Risk Factors For Guillain-Barre Syndrome (Gbs) In Northern Italy: Analysis Of Anamnestic Antecedent Events And Serological Evidence Of Infections
Antecedent gastrointestinal or respiratory infections are frequently reported in GBS patients where they have been often attributed to Campylobacter jejuni (CJ), Cytomegalovirus (CMV) or Ebstain-Barr virus (EBV). In order to determine the relative risk (RR) for the development of GBS of anamnestic and/or serological evidence of an antecedent infection we analysed the anamnestic data and sera of 47 GBS patients, 45 neurological controls (NC) and 44 non-neurological controls (NNC) in a prospective case-control study in northern Italy. After receiving an informed consent, we analysed the preceding events reported by GBS patients and controls within 2 months before the onset of the neurological or non-neurological disease leading to admission in the hospital by a questionnaire administered to each subject. Patients' sera were then screened by ELISA for reactivity with CJ, CMV, EBV, Herpes simplex virus (HSV), Mycoplasma Pneumoniae, Hepatitis A, B, C and HIV. The analysis of the questionnaires revealed that 9 GBS patients (19%) have had diarrhea compared to 3 NC and 3 NNC (7% each) (GBS vs. NC/NNC p < 0.05; RR 3.35). By ELISA only 2 of 47 GBS patients (4%), both with diarrhea (22% of GBS patients with diarrhea), and 1 (without diarrhea) of 89 NC and NNC had anti-CJ IgG antibodies (RR: 3.91). An antecedent respiratory tract infection was reported by 32 GBS (68%), 16 NC and 16 NNC (35% and 36%, respectively) (GBS vs. NC/NNC p < 0.05; RR: 3.8). Serological data revealed that 28% and 30% of GBS had anti-CMV and anti-HSV IgM antibodies, respectively, in the acute sera compared to 4% and 11% of controls (p < 0.005 and <0.01, respectively; RR: 8.1 and 3.35, respectively). Anti-CMV and anti-HSV IgM antibodies were, however, similarly frequent in GBS patients with or without respiratory infection. No other antibody reactivity with virus or bacteria was detected in our population. Diarrhea and respiratory infections were the most frequent antecedent events of GBS in this Italian population. Even if serological evidences of CJ, CMV, and HSV infection were associated with an increased RR for GBS, their association with an history of antecedent infection in GBS was either infrequent (diarrhea) or elusive (respiratory infection).
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Document Type: Abstract
Affiliations: Institute of Clinical Neurology, Milan University, IRCCS Ospedale Maggiore Policlinico, Milan and IRCCS C. Mondino, Pavia University, Pavia.
Publication date: March 1, 2001