity-associated local inflammation following neurotropic viruses egress, whereas the autoantibody production might be an optional complementary secondary process.
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Affiliation(s)
- Rustam H Ziganshin
- From the ‡Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Miklukho-Maklaya str., 16/10, Moscow 117997, Russian Federation;
| | - Olga M Ivanova
- From the ‡Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Miklukho-Maklaya str., 16/10, Moscow 117997, Russian Federation
| | - Yakov A Lomakin
- From the ‡Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Miklukho-Maklaya str., 16/10, Moscow 117997, Russian Federation
| | - Alexey A Belogurov
- From the ‡Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Miklukho-Maklaya str., 16/10, Moscow 117997, Russian Federation
| | - Sergey I Kovalchuk
- From the ‡Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Miklukho-Maklaya str., 16/10, Moscow 117997, Russian Federation
| | - Igor V Azarkin
- From the ‡Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Miklukho-Maklaya str., 16/10, Moscow 117997, Russian Federation
| | - Georgij P Arapidi
- From the ‡Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Miklukho-Maklaya str., 16/10, Moscow 117997, Russian Federation; §Moscow Institute of Physics and Technology, Institutskiy pereulok 9, Dolgoprudny 141700, Russian Federation
| | - Nikolay A Anikanov
- From the ‡Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Miklukho-Maklaya str., 16/10, Moscow 117997, Russian Federation
| | - Victoria O Shender
- From the ‡Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Miklukho-Maklaya str., 16/10, Moscow 117997, Russian Federation
| | - Mikhail A Piradov
- ¶Research Center of Neurology, Volokolamskoye highway, 80, Moscow 125367, Russian Federation
| | - Natalia A Suponeva
- ¶Research Center of Neurology, Volokolamskoye highway, 80, Moscow 125367, Russian Federation
| | - Anna A Vorobyeva
- ¶Research Center of Neurology, Volokolamskoye highway, 80, Moscow 125367, Russian Federation
| | - Alexander G Gabibov
- From the ‡Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Miklukho-Maklaya str., 16/10, Moscow 117997, Russian Federation
| | - Vadim T Ivanov
- From the ‡Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Miklukho-Maklaya str., 16/10, Moscow 117997, Russian Federation
| | - Vadim M Govorun
- From the ‡Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Miklukho-Maklaya str., 16/10, Moscow 117997, Russian Federation; §Moscow Institute of Physics and Technology, Institutskiy pereulok 9, Dolgoprudny 141700, Russian Federation; ‖Research Institute of Physical Chemical Medicine, Malaya Pirogovskaya str., 1a, Moscow 119435, Russian Federation
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Shaban E, Gohh R, Knoll BM. Late-onset cytomegalovirus infection complicated by Guillain-Barre syndrome in a kidney transplant recipient: case report and review of the literature. Infection 2015; 44:255-8. [PMID: 26141820 DOI: 10.1007/s15010-015-0819-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/29/2015] [Indexed: 11/29/2022]
Abstract
Cytomegalovirus (CMV) infection remains a common infection after solid-organ transplantation. In the general population CMV disease is associated with Guillain-Barre syndrome (GBS), an autoimmune disease leading to an acute peripheral neuropathy, in 1 of 1000 cases. Interestingly, GBS is a rarely observed complication in solid-organ transplant recipients, possibly related to maintenance immunosuppression. We describe a case of CMV infection complicated by GBS in a kidney transplant recipient and review the literature.
