title: Patterns of Guillain-Barre syndrome in children: results from a Mexican population.
abstract: BACKGROUND
  Guillain-Barré syndrome (GBS) is an acute, immune-mediated flaccid paralysis frequently associated with Campylobacter infection. Of two predominant GBS subtypes, a demyelinating subtype (acute inflammatory demyelinative polyneuropathy [AIDP]) predominates in the United States and Europe, and axonal subtype (acute motor axonal neuropathy [AMAN]) is the predominant form in China. Previous clinical studies suggested that AMAN also occurs in Mexican children. The purpose of this study was to describe the subtypes of GBS in children from Mexico City.
  
  
  METHODS
  We prospectively studied 121 children admitted to two pediatric hospitals in Mexico City from 1996 to 2002. Clinical histories were obtained, electrophysiologic studies were performed to determine GBS subtype, and microbiologic studies were performed.
  
  
  RESULTS
  Of the 121 children, 46 had AMAN and 32 had AIDP. The male to female ratio was 1.3 for AMAN cases (mean age = 6.3) and 3.0 for AIDP cases (mean age = 7.0). There was a strong seasonal distribution of AMAN cases in July to September. Children with AMAN, but not AIDP, had worsening of illness during hospitalization as judged by peak severity scores. Vomiting was more likely in AIDP (28.1%) vs AMAN (6.5%) (p = 0.012) and diarrhea was more common in AMAN (32.6%) than AIDP (12.5%) (p = 0.06). IgG anti-GM1 antibody titers were higher in patients with AMAN vs AIDP (p = 0.067). Anti-GD1a antibodies were equally present in both groups. Anti GQ1b titers were higher in AMAN vs AIDP (p = 0.009). Campylobacter antibody responses were positive in 44.1% of patients with AMAN and 37.0% of patients with AIDP. Twenty patients (14 = AMAN, 6 = AIDP) had positive stool cultures for C jejuni. Two serotypes, HS:19 and HS:41, accounted for 6 of 10 Campylobacter isolates available for serotyping from these cases.
  
  
  CONCLUSIONS
  This study confirms that acute motor axonal neuropathy is an important Guillain-Barré syndrome subtype in Mexican children, is associated with diarrhea, and occurs seasonally.
authors: Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, 3400 Spruce Street, 4th Floor Gates Building, Philadelphia, PA 19104-4283, USA. nachamki@mail.med.upenn.edu
authors: I
authors: I
authors: Nachamkin
authors: P
authors: P
authors: Arzarte Barbosa
authors: P Arzate
authors: PA
authors: Barbosa
authors: Huong
authors: H
authors: Ung
authors: H
authors: H
authors: Ung
authors: C
authors: C
authors: Lobato
authors: A
authors: A
authors: Gonzalez Rivera
authors: A Gonzalez
authors: AG
authors: Rivera
authors: P
authors: P
authors: Rodriguez
authors: A
authors: A
authors: Garcia Briseno
authors: A Garcia
authors: AG
authors: Briseno
authors: L Maria
authors: LM
authors: Cordero
authors: L
authors: L
authors: Garcia Perea
authors: L Garcia
authors: LG
authors: Perea
authors: J Carlos
authors: JC
authors: Perez
authors: M
authors: M
authors: Ribera
authors: P Chico
authors: PC
authors: Aldama
authors: G Dávila
authors: GD
authors: Guitérrez
authors: L Flores
authors: LF
authors: Sarnat
authors: M Ruiz
authors: MR
authors: García
authors: J
authors: J
authors: Veitch
authors: C
authors: C
authors: Fitzgerald
authors: D R
authors: DR
authors: Cornblath
authors: D
authors: D
authors: Cornblath
authors: M
authors: M
authors: Rodriguez Pinto
authors: M Rodriguez
authors: MR
authors: Pinto
authors: J W
authors: JW
authors: Griffin
authors: H J
authors: HJ
authors: Willison
authors: A K
authors: AK
authors: Asbury
authors: G M
authors: GM
authors: McKhann
mesh_terms: D000293:Adolescent; D002169:Campylobacter Infections / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000209:etiology; D005260:Female; D005677:G(M1) Ganglioside / Q000031:analogs & derivatives / Q000276:immunology; D020275:Guillain-Barre Syndrome / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D008297:Male; D008800:Mexico / Q000453:epidemiology; D009046:Motor Neurons / Q000473:pathology; D012621:Seasons
chemical_list: D007074:Immunoglobulin G; C064020:ganglioside GD1alpha; D005677:G(M1) Ganglioside