Campylobacter Infection as a Trigger for Guillain-Barré Syndrome in Egypt

BACKGROUND: Most studies of Campylobacter infection triggering Guillain-Barré Syndrome (GBS) are conducted in western nations were Campylobacter infection and immunity is relatively rare. In this study, we explored Campylobacter infections, Campylobacter serotypes, autoantibodies to gangliosides, and GBS in Egypt, a country where Campylobacter exposure is common. METHODS: GBS cases (n = 133) were compared to age- and hospital-matched patient controls (n = 374). A nerve conduction study was performed on cases and a clinical history, serum sample, and stool specimen obtained for all subjects. RESULTS: Most (63.3%) cases were demyelinating type; median age four years. Cases were more likely than controls to have diarrhea (29.5% vs. 22.5%, Adjusted Odds Ratio (ORa) = 1.69, P = 0.03), to have higher geometric mean IgM anti-Campylobacter antibody titers (8.18 vs. 7.25 P<0.001), and to produce antiganglioside antibodies (e.g., anti-Gd1a, 35.3 vs. 11.5, ORa = 4.39, P<0.0001). Of 26 Penner:Lior Campylobacter serotypes isolated, only one (41:27, C. jejuni, P = 0.02) was associated with GBS. CONCLUSIONS: Unlike results from western nations, data suggested that GBS cases were primarily in the young and cases and many controls had a history of infection to a variety of Campylobacter serotypes. Still, the higher rates of diarrhea and greater antibody production against Campylobacter and gangliosides in GBS patients were consistent with findings from western countries

Natural log of IgM serum antibody titers against Campylobacter among Guillain-Barré Syndrome cases and patient-controls and among cases and controls reporting diarrhea or excreting Campylobacter, the Arab Republic of Egypt, April 2001 through September 2003.

<p>Natural log of IgM serum antibody titers against Campylobacter among Guillain-Barré Syndrome cases and patient-controls and among cases and controls reporting diarrhea or excreting Campylobacter, the Arab Republic of Egypt, April 2001 through September 2003.</p

Percent of each Penner and Lior (Penner:Lior) <i>Campylobacter</i> serogroup isolated from Guillain-Barré Syndrome cases and patient-controls, the Arab Republic of Egypt, April 2001 through September 2003.

a<p>One case specimen and two controls specimens were not serotyped.</p>b<p>Fisher's exact test.</p>c<p>Subscript “J” = <i>C jejuni</i> and subscript “C” = <i>C coli</i>.</p

Odds of having IgM serum antibodies against GMI, GM2, GD1a, GD1b, and GT1b gangliosides in Guillain-Barré Syndrome cases and patient-controls for all cases and controls, for patients reporting diarrhea, and for patients excreting <i>Campylobacter</i>, the Arab Republic of Egypt, April 2001 through September 2003.

a<p>Conditional logistic regression controlling for age, gender, ownership of farm animals, and ownership of luxury items.</p>b<p>Unconditional logistic regression controlling for age, gender, livestock ownership, and possession of luxury items.</p>c<p>Unconditional logistic regression controlling for possession of luxury items. Other variable were excluded because of sparse data.</p>d<p>Odds Ratio (95% CI).</p>e<p><.0001.</p>f<p>P = 0.047.</p>g<p>P = .004.</p>h<p>P = 0.04.</p>i<p>P = 0.006.</p>j<p>P = .007.</p

Characteristics of cases and controls enrolled in study of <i>Campylobacter</i> infection and Guillain-Barré Syndrome, the Arab Republic of Egypt, April 2001 through September 2003.

a<p>Median (interquartile range).</p>b<p>Patients were matched to controls for age (±2 years) and hospital for all cases and controls; matching was incomplete when analyzing subgroups (e.g., Cases and controls with diarrhea).</p>c<p>P = .002; Odds Ratio = 1.86 (95% CI: 1.25 to 2.78), univariate unconditional logistic regression.</p>d<p>Owned three or more luxury items (e.g., cell phone, car).</p>e<p>P = .04; Odd Ratio = 0.10 (95% CI: 0.01 to 0.93), univariate unconditional logistic regression.</p