Journal Article

Guillain-Barré Syndrome and Influenza Virus Infection

Valérie Sivadon-Tardy, David Orlikowski, Raphaël Porcher, Tarek Sharshar, Marie-Christine Durand, Vincent Enouf, Flore Rozenberg, Christiane Caudie, Djillali Annane, Sylvie van der Werf, Pierre Lebon, Jean-Claude Raphaël, Jean-Louis Gaillard and Elyanne Gault

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 48, issue 1, pages 48-56
Published in print January 2009 | ISSN: 1058-4838
Published online January 2009 | e-ISSN: 1537-6591 | DOI:
Guillain-Barré Syndrome and Influenza Virus Infection

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Background. In Western countries, the cause of 60% of all Guillain-Barré syndrome (GBS) cases remains unidentified. The number of cases of unidentified cause peaks in winter, and these cases are commonly preceded by respiratory tract infection or influenza-like illness. We investigated the triggering role of influenza virus infection.

Methods. Of 405 patients with GBS who were admitted to a French reference center during 1996–2004, 234 had cases caused by an unidentified agent. We used time-series methods to study the correlation between the monthly incidence of such cases and influenza-like illnesses reported by the Sentinelles surveillance network. We analyzed anti-influenza antibodies using complement fixation testing and hemagglutination-inhibition assays. We studied etiological subgroups using Wilcoxon and Fisher's exact tests.

Results. We found a positive association between the monthly incidence of GBS caused by an unidentified agent and reported influenza-like illnesses. Of 73 patients whose cases occurred during periods in which there was a possible link to influenza, 10 (13.7%) had serological evidence of recent influenza A, and 4 (5.5%) had serological evidence of influenza B. Eight of 10 influenza A—related cases occurred during “major” influenza seasons, and antibodies specific to the current epidemic strain were found in 9 cases. Most patients with influenza A—related cases were aged <65 years, and none had antiganglioside antibodies. Influenza-related cases differed both from Campylobacter jejuni—related cases, with regard to the lack of need for mechanical ventilation (P=.014), and from the cases caused by an unidentified agent, with regard to the presence of preceding influenza-like illness or respiratory tract infection (P=.015) and longer time from the infectious event to GBS onset (P=.04).

Conclusions. Influenza viruses are infrequent triggering agents of GBS but may play a significant role during major influenza outbreaks. Influenza-related GBS displays specific features and is not associated with antiganglioside antibody response, which suggests the presence of underlying immune mechanisms.

Journal Article.  4634 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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