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Affiliation(s)
- E Shaban
- Division of Organ Transplantation, Alpert Medical School of Brown University, Providence, RI, USA
| | - R Gohh
- Division of Organ Transplantation, Alpert Medical School of Brown University, Providence, RI, USA
| | - B M Knoll
- Division of Organ Transplantation, Alpert Medical School of Brown University, Providence, RI, USA. .,Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
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13
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Vlam L, Cats EA, Harschnitz O, Jansen MD, Piepers S, Veldink JH, Franssen H, Stork ACJ, Heezius E, Rooijakkers SHM, Herpers BL, van Strijp JA, van den Berg LH, van der Pol WL. Complement activity is associated with disease severity in multifocal motor neuropathy. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e119. [PMID: 26161430 PMCID: PMC4484896 DOI: 10.1212/nxi.0000000000000119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/11/2015] [Indexed: 11/19/2022]
Abstract
Objective: To investigate whether high innate activity of the classical and lectin pathways of complement is associated with multifocal motor neuropathy (MMN) and whether levels of innate complement activity or the potential of anti-GM1 antibodies to activate the complement system correlate with disease severity. Methods: We performed a case-control study including 79 patients with MMN and 79 matched healthy controls. Muscle weakness was documented with Medical Research Council scale sum score and axonal loss with nerve conduction studies. Activity of the classical and lectin pathways of complement was assessed by ELISA. We also determined serum mannose-binding lectin (MBL) concentrations and polymorphisms in the MBL gene (MBL2) and quantified complement-activating properties of anti-GM1 IgM antibodies by ELISA. Results: Activity of the classical and lectin pathways, MBL2 genotypes, and serum MBL concentrations did not differ between patients and controls. Complement activation by anti-GM1 IgM antibodies was exclusively mediated through the classical pathway and correlated with antibody titers (p < 0.001). Logistic regression analysis showed that both high innate activity of the classical pathway of complement and high complement-activating capacity of anti-GM1 IgM antibodies were significantly associated with more severe muscle weakness and axonal loss. Conclusion: High innate activity of the classical pathway of complement and efficient complement-activating properties of anti-GM1 IgM antibodies are determinants of disease severity in patients with MMN. These findings underline the importance of anti-GM1 antibody–mediated complement activation in the pathogenesis and clinical course of MMN.
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Affiliation(s)
- Lotte Vlam
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Elisabeth A Cats
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Oliver Harschnitz
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Marc D Jansen
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Sanne Piepers
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Jan Herman Veldink
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Hessel Franssen
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Abraham C J Stork
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Erik Heezius
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Suzan H M Rooijakkers
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Bjorn L Herpers
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Jos A van Strijp
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Leonard H van den Berg
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - W Ludo van der Pol
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
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Koski CL. Treatment of Multifocal Motor Neuropathy with Intravenous Immunoglobulin. J Clin Immunol 2014; 34 Suppl 1:S127-31. [DOI: 10.1007/s10875-014-0016-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 03/19/2014] [Indexed: 12/15/2022]
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Abstract
Understanding of Guillain-Barré syndrome (GBS) has progressed substantially since the seminal 1916 report by Guillain et al. Although Guillain, Barré, and Strohl summarised the syndrome based on observations of two French infantrymen, 2012 saw the beginning of an ambitious collaborative study designed to collect detailed data from at least 1,000 patients worldwide (IGOS, www.gbsstudies.org/about-igos). Progress has been made in many areas even since GBS was last reviewed in this journal in 2009. GBS subsequently received prominent attention in light of concerns regarding H1N1 influenza vaccinations, and several large-scale surveillance studies resulted. Despite these developments, and promising pre-clinical studies, disease-modifying therapies for GBS have not substantially altered since intravenous immunoglobulin was introduced over 20 years ago. In other areas, management has improved. Antibiotic prophylaxis in ventilated patients reduces respiratory tract infection, thromboprophylaxis has reduced the risk of venous thromboembolism, and there is increasing awareness of the benefit of high-intensity rehabilitation. This article highlights some of the interesting and thought-provoking developments of the last 3 years, and is based on a plenary lecture given at the 2012 Peripheral Nerve Society (PNS) meeting.
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Affiliation(s)
- Simon Rinaldi
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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16
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Uncini A, Yuki N. Electrophysiologic and immunopathologic correlates in Guillain–Barré syndrome subtypes. Expert Rev Neurother 2014; 9:869-84. [DOI: 10.1586/ern.09.43] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Revisiting the old link between infection and autoimmune disease with commensals and T helper 17 cells. Immunol Res 2013; 54:50-68. [PMID: 22460741 DOI: 10.1007/s12026-012-8311-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Genetic composition and major histocompatibility complex polymorphisms unequivocally predispose to autoimmune disease, but environmental factors also play a critical role in precipitating disease in susceptible individuals. Notorious among these has been microbial infection. Older studies describing associations between microbial infection and autoimmune disease are now followed by new studies demonstrating correlations between susceptibility to autoimmune disease and commensal colonization of the intestinal tract. T helper 17 (T(H)17) cells have gained a prominent role in autoimmune disease, and notably, their development within the intestine has been linked to colonization with specific commensal bacteria. Here, we consider current views on how microbes, T(H)17 cells, and autoimmunity are connected. We speculate on how the intricate relationships among commensal, pathogen, and the host might ultimately determine susceptibility to autoimmune disease.
