Infections and vaccinations preceding childhood Guillain-Barré syndrome: a prospective study.
BACKGROUND
We performed a prospective, multicentre study in children with Guillain-Barré syndrome (GBS), diagnosed according to international criteria, to investigate the frequency and aetiology of antecedent diseases. All infections and vaccinations occurring within a 6-week period prior to the onset of GBS were documented.


METHODS
Stool cultures, standardised serological investigations and PCR analyses for 24 different infective agents were performed. Serological findings were regarded as significant if specific immunoglobulin (Ig)M or IgA antibodies were detected, if the IgM enzyme immunoassay or immunfluorescence assay findings were confirmed by immunoblot, if complement fixation test titres rose fourfold or if geometric titres were more than threefold higher than in uninfected control persons. Ninety-five children with GBS were included in the study over a 40-month period. Preceding events were reported in 82%.


RESULTS
Microbiological studies carried out on 84 patients resulted in a probable diagnosis in 46 (55%). Coxsackieviruses (15%), Chlamydia pneumoniae (8%), cytomegalovirus (7%) and Mycoplasma pneumoniae (7%) were the most frequently involved agents. Serological evidence of a Campylobacter jejuni infection was found in six patients (7%). Eight children had been vaccinated during the 6 weeks preceding the onset of GBS; in six of these children concomitant infectious diseases were reported, and in one child the time between vaccination and GBS was extremely short.


CONCLUSIONS
We conclude that, in contrast to adults, Campylobacter spp. does not seem to play a major role in childhood GBS in German-speaking countries. The aetiology of antecedent diseases is distributed over a wide spectrum of paediatric infectious diseases. Most of the children who had been vaccinated showed concomitant infectious diseases, thus obscuring the causative role for GBS.
Schessl
Joachim
J
Department of Paediatrics and Adolescent Medicine, Division of Neuropaediatrics and Muscular Disorders, University Hospital Freiburg, Mathildenstr. 1, 79106 Freiburg, Germany.
Luther
Birgit
B
Kirschner
Janbernd
J
Mauff
Gottfried
G
Korinthenberg
Rudolf
R
D000293:Adolescent; D000907:Antibodies, Bacterial / Q000276:immunology; D000914:Antibodies, Viral / Q000276:immunology; D001317:Austria / Q000453:epidemiology; D001428:Bacterial Vaccines / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004266:DNA Virus Infections / Q000150:complications / Q000276:immunology / Q000628:therapy* / Q000821:virology; D004267:DNA Viruses / Q000276:immunology / Q000302:isolation & purification; D005260:Female; D005455:Fluorescent Antibody Technique; D005858:Germany / Q000453:epidemiology; D006090:Gram-Negative Bacteria / Q000276:immunology / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D020275:Guillain-Barre Syndrome / Q000209:etiology* / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D007124:Immunoenzyme Techniques; D007070:Immunoglobulin A / Q000302:isolation & purification; D007074:Immunoglobulin G / Q000302:isolation & purification; D007075:Immunoglobulin M / Q000302:isolation & purification; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012327:RNA Virus Infections / Q000150:complications / Q000276:immunology / Q000628:therapy* / Q000821:virology; D012328:RNA Viruses / Q000276:immunology / Q000302:isolation & purification; D012698:Serologic Tests; D013548:Sweden / Q000453:epidemiology; D014611:Vaccination; D014765:Viral Vaccines / Q000627:therapeutic use
D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D001428:Bacterial Vaccines; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D014765:Viral Vaccines