CAMPYLOBACTER-JEJUNI INFECTION AND GUILLAIN-BARRE-SYNDROME

Background. Although infection with Campylobacter jejuni is recognized as a common antecedent of the Guillain-Barre syndrome, the clinical a nd epidemiologic features of this association are not well understood. Methods. We performed a prospective case-control study in a cohort of patients with Guillajn-Barre syndrome (96 patients) or Miller Fisher syndrome (7 patients) who were admitted to hospitals throughout Englan d and Wales between November 1992 and April 1994. Bacteriologic and se rologic techniques were used to diagnose preceding C. jejuni infection . Results. There was evidence of recent C. jejuni infection in 26 perc ent of the patients with Guillain-Barre or Miller Fisher syndrome, as compared with 2 percent of household controls and 1 percent of age-mat ched hospital controls (P<0.001). Of the 27 patients with C. jejuni in fection, 19 (70 percent) reported having had a diarrheal illness withi n 12 weeks before the onset of the neurologic illness. No specific ser otypes were associated with Guillain-Barre syndrome. C. jejuni infecti on was slightly more common in men (P=0.14) and was more likely to be associated with a pure motor syndrome and a slower recovery (P=0.03). The patients with preceding C. jejuni infection were more likely to ha ve acute axonal neuropathy or axonal degeneration in association with acute inflammatory demyelinating polyradiculoneuropathy, and they had greater disability after one year (P=0.02). C. jejuni infection was si gnificantly associated with a poor outcome even after correction for o ther factors associated with a poor prognosis. Conclusions. Infection with C. jejuni often precedes the Guillain-Barre syndrome and is assoc iated with axonal degeneration, slow recovery, and severe residual dis ability.