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18
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Abstract
The latest estimation for the frequency of Guillain-Barré syndrome (GBS) is 1.1 to 1.8 per 100000 persons per year. Guillain-Barré syndrome is today divided into two major subtypes: acute inflammatory demyelinating polyneuropathy (AIDP) and the axonal subtypes, acute motor axonal neuropathy (AMAN) and acute motor and sensory axonal neuropathy (AMSAN). The axonal forms of GBS are caused by certain autoimmune mechanisms, due to a molecular mimicry between antecedent bacterial infection (particularly Campylobacter jejuni) and human peripheral nerve gangliosides. Improvements in patient management in intensive care units has permitted a dramatic drop in mortality rates. Immunotherapy, including plasma exchange (PE) or intravenous immunoglobulin (IVIg), seems to shorten the time to recovery, but their effect remains limited. Further clinical investigations are needed to assess the effect of PE or IVIg on the GBS patients with mild affection, no response, or relapse.
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Affiliation(s)
- Harutoshi Fujimura
- Department of Neurology, Toneyama National Hospital, Toneyama, Toyonaka, Japan.
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19
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Islam Z, Gilbert M, Mohammad QD, Klaij K, Li J, van Rijs W, Tio-Gillen AP, Talukder KA, Willison HJ, van Belkum A, Endtz HP, Jacobs BC. Guillain-Barré syndrome-related Campylobacter jejuni in Bangladesh: ganglioside mimicry and cross-reactive antibodies. PLoS One 2012; 7:e43976. [PMID: 22952833 PMCID: PMC3428305 DOI: 10.1371/journal.pone.0043976] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 07/27/2012] [Indexed: 12/11/2022] Open
Abstract
Background Campylobacter jejuni is the predominant antecedent infection in Guillain-Barré syndrome (GBS). Molecular mimicry and cross-reactive immune responses to C. jejuni lipo-oligosaccharides (LOS) precipitate the development of GBS, although this mechanism has not been established in patients from developing countries. We determined the carbohydrate mimicry between C. jejuni LOS and gangliosides, and the cross-reactive antibody response in patients with GBS in Bangladesh. Methodology Sera from 97 GBS patients, and 120 neurological and family controls were tested for antibody reactivity against LOS from C. jejuni isolates from GBS patients in Bangladesh (BD-07, BD-39, BD-10, BD-67 and BD-94) by enzyme-linked immunosorbent assay (ELISA). Cross-reactivity to LOS was determined by ELISA. The LOS outer core structures of C. jejuni strains associated with GBS/MFS were determined by mass spectrometry. Principle Findings IgG antibodies to LOS from C. jejuni BD-07, BD-39, BD-10, and BD-67 IgG antibodies were found in serum from 56%, 58%, 14% and 15% of GBS patients respectively, as compared to very low frequency (<3%) in controls (p<0.001). Monoclonal antibodies specific for GM1 and GD1a reacted strongly with LOS from the C. jejuni strains (BD-07 and BD-39). Mass spectrometry analysis confirmed the presence of GM1 and GD1a carbohydrate mimics in the LOS from C. jejuni BD-07 and BD-39. Both BD-10 and BD-67 express the same LOS outer core, which appears to be a novel structure displaying GA2 and GD3 mimicry. Up to 90–100% of serum reactivity to gangliosides in two patients (DK-07 and DK-39) was inhibited by 50 µg/ml of LOS from the autologous C. jejuni isolates. However, patient DK-07 developed an anti-GD1a immune response while patient DK-39 developed an anti-GM1 immune response. Conclusion Carbohydrate mimicry between C. jejuni LOS and gangliosides, and cross-reactive serum antibody precipitate the majority of GBS cases in Bangladesh.
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Affiliation(s)
- Zhahirul Islam
- Emerging Diseases and Immunobiology, Centre for Food and Waterborne Diseases, icddr,b, Dhaka, Bangladesh.
