SEROLOGIC EVIDENCE OF PREVIOUS CAMPYLOBACTER-JEJUNI INFECTION IN PATIENTS WITH THE GUILLAIN-BARRE-SYNDROME

Objective: To determine if patients with the Guillain-Barre syndrome are likely to have had Campylobacter jejuni infection before onset of neurologic symptoms. Design: A case-control study. Setting: Several university medical centers. Patients: Case patients met clinical criteria for the Guillain-Barre syndrome between 1983 and 1990 and had a serum sample collected and frozen within 3 weeks after onset of neurologic symptoms (n = 118). Disease controls were patients with other neurologic illnesses (n = 56); healthy controls were hospital employees or healthy family members of patients (n = 47). Measurements: Serum IgA, IgG, and IgM antibodies to C. jejuni were determined by enzyme-linked immunosorbent assays. Assays were done in a blinded manner. Results: Optical density ratios greater-than-or-equal-to 2 in two or more immunoglobulin classes were seen in 43 (36%) of patients with the Guillain-Barre syndrome and in 10 (10%) of controls (odds ratio, 5.3; 95% CI, 2.4 to 12.5; P < 0.001). Increasing the optical density ratio or the number of immunoglobulin classes necessary to yield a positive result increased the strength of the association. The number of patients with the Guillain-Barre syndrome who had positive serologic responses was greatest from September to November (P = 0.02). Male patients were three times more likely to have serologic evidence of C. jejuni infection (P = 0.009); the proportion of patients with the syndrome who had a