THE SPECTRUM OF ANTECEDENT INFECTIONS IN GUILLAIN-BARRE-SYNDROME - A CASE-CONTROL STUDY

Objective: To determine which antecedent infections are specifically a ssociated with the Guillain-Barre syndrome (GBS). Background: Infectio ns with many agents have been reported preceding GBS. Some infections are related to specific clinical and immunologic subgroups in GBS. Mos t agents were reported in case reports and uncontrolled small series o f GBS patients only, and their relation to GBS and its subgroups remai ns unclear. Method: A serologic study for 16 infectious agents in 154 GBS patients and 154 sex- and age-matched controls with other neurolog ic diseases. Acute phase, pretreatment samples were used from clinical ly well-defined GBS patients. The seasonal distribution of serum sampl ing in the GBS and control group was the same. Results: Multivariate a nalysis showed that in GBS patients, infections with Campylobacter jej uni (32%), cytomegalovirus (13%), and Epstein-Barr virus (10%) were si gnificantly more frequent than in controls. Mycoplasma pneumoniae infe ctions occurred more often in GBS patients (5%) than in controls in un ivariate analysis. Infections with Haemophilus influenzae (1%), parain fluenza 1 virus (1%), influenza A virus (1%), influenza B virus (1%), adenovirus (1%), herpes simplex virus (1%), and varicella tester virus (1%) were also demonstrated in GBS patients, but not more frequently than in controls. C. jejuni infections were associated with antibodies to the gangliosides GM1 and GD1b and with a severe pure motor form of GBS. Cytomegalovirus infections were associated with antibodies to th e ganglioside GM2 and with severe motor sensory deficits. Other infect ions were not related to specific antiganglioside antibodies and neuro logic patterns. Conclusions: Recent infections with C. jejuni, cytomeg alovirus, Epstein-Barr virus, and M. pneumoniae are specifically relat ed to GBS. The variety of infections may contribute to the clinical an d immunologic heterogeneity of GBS.