title: Primary cytomegalovirus infection in patients with Guillain-Barré syndrome.
abstract: Guillain-Barré syndrome (GBS) is frequently associated with the presence of CMV-specific IgM-antibodies or CMV-DNA in serum. Detection of IgM-antibodies or viremia may indicate primary infection, but also reactivation or reinfection. We identified 46 GBS patients with detectable CMV-specific IgM- or IgG-antibodies, or both. Sera from these patients were tested for the presence of CMV-specific, low-avidity IgG-antibodies, which indicate primary infection that occurred <6 months before sample collection, and for the presence of CMV-DNA by polymerase chain reaction (PCR). Primary infection was identified by the presence of low-avidity IgG-antibodies in 9/46 (20%) or by detection of IgM-antibodies in the absence of IgG-antibodies in 1/46 (2%) patients. CMV-DNA was detectable in 17/46 (37%) sera. In contrast, CMV-DNA was detected in only 2% of sera from 46 age-matched patients with neuroborreliosis. The likelihood of viremia decreased in GBS patients significantly with increasing antibody-avidity (P=0.041). Detection of IgM-antibodies correlated with that of CMV-DNA in patients with low-avidity IgG-antibodies (P=0.048) but not in those with high-avidity IgG-antibodies (P=0.543). In 45 age-matched healthy controls, low-avidity IgG-antibodies and CMV-DNA were detected in only 2% and 0% of sera, respectively. Our findings further strengthen evidence for an association between CMV infection and GBS. Primary CMV infection was identified in almost one-fourth of patients with detectable CMV-specific antibodies. Nevertheless, endogenous reactivation and reinfection have to be considered also as relevant events associated with GBS.
authors.affiliation: Institute of Virology, Medical University of Vienna, Department of Neurology, Hospital Rudolfstiftung, Vienna, Austria. christoph.steininger@meduniwien.ac.at
authors.forename: Christoph
authors.initials: C
authors.lastname: Steininger
authors.forename: Andreas
authors.initials: A
authors.lastname: Seiser
authors.forename: Nevzat
authors.initials: N
authors.lastname: Gueler
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Puchhammer-Stöckl
authors.forename: Stephan W
authors.initials: SW
authors.lastname: Aberle
authors.forename: Gerold
authors.initials: G
authors.lastname: Stanek
authors.forename: Theresia
authors.initials: T
authors.lastname: Popow-Kraupp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood / Q000134:cerebrospinal fluid / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000276:immunology* / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications / Q000276:immunology*; D005260:Female; D020275:Guillain-Barre Syndrome / Q000097:blood / Q000134:cerebrospinal fluid / Q000150:complications / Q000276:immunology* / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D000914:Antibodies, Viral