The role of cytomegalovirus, Haemophilus influenzae and Epstein Barr virus in Guillain Barre syndrome.
AbstractGuillain Barre Syndrome (GBS) is an inflammatory, usually demyelinating, polyneuropathy; clinically characterized by acute onset of symmetric progressive muscle weakness with loss of myotatic reflexes. Thirty five patients with GBS, defined clinically according to the criteria of Asbury and Cornblath, were recruited from three hospital affiliated to Tehran University of Medical Sciences.As a control group 35 age and sex matched patients with other neurological diseases admitted to the same hospital at the same time, were included in our study. Serum samples were collected before treatment from each patient (within 4 weeks after the disease onset) and controls, and stored frozen at -80ºC until serologic assays were done. Serologic testing of pretreatment serum was performed in all patients. Positive titer of virus specific IgM antibody against cytomegalovirus (CMV) was found in 6 cases and 2 controls. 34 patients and 31 controls had high titer of anti Haemophilus influenzae IgG and one patient had serologic evidence of a recent Epstein Barr virus (EBV) infection. The mean titer of IgG antibody against Haemophilus influenzae in cases and controls was 5.21 and 2.97 respectively. Although serologic evidence of all these infections were more frequent in cases than in controls, only Haemophilus influenzae infection appeared to be significantly related to GBS (P=0.002). Eleven cases and 3 controls had high titers of IgG antibody against Haemophilus influenzae type B (titer >8). There is significant association between high titer of IgG antibody against Haemophilus influenzae and GBS (P=0.017). Our results provide further evidence that Haemophilus influenzae and probably CMV, can be associated with GBS.
Vucic S, Kiernan MC, Cornblath DR. Guillain-Barre syndrome: an update. J Clin Neurosci 2009;16(6):733-41.
Hughes RA, Cornblath DR. Guillain-Barre syndrome. Lancet 2005;366(9497):1653-66.
Hughes RA, Hadden RD, Gregson NA, Smith KJ. Pathogenesis of Guillain-Barre syndrome. J Neuroimmunol 1999;100(1-2):74-97.
Govoni V, Granieri E. Epidemiology of the Guillain-Barre syndrome. Curr Opin Neurol 2001;14(5):605-13.
Visser LH, van der Meché FG, Meulstee J, Rothbarth PP, Jacobs BC, Schmitz PI, van Doorn PA. Cytomegalovirus infection and Guillain-Barre syndrome: the clinical, electrophysiologic, and prognostic features. Dutch Guillain-Barre Study Group. Neurology 1996;47(3):668-73.
Koga M, Yuki N, Tai T, Hirata K. Miller Fisher syndrome and Haemophilus influenzae infection. Neurology 2001;57(4):686-91.
Hughes RA, Rees JH. Clinical and epidemiologic features of Guillain-Barre syndrome. J Infect Dis 1997;176 Suppl 2:S92-8.
Rees JH, Soudain SE, Gregson NA, Hughes RA.Campylobacter jejuni infection and Guillain-Barre syndrome. N Engl J Med 1995;333(21):1374-9.
Drenthen J, Yuki N, Meulstee J, Maathuis EM, van Doorn PA, Visser GH, Blok JH, Jacobs BC. Guillain-Barre syndrome subtypes related to Campylobacter infection. J Neurol Neurosurg Psychiatry 2011;82(3):300-5.
Hadden RD, Cornblath DR, Hughes RA, et al. Electrophysiological classification of Guillain-Barre,syndrome: clinical associations and outcome. PlasmaExchange/Sandoglobulin Guillain-Barre Syndrome Trial Group. Ann Neurol 1998;44(5):780-8.
Hartung HP, Kieseier BC, Kiefer R. Progress in Guillain- Barre syndrome. Curr Opin Neurol 2001;14(5):597-604.
Jacobs BC, Rothbarth PH, van der Meché FG, Herbrink P, Schmitz PI, de Klerk MA, van Doorn PA. The spectrum of antecedent infections in Guillain-Barre syndrome: a casecontrol study. Neurology 1998;51(4):1110-5.
Gervaix A, Caflisch M, Suter S, Haenggeli CA. Guillain- Barre syndrome following immunisation with Haemophilus influenzae type b conjugate vaccine. Eur JPediatr 1993;152(7):613-4.
Mori M, Kuwabara S, Miyake M, Noda M, Kuroki H, Kanno H, Ogawara K, Hattori T. Haemophilus influenzae infection and Guillain-Barre syndrome. Brain 2000;123 (Pt10):2171-8.