Axonal variant of Guillain-Barre syndrome associated with Campylobacter infection in Bangladesh.
BACKGROUND
Campylobacter jejuni enteritis is the predominant bacterial infection preceding Guillain-Barré syndrome (GBS), an acute postinfectious immune-mediated polyradiculoneuropathy. The purpose of this study was to define the clinical phenotype of GBS and the relation with preceding C jejuni infections in Bangladesh.


METHODS
We performed a prospective matched case-control hospital surveillance including 100 patients fulfilling the National Institute of Neurological Disorders and Stroke criteria for GBS from 2006 to 2007 in the Dhaka area of Bangladesh. Detailed clinical, electrophysiologic, serologic, and microbiologic data were obtained with a follow-up of 6 months.


RESULTS
GBS affected predominantly young adult males living in rural areas. Sixty-nine percent of the patients had clinical evidence of a preceding infection. The most frequent symptom was diarrhea (36%). The majority of patients had a pure motor variant of GBS (92%) with relatively infrequent cranial nerve involvement (30%). Twenty-five percent of patients required respiratory support. Electrophysiologic studies showed that 67% of patients had an axonal variant of GBS. Eleven patients (14%) died, and 23 (29%) remained severely disabled during the follow-up. Positive C jejuni serology was found in an unprecedented high frequency of 57% as compared with 8% in family controls and 3% in control patients with other neurologic diseases (p < 0.001). C jejuni infection was significantly associated with serum antibodies to the gangliosides GM1 and GD1a, axonal neuropathy, and greater disability.


CONCLUSIONS
We report an unusually high frequency of the axonal variant of Guillain-Barré syndrome in Bangladesh, associated with preceding Campylobacter jejuni infection, severe residual disability, and high mortality.
Islam
Z
Z
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka-1000, Bangladesh. zislam@icddrb.org
Jacobs
B C
BC
van Belkum
A
A
Mohammad
Q D
QD
Islam
M B
MB
Herbrink
P
P
Diorditsa
S
S
Luby
S P
SP
Talukder
K A
KA
Endtz
H P
HP
D000293:Adolescent; D000328:Adult; D000368:Aged; D001369:Axons / Q000502:physiology; D001459:Bangladesh / Q000453:epidemiology; D002169:Campylobacter Infections / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D016123:Campylobacter jejuni; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D020275:Guillain-Barre Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult