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Serologic Evidence of Previous Campylobacter jejuni Infection in Patients with the Guillain-Barre Syndrome

Ban Mishu, MD; Amjad A. Ilyas, PhD; Carol L. Koski, MD; Francine Vriesendorp, MD; Stuart D. Cook, MD; Francis A. Mithen, MD, PhD; and Martin J. Blaser, MD
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From Vanderbilt University School of Medicine and Veterans Affairs Medical Center, Nashville, Tennessee; University of Medicine and Dentistry of New Jersey Newark, New Jersey; University of Maryland School of Medicine, Baltimore, Maryland; St. Louis University, St. Louis, Missouri. Grant Support: In part by the Muscular Dystrophy Association, the U.S. Army Medical Research and Development Command, the Thrasher Research Fund, and the Medical Research Service of the Department of Veterans Affairs.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;118(12):947-953. doi:10.7326/0003-4819-118-12-199306150-00006
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Objective: To determine if patients with the Guillain-Barre syndrome are likely to have had Campylobacter jejuni infection before onset of neurologic symptoms.

Design: A casecontrol study.

Setting: Several university medical centers.

Patients: Case patients met clinical criteria for the Guillain-Barre syndrome between 1983 and 1990 and had a serum sample collected and frozen within 3 weeks after onset of neurologic symptoms (n = 118). Disease controls were patients with other neurologic illnesses (n = 56); healthy controls were hospital employees or healthy family members of patients (n = 47).

Measurements: Serum IgA, IgG, and IgM antibodies to C. jejuni were determined by enzyme-linked immunosorbent assays. Assays were done in a blinded manner.

Results: Optical density ratios 2 in two or more immunoglobulin classes were seen in 43 (36%) of patients with the Guillain-Barre syndrome and in 10 (10%) of controls (odds ratio, 5.3; 95% CI, 2.4 to 12.5; P < 0.001). Increasing the optical density ratio or the number of immunoglobulin classes necessary to yield a positive result increased the strength of the association. The number of patients with the Guillain-Barre syndrome who had positive serologic responses was greatest from September to November (P = 0.02). Male patients were three times more likely to have serologic evidence of C. jejuni infection (P = 0.009); the proportion of patients with the syndrome who had a positive serologic response increased with age.

Conclusions: Patients with the Guillain-Barre syndrome are more likely than controls to have serologic evidence of C. jejuni infection in the weeks before onset of neurologic symptoms. Campylobacter jejuni may play a role in the initiation of the Guillain-Barre syndrome in many patients.





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