Antecedent infections in Guillain-Barré syndrome patients from south India.

Dutta, Debprasad; Debnath, Monojit; Nagappa, Madhu; Das, Sumit Kumar; Wahatule, Rahul; Sinha, Sanjib; Taly, Arun B; Ravi, Vasanthapuram

BACKGROUND AND AIMS Guillain-Barré syndrome (GBS) is the commonest postinfectious inflammatory peripheral neuropathy with undiscerned aetiology. The commonly reported antecedent infections implicated in India include Campylobacter jejuni (C. jejuni), chikungunya, dengue and Japanese encephalitis (JE). In this study from south India, we investigated the role of these four agents in triggering GBS. METHODS This case-control study was performed on 150 treatment-naive patients with GBS and 150 age and sex-matched controls from the same community. IgM immunoreactivity for C. jejuni, chikungunya and dengue were detected by enzyme-linked immunosorbent assay (ELISA) in serum patients with GBS and control subjects. Immunoreactivity against JE was detected in serum as well as CSF from patients (n=150) and orthopaedic control (n=45) subjects. The immunoreactivity against infections was compared between demyelinating and axonal subtypes of GBS. RESULTS Overall, 119/150 patients with GBS had serological evidence of antecedent infection. Amongst those with evidence of antecedent infection, 24(16%), 8(5%), 9(6%) patients were exclusively immunoreactive to chikungunya, JE and C. jejuni, respectively. In the remaining patients (78/119), immunoreactivity to multiple pathogens was noted. C. jejuni infection was found in 32% of GBS patients compared to 2.7% controls (p<0.001), whereas chikungunya virus was reported in 66.7% of patients with GBS compared to 44.7% controls (p=0.006). Anti-dengue immunoreactivity was significantly associated with the demyelinating subtype of GBS. Patients positive for JE IgM (CSF) manifested demyelinating electrophysiology. INTERPRETATIONS In this large case-control study, immunoreactivity against multiple infectious agents was observed in a subset of patients. Chikungunya was the commonest antecedent infection, followed by C. jejuni. This article is protected by copyright. All rights reserved.