Study of association of Guillain barre syndrome with Campylobacter infections.
A case control study on a total of 177 patients-59 patients with Guillain barre syndrome, 58 patients with non-paralytic neurological disease as neurological controls and 60 patients from various other wards of the hospital as non-neurological controls was carried out to investigate the association between Campylobacter jejuni infection and Guillain barre syndrome (GBS). The enrolled patients underwent a detailed enquiry and clinical examination. Nerve conduction studies were carried out to establish the diagnosis of GBS. The GBS patients were classified into different subgroups according to their clinical presentation and comprised of 28 patients with acute inflammatory demyelinating polyneuropathy (AIDP), 23 with acute motor axonal neuropathy (AMAN) and 8 with acute motor sensory axonal neuropathy (AMSAN). Stool samples could be collected from 35 GBS patients and blood samples from all the patients. Stool samples were cultured by direct inoculation and by filtration methods on to selective Campylobacter agar media and isolates were identified biochemically and serologically. C. jejuni could be isolated from the stool samples of 5.7% GBS patients but none from the neurological control (NC) and non neurological control (NNC) groups. The isolates were serologically typed and found to belong to Penner group 0:19.
Sera separated from the blood samples of both GBS patients and control subjects (NC and NNC groups) were tested for the presence of IgG and IgM antibodies to the gangliosides--GM1, GM2, GM3, GD1a, GD1b, GT1b and GQ1 b using commercially available Euroline test kit.
Antibodies against GM1 are associated with GBS and with multifocal motor neuropathy. IgM and IgG antibodies were found against GM1 ranging from 15-18% in both GBS and NC groups, but none in the NNC group. Similarly GM2 and GM3 antibodies were present in both GBS and NC group from 9-24%, but none in the NNC group. GD1 a and GT1 b and GQ1 b were associated with GBS and a very high association was found with GBS patients. Antibodies against GB1 b were found in 2-17% with GBS and NC group, but none in the NNC group. Only GT1b was detected in 6.7% of NNC patients, as very weak bands.
IgG antibodies against gangliosides were present in 23/28 (82%) and IgM antibodies in 13/28 (46%) and AIDP patients. In the AMAN subgroup they were present respectively in 16/23 (70%) and 10/23 (44%). In AMSAN subgroup both the classes of antibodies were present in 3/8 (38%) of the samples. It is concluded that C. jejuni was isolated from only 5.7% of the GBS patients, probably because of late reporting to the hospitals and though high intensity of anti gangliosides antibodies were present in the different subgroups of GBS patients, the NC patients also had adequate anti ganglioside antibodies compared to the NNC patients in whom the specific antibodies were nearly absent.
Dr. Chetna Vaishnavi
Department of Gastroenterology
Postgraduate Institute of Medical Education and Research
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|Title Annotation:||ABSTRACTS: Some Research Projects Completed Recently|
|Date:||Aug 1, 2011|
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