title: Mycoplasma pneumoniae triggering the Guillain-Barré syndrome: A case-control study.
abstract: Guillain-Barré syndrome (GBS) is an acute postinfectious immune-mediated polyneuropathy. Although preceding respiratory tract infections with Mycoplasma pneumoniae have been reported in some cases, the role of M. pneumoniae in the pathogenesis of GBS remains unclear. We here cultured, for the first time, M. pneumoniae from a GBS patient with antibodies against galactocerebroside (GalC), which cross-reacted with the isolate. This case prompted us to unravel the role of M. pneumoniae in GBS in a case-control study.
  
  
  
  We included 189 adults and 24 children with GBS and compared them to control cohorts for analysis of serum antibodies against M. pneumoniae (n = 479) and GalC (n = 198).
  
  
  
  Anti-M. pneumoniae immunoglobulin (Ig) M antibodies were detected in GBS patients and healthy controls in 3% and 0% of adults (p = 0.16) and 21% and 7% of children (p = 0.03), respectively. Anti-GalC antibodies (IgM and/or IgG) were found in 4% of adults and 25% of children with GBS (p = 0.001). Anti-GalC-positive patients showed more-frequent preceding respiratory symptoms, cranial nerve involvement, and a better outcome. Anti-GalC antibodies correlated with anti-M. pneumoniae antibodies (p < 0.001) and cross-reacted with different M. pneumoniae strains. Anti-GalC IgM antibodies were not only found in GBS patients with M. pneumoniae infection, but also in patients without neurological disease (8% vs 9%; p = 0.87), whereas anti-GalC IgG was exclusively found in patients with GBS (9% vs 0%; p = 0.006).
  
  
  
  M. pneumoniae infection is associated with GBS, more frequently in children than adults, and elicits anti-GalC antibodies, of which specifically anti-GalC IgG may contribute to the pathogenesis of GBS. Ann Neurol 2016;80:566-580.
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center, 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 Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Ruth
authors.initials: R
authors.lastname: Huizinga
authors.affiliation: Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Anne P
authors.initials: AP
authors.lastname: Tio-Gillen
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: Laboratory of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Hoogenboezem
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 Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: van Rijn
authors.affiliation: Department of Viroscience, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Annemiek A
authors.initials: AA
authors.lastname: van der Eijk
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: 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: Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Annemarie M C
authors.initials: AM
authors.lastname: van Rossum
authors.affiliation: Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. b.jacobs@erasmusmc.nl.|Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. b.jacobs@erasmusmc.nl.
authors.forename: Bart C
authors.initials: BC
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000276:immunology*; D001323:Autoantibodies / Q000276:immunology*; D016022:Case-Control Studies; D002648:Child; D003429:Cross Reactions; D005260:Female; D005699:Galactosylceramides / Q000276:immunology*; D020275:Guillain-Barre Syndrome / Q000209:etiology / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D008297:Male; D008875:Middle Aged; D009175:Mycoplasma Infections / Q000150:complications / Q000276:immunology*; D009177:Mycoplasma pneumoniae / Q000276:immunology*; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D001323:Autoantibodies; D005699:Galactosylceramides; D007074:Immunoglobulin G; D007075:Immunoglobulin M; C002454:galactocerebroside