title: Severe childhood Guillain-Barré syndrome associated with Mycoplasma pneumoniae infection: a case series.
abstract: We report seven children with recent Mycoplasma pneumoniae infection and severe Guillain-Barré syndrome (GBS) that presented to two European medical centres from 1992 to 2012. Severe GBS was defined as the occurrence of respiratory failure, central nervous system (CNS) involvement, or death. Five children had GBS, one Bickerstaff brain stem encephalitis (BBE), and one acute-onset chronic inflammatory demyelinating polyneuropathy (A-CIDP). The five patients with severe GBS were derived from an original cohort of 66 children with GBS. In this cohort, 17 children (26%) had a severe form of GBS and 47% of patients with M. pneumoniae infection presented with severe GBS. Of the seven patients in this case series, five were mechanically ventilated and four had CNS involvement (two were comatose). Most patients presented with non-specific clinical symptoms (nuchal rigidity and ataxia) and showed a rapidly progressive disease course (71%). Antibodies against M. pneumoniae were detected in all patients and were found to be intrathecally synthesised in two cases (GBS and BBE), which proves intrathecal infection. One patient died and only two patients recovered completely. These cases illustrate that M. pneumoniae infection in children can be followed by severe and complicated forms of GBS. Non-specific clinical features of GBS in such patients may predispose a potentially life-threatening delay in diagnosis.
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.|Laboratory of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.|Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center (CRC), University Children's Hospital of Zurich, Zurich, Switzerland.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Meyer Sauteur
authors.affiliation: Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Department of Pediatrics, Division of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Joyce
authors.initials: J
authors.lastname: Roodbol
authors.affiliation: Division of Neurology, and Children's Research Center (CRC), University Children's Hospital of Zurich, Zurich, Switzerland.
authors.forename: Annette
authors.initials: A
authors.lastname: Hackenberg
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Marie-Claire Y
authors.initials: MC
authors.lastname: de Wit
authors.affiliation: Laboratory of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.|Erasmus University College, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: Vink
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center (CRC), University Children's Hospital of Zurich, Zurich, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Berger
authors.affiliation: TU Dresden, Medical Faculty Carl Gustav Carus, Institute of Medical Microbiology and Hygiene, Dresden, Germany.
authors.forename: Enno
authors.initials: E
authors.lastname: Jacobs
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Annemarie M C
authors.initials: AM
authors.lastname: van Rossum
authors.affiliation: Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Bart C
authors.initials: BC
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D020275:Guillain-Barre Syndrome / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009177:Mycoplasma pneumoniae / Q000472:pathogenicity*; D011019:Pneumonia, Mycoplasma / Q000150:complications* / Q000175:diagnosis
keywords: Bickerstaff brain stem encephalitis; Mycoplasma pneumoniae; acute-onset chronic inflammatory demyelinating polyneuropathy; central nervous system infection; children