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20
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Kurokawa K, Sonoo M. [Internal medicine and neurological diseases: progress in diagnosis and treatment. Topics: XIII. Infection immunity and neurological disorders (Guillain-Barré syndrome, Fisher syndrome, Crow-Fukase syndrome, influenza-associated encephalopathy, AIDS encephalopathy)]. ACTA ACUST UNITED AC 2012; 101:2265-9. [PMID: 22973700 DOI: 10.2169/naika.101.2265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Yuki N, Kokubun N, Kuwabara S, Sekiguchi Y, Ito M, Odaka M, Hirata K, Notturno F, Uncini A. Guillain-Barré syndrome associated with normal or exaggerated tendon reflexes. J Neurol 2011; 259:1181-90. [PMID: 22143612 DOI: 10.1007/s00415-011-6330-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/09/2011] [Accepted: 11/13/2011] [Indexed: 11/27/2022]
Abstract
Areflexia is part one of the clinical criteria required to make a diagnosis of Guillain-Barré syndrome (GBS). The diagnostic criteria were stringently developed to exclude non-GBS cases but there have been reports of patients with GBS following Campylobacter jejuni enteritis with normal and exaggerated deep tendon reflexes (DTRs). The aim of this study is to expand the existing diagnostic criteria to preserved DTRs. From the cohort of patients referred for anti-ganglioside antibody testing from hospitals throughout Japan, 48 GBS patients presented with preserved DTR at admission. Thirty-two patients had normal or exaggerated DTR throughout the course of illness whereas in 16 patients the DTR became absent or diminished during the course of the illness. IgG antibodies against GM1, GM1b, GD1a, or GalNAc-GD1a were frequently present in either group (84 vs. 94%), suggesting a close relationship between the two groups. We then investigated the clinical and laboratory findings of 213 GBS patients from three hospital cohorts. In 23 patients, eight presented with normal tendon reflexes throughout the clinical course of the illness. Twelve showed hyperreflexia, with at least one of the jerks experienced even at nadir, and exaggerated reflexes returning to normal at recovery. The other three had hyperreflexia throughout the disease course. Compared to 190 GBS patients with reduced or absent DTR, the 23 DTR-preserved patients more frequently presented with pure motor limb weakness (87 vs. 47%, p = 0.00026), could walk 5 m independently at the nadir (70 vs. 33%, p = 0.0012), more frequently had antibodies against GM1, GM1b, GD1a, or GalNAc-GD1a (74 vs. 47%, p = 0.014) and were more commonly diagnosed with acute motor axonal neuropathy (65 vs. 34%, p = 0.0075) than with acute inflammatory demyelinating polyneuropathy (13 vs. 43%, p = 0.0011). This study demonstrated that DTRs could be normal or hyperexcitable during the entire clinical course in approximately 10% of GBS patients. This possibility should be added in the diagnostic criteria for GBS to avoid delays in diagnosis and effective treatment to these patients.
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Affiliation(s)
- Nobuhiro Yuki
- Departments of Microbiology and Medicine, National University of Singapore, Block MD4A, Level 5, 5 Science Drive 2, Singapore 117597, Singapore.
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22
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Serial nerve conduction studies provide insight into the pathophysiology of Guillain–Barré and Fisher syndromes. J Neurol Sci 2011; 309:26-30. [DOI: 10.1016/j.jns.2011.07.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 07/20/2011] [Accepted: 07/22/2011] [Indexed: 11/20/2022]
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23
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Hardy TA, Blum S, McCombe PA, Reddel SW. Guillain-barré syndrome: modern theories of etiology. Curr Allergy Asthma Rep 2011; 11:197-204. [PMID: 21451970 DOI: 10.1007/s11882-011-0190-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Guillain-Barré syndrome (GBS) is a classic failure of the immune system with a life-threatening attack upon a critical self-component. The active phase of the disease is short, concordant with the latency of a primary adaptive immune response. Triggers for GBS include infection and (rarely) vaccination; cross-reactivity between infectious and neural epitopes has been well demonstrated, particularly for Campylobacter jejuni and motor axonal forms of GBS in which non-protein gangliosides are antigenic. Most people are probably exposed to a GBS trigger, but only rarely does the disease develop. We propose that GBS illustrates competing determinants of the immune system's decision about whether to mount a response, and that in unlucky affected individuals, co-presentation of cross-reactive antigens with danger signals activating pattern-recognition receptors overcomes normal self-recognition such that a primary response is initiated that attacks the nerve. Then, in most cases of GBS, the response rapidly turns off, and second attacks rarely occur. This suggests active restoration of tolerance, and specific privileged site attributes of nerve and declining danger signals as the trigger wanes may contribute to this restoration. Standard immunosuppression has not been effective in GBS. We suggest this is because immune tolerance is already being restored by the time such therapies are initiated. This in turn suggests that improvements in GBS outcomes are likely to come from better protection of the nerve cells under attack while normal resumption of tolerance is permitted to proceed rather than exploring more aggressive immunosuppressive approaches.
