Guillain–Barré syndrome subtypes related to Campylobacter infection
- Judith Drenthen1,2,
- Nobuhiro Yuki3,
- Jan Meulstee4,
- Ellen M Maathuis1,
- Pieter A van Doorn2,
- Gerhard H Visser1,
- Joleen H Blok1,
- Bart C Jacobs2,5
- 1Department of Clinical Neurophysiology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands
- 2Department of Neurology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands
- 3Departments of Microbiology and Medicine, National University of Singapore, Singapore
- 4Department of Clinical Neurophysiology, Canisius–Wilhelmina Hospital, Nijmegen, The Netherlands
- 5Department of Immunology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands
- Correspondence to Dr J Drenthen, Department of Clinical Neurophysiology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands;
- Received 10 August 2010
- Revised 27 October 2010
- Accepted 28 November 2010
- Published Online First 26 January 2011
Background In Guillain–Barré syndrome (GBS), the diversity in electrophysiological subtypes is unexplained but may be determined by geographical factors and preceding infections. Acute motor axonal neuropathy (AMAN) is a frequent GBS variant in Japan and one study proposed that in Japan, Campylobacter jejuni infections exclusively elicit AMAN. In The Netherlands C jejuni is the predominant type of preceding infection yet AMAN is rare. This may indicate that not all Dutch GBS patients with C jejuni infections have AMAN.
Objective To determine if GBS patients with a preceding C jejuni infection in The Netherlands exclusively have AMAN.
Methods Retrospective analysis of preceding infections in relation to serial electrophysiology and clinical data from 123 GBS patients. C jejuni related cases were defined as having preceding diarrhoea and positive C jejuni serology. Electrophysiological characteristics in C jejuni related cases were compared with those in viral related GBS patients. In addition, eight GBS patients from another cohort with positive stool cultures for C jejuni were analysed.
Results 17 (14%) of 123 patients had C jejuni related GBS. C jejuni patients had lower motor and higher sensory action potentials compared with viral related cases. Nine (53%) C jejuni patients had either AMAN or inexcitable nerves. However, three (18%) patients fulfilled the criteria for acute inflammatory demyelinating polyneuropathy (AIDP). Also, two (25%) of eight additional patients with a C jejuni positive stool sample had AIDP.
Conclusion In The Netherlands, C jejuni infections are strongly, but not exclusively, associated with axonal GBS. Some patients with these infections fulfil current criteria for demyelination.
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Linked article 237040.
The material in this paper has been presented in poster form at the AANEM 55th Annual Meeting, Providence, Rhode Island, 16–20 September 2008 and at the Peripheral Nerve Society Meeting, Würzburg, Germany, 4–8 July 2009.
Funding he study received financial support from the Prinses Beatrix Fonds (research grant WAR06-215).
Competing interests JHB and BCJ received a research grant from the Princess Beatrix Fund (WAR06-215).
Ethics approval The study was approved by the local medical ethics committee.
Provenance and peer review Not commissioned; externally peer reviewed.