title: Guillain-Barré syndrome following primary cytomegalovirus infection: a prospective cohort study.
abstract: BACKGROUND
  Little is known about the epidemiology and the prognostic factors of Guillain-Barré syndrome (GBS) following primary infection with cytomegalovirus (CMV-GBS).
  
  
  METHODS
  We prospectively followed up 506 patients with cases of GBS who were admitted to our center from 1996 through 2006. We diagnosed 63 (12.4%) CMV-GBS cases by immunoglobulin (Ig) M detection and IgG avidity. Plasma CMV DNA was detected at hospital admission. Patient subgroups were compared using Fisher's exact test and the Wilcoxon rank-sum test. Temporal variations were analyzed with time series methods.
  
  
  RESULTS
  Patients with CMV-GBS were mostly young (median age, 32 years; sex ratio, 0.85), but we also identified a subpopulation of patients consisting of women aged >50 years. Sensory defects (in 72% of cases) and facial palsy (49%) were frequent, and test results positive for CMV DNA in plasma at hospital admission (found in 62% of cases) tended to be associated with objective sensory defect (P=.052). The main factors associated with long-term neurological sequelae (21%) were older age (P<.001) and assisted ventilation during hospitalization (P=.005). The number of CMV-GBS cases decreased between 1996 and 2006 (P=.019) and displayed an annual periodicity between the months of July and October. The incidence of CMV-GBS was estimated to be between 0.6 and 2.2 cases per 1000 cases of primary CMV infection (versus 0.25 to 0.65 cases per 1000 cases of Campylobacter jejuni infection).
  
  
  CONCLUSIONS
  This study provides new insights about the epidemiology of CMV-GBS and shows that the risk of developing GBS is similar following primary CMV infection or C. jejuni infection. Our results also suggest a direct or indirect involvement of viral replication in the neuropathological processes of CMV-GBS.
authors.affiliation: Service de Réanimation, AP-HP, Hôpital Raymond Poincaré, Garches, France.
authors.forename: David
authors.initials: D
authors.lastname: Orlikowski
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.forename: Valérie
authors.initials: V
authors.lastname: Sivadon-Tardy
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Quincampoix
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Raphaël
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Durand
authors.forename: Tarek
authors.initials: T
authors.lastname: Sharshar
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Roussi
authors.forename: Christiane
authors.initials: C
authors.lastname: Caudie
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
authors.forename: Flore
authors.initials: F
authors.lastname: Rozenberg
authors.forename: Marianne
authors.initials: M
authors.lastname: Leruez-Ville
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Gaillard
authors.forename: Elyanne
authors.initials: E
authors.lastname: Gault
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000150:complications*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D020275:Guillain-Barre Syndrome / Q000453:epidemiology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M