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Affiliation(s)
- Todd A Hardy
- Department of Neurology, Concord Hospital, Sydney, Australia.
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24
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Shahrizaila N, Yuki N. The role of immunotherapy in Guillain-Barré syndrome: understanding the mechanism of action. Expert Opin Pharmacother 2011; 12:1551-60. [DOI: 10.1517/14656566.2011.564160] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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25
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Kuwabara S, Misawa S. Chronic inflammatory demyelinating polyneuropathy: Clinical subtypes and their correlation with electrophysiology. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1759-1961.2011.00020.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Zhang M, Li Q, He L, Meng F, Gu Y, Zheng M, Gong Y, Wang P, Ruan F, Zhou L, Wu J, Chen L, Fitzgerald C, Zhang J. Association study between an outbreak of Guillain-Barre syndrome in Jilin, China, and preceding Campylobacter jejuni infection. Foodborne Pathog Dis 2010; 7:913-9. [PMID: 20455754 DOI: 10.1089/fpd.2009.0493] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
From June to July 2007, 36 cases of Guillain-Barre syndrome (GBS) occurred in a township in north China. Serological study and bacteria culture were performed to investigate the association between preceding Campylobacter jejuni infection and this GBS outbreak. Anti-C. jejuni antibodies were found in significantly higher numbers of GBS patients (IgM 84%, IgG 87.5%) than in healthy inspection cases (IgM 33%, IgG 27%). IgG anti-GM1 was the dominant anti-ganglioside antibody among the GBS patients. Seven C. jejuni isolates (four from human stool and three from poultry specimens taken from the patients' houses) were obtained. Serotyping and molecular analysis were used to investigate the genetic relatedness among these C. jejuni isolates. The four human isolates, collected from residents of the same district, were indistinguishable by both pulsed-field gel electrophoresis and multilocus sequence typing, suggesting these patients had a common source of infection. A new sequence type, sequence type-2993, was assigned to the human C. jejuni isolates, three of which belonged to Penner serotype heat-stable (HS):41. Both serotype and molecular subtype of the human C. jejuni isolates were different from those of isolates obtained from poultry specimens. Our results suggest that the antecedent C. jejuni infection triggered this GBS outbreak in China.
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Affiliation(s)
- Maojun Zhang
- Department of Diagnosis, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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27
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Affiliation(s)
- Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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28
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Kuijf ML, Samsom JN, van Rijs W, Bax M, Huizinga R, Heikema AP, van Doorn PA, van Belkum A, van Kooyk Y, Burgers PC, Luider TM, Endtz HP, Nieuwenhuis EES, Jacobs BC. TLR4-mediated sensing of Campylobacter jejuni by dendritic cells is determined by sialylation. THE JOURNAL OF IMMUNOLOGY 2010; 185:748-55. [PMID: 20525894 DOI: 10.4049/jimmunol.0903014] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In Guillain-Barré syndrome (GBS), ganglioside mimicry of Campylobacter jejuni lipo-oligosaccharide (LOS) drives the production of cross-reactive Abs to peripheral nerve gangliosides. We determined whether sialic acid residues in C. jejuni LOS modulate dendritic cell (DC) activation and subsequent B cell proliferation as a possible mechanism for the aberrant humoral immune response in GBS. Highly purified sialylated LOS of C. jejuni isolates from three GBS patients induced human DC maturation and secretion of inflammatory cytokines that were inhibited by anti-TLR4 neutralizing Abs. The extent of TLR4 signaling and DC activation was greater with LOS of the wild type isolates than with nonsialylated LOS of the corresponding sialyltransferase gene knockout (cst-II mutant) strains, indicating that sialylation boosts the DC response to C. jejuni LOS. Supernatants of LOS-activated DCs induced B cell proliferation after cross-linking of surface Igs in the absence of T cells. Lower B cell proliferation indices were found with DC supernatants after DC stimulation with cst-II mutant or neuraminidase desialylated LOS. This study showed that sialylation of C. jejuni LOS enhances human DC activation and subsequent B cell proliferation, which may contribute to the development of cross-reactive anti-ganglioside Abs found in GBS patients following C. jejuni infection.
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Affiliation(s)
- Mark L Kuijf
- Department of Neurology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
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Syndrome de Guillain-Barré postopératoire récurrent. Rev Neurol (Paris) 2010; 166:644-7. [DOI: 10.1016/j.neurol.2009.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 11/24/2009] [Accepted: 12/07/2009] [Indexed: 11/18/2022]
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GD1a-associated pure motor Guillain-Barré syndrome with hyperreflexia and bilateral papillitis. J Clin Neuromuscul Dis 2010; 11:114-9. [PMID: 20215983 DOI: 10.1097/cnd.0b013e3181cc21de] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A patient with acute purely motor polyneuropathy with positive GD1a ganglioside antibodies who presented with paresis in combination with hyperreflexia is reported. Neurophysiological tests revealed features compatible with acute motor axonal neuropathy. Therapy with intravenous immunoglobulin led to rapid clinical improvement. However, at the time when signs of active denervation appeared on electromyographic testing, the patient developed bilateral papillitis. The pathogenesis of pure motor Guillain-Barré syndrome with hyperreflexia and papillitis is discussed.
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Piao H, Minohara M, Kawamura N, Li W, Mizunoe Y, Umehara F, Goto Y, Kusunoki S, Matsushita T, Ikenaka K, Maejima T, Nabekura JI, Yamasaki R, Kira JI. Induction of paranodal myelin detachment and sodium channel loss in vivo by Campylobacter jejuni DNA-binding protein from starved cells (C-Dps) in myelinated nerve fibers. J Neurol Sci 2010; 288:54-62. [DOI: 10.1016/j.jns.2009.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 09/30/2009] [Accepted: 10/07/2009] [Indexed: 11/17/2022]
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Islam Z, van Belkum A, Wagenaar JA, Cody AJ, de Boer AG, Tabor H, Jacobs BC, Talukder KA, Endtz HP. Comparative genotyping of Campylobacter jejuni strains from patients with Guillain-Barré syndrome in Bangladesh. PLoS One 2009; 4:e7257. [PMID: 19789649 PMCID: PMC2748714 DOI: 10.1371/journal.pone.0007257] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 08/12/2009] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Campylobacter jejuni is a common cause of acute gastroenteritis and is associated with post-infectious neuropathies such as the Guillain-Barré syndrome (GBS) and the Miller Fisher syndrome (MFS). We here present comparative genotyping of 49 C. jejuni strains from Bangladesh that were recovered from patients with enteritis or GBS. All strains were serotyped and analyzed by lipo-oligosaccharide (LOS) genotyping, amplified fragment length polymorphism (AFLP) analysis, multilocus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE). METHODOLOGY/PRINCIPAL FINDINGS C. jejuni HS:23 was a predominant serotype among GBS patients (50%), and no specific serotype was significantly associated with GBS compared to enteritis. PCR screening showed that 38/49 (78%) of strains could be assigned to LOS classes A, B, C, or E. The class A locus (4/7 vs 3/39; p<0.01) was significantly associated in the GBS-related strains as compared to enteritis strains. All GBS/oculomotor related strains contained the class B locus; which was also detected in 46% of control strains. Overlapping clonal groups were defined by MLST, AFLP and PFGE for strains from patients with gastroenteritis and GBS. MLST defined 22 sequence types (STs) and 7 clonal complexes including 7 STs not previously identified (ST-3742, ST-3741, ST-3743, ST-3748, ST-3968, ST-3969 and ST-3970). C. jejuni HS:23 strains from patients with GBS or enteritis were clonal and all strains belonged to ST-403 complex. Concordance between LOS class B and ST-403 complex was revealed. AFLP defined 25 different types at 90% similarity. The predominant AFLP type AF-20 coincided with the C. jejuni HS:23 and ST-403 complex. CONCLUSION/SIGNIFICANCE LOS genotyping, MLST, AFLP and PFGE helped to identify the HS:23 strains from GBS or enteritis patients as clonal. Overall, genotypes exclusive for enteritis or for GBS-related strains were not obtained although LOS class A was significantly associated with GBS strains. Particularly, the presence of a clonal and putative neuropathogenic C. jejuni HS:23 serotype may contribute to the high prevalence of C. jejuni related GBS in Bangladesh.
