Gastroenteritis-associated Guillain-Barre syndrome on the Caribbean islandCuracao

Background: The number of patients with Guillain-Barre syndrome (GBS) who h ave been observed in Curacao, the Netherlands Antilles, may be increasing. Methods: Clinical and serologic data were obtained from records of patients admitted between 1987 and 1999 and fulfilling National Institute of Neurol ogical and Communicative Disorders and Stroke criteria for GBS. When possib le, serum and stool samples were collected. The results were compared with a large Dutch epidemiologic study. Results: The authors identified 49 patie nts, an overall crude incidence rate (IR) in Curacao of 2.53/100,000 inhabi tants (95% CI 1.87 to 3.35) (Dutch study 1.18, rate ratio (RR) of 2.14, p < 0.001). The IR in Curacao increased from 1.62 in 1987 to 1991 to 3.10 in 1 992 to 1999, RR 5.22 (95% CI 2.48 to 10.2, p = 0.02). The IR showed a curvi linear shape within a year. In comparison with the Dutch group, patients fr om Curacao had a more severe course of the disease, with a mortality rate o f 23% (3.4% in the Dutch group, p < 0.001), a higher percentage of precedin g gastroenteritis (p <less than> 0.001), and less sensory involvement (p < 0.001). In 8 of 10 serum samples, evidence was found for a recent infection with Campylobacter jejuni. Conclusions: The authors found a steady increas e in incidence of GBS over the years in association with a more pronounced seasonal preponderance and a more severe course. The clinical characteristi cs suggest a role for C jejuni.