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Affiliation(s)
- Zhahirul Islam
- International Centre for Diarrheal Diseases Research, Dhaka, Bangladesh.
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Rajabally Y, Ramlackhansingh A, Fraser M, Abbott R. Neuroleptic malignant syndrome and acute motor axonal neuropathy after Campylobacter jejuni infection. Neurophysiol Clin 2009; 39:135-8. [DOI: 10.1016/j.neucli.2009.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 01/14/2009] [Accepted: 02/22/2009] [Indexed: 10/21/2022] Open
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Rabie M, Nevo Y. Childhood acute and chronic immune-mediated polyradiculoneuropathies. Eur J Paediatr Neurol 2009; 13:209-18. [PMID: 18585069 DOI: 10.1016/j.ejpn.2008.04.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 04/26/2008] [Accepted: 04/30/2008] [Indexed: 11/30/2022]
Abstract
Immune-mediated polyradiculoneuropathies are divided into Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). In children subacute inflammatory demyelinating polyradiculoneuropathy is included in CIDP. Immune polyradiculoneuropathies are not exclusively demyelinating, and axonal forms also responding favourably to immunotherapy occur. Evidence-based data on efficacy of therapy in children is lacking, relying on retrospective data, open label studies on small numbers of children, and mainly adult derived data. Immunotherapy (intravenous human immunoglobulin [IVIg] and plasmapheresis) shortens GBS recovery time with most children recovering completely. Childhood CIDP usually responds to corticosteroids and slow tapering is required to prevent relapses. IVIg and plasmapheresis are also effective. CIDP children resistant to steroids, IVIg, and steroid-dependent patients present a therapeutic challenge. Immunosuppressive agents including methotrexate, azathioprine and cyclosporine are helpful in some cases. Anecdotal reports of treatment with interferons alpha or beta and monoclonal antibodies against specific B-cell antigens (Rituximab, Alemtuzumab) have been described in limited case reports. Childhood CIDP prognosis is mostly favourable. However, a proportion of cases have residual neurological deficit.
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Affiliation(s)
- Malcolm Rabie
- Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
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Berciano J, García A, Villagrá NT, González F, Ramón C, Illa I, Berciano MT, Lafarga M. Severe Guillain-Barré syndrome: sorting out the pathological hallmark in an electrophysiological axonal case. J Peripher Nerv Syst 2009; 14:54-63. [DOI: 10.1111/j.1529-8027.2009.00206.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cerebrospinal fluid biomarkers in Guillain-Barré syndrome – Where do we stand? J Neurol 2009; 256:3-12. [DOI: 10.1007/s00415-009-0097-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 05/08/2008] [Accepted: 05/26/2008] [Indexed: 11/28/2022]
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Wierzba TF, Abdel-Messih IA, Gharib B, Baqar S, Hendaui A, Khalil I, Omar TA, Khayat HE, Putnam SD, Sanders JW, Ng LK, Price LJ, Scott DA, Frenck RR. Campylobacter infection as a trigger for Guillain-Barré syndrome in Egypt. PLoS One 2008; 3:e3674. [PMID: 19002255 PMCID: PMC2577883 DOI: 10.1371/journal.pone.0003674] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 10/09/2008] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Most 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. METHODS GBS 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. RESULTS Most (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. CONCLUSIONS Unlike 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.
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Current world literature. Curr Opin Neurol 2008; 21:615-24. [PMID: 18769258 DOI: 10.1097/wco.0b013e32830fb782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Acute neuropathy with multiple motor conduction blocks: A variant of Guillain-Barré syndrome or multifocal motor neuropathy with conduction blocks with acute onset? Neurophysiol Clin 2008; 38:209-10. [DOI: 10.1016/j.neucli.2008.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Accepted: 04/09/2008] [Indexed: 11/18/2022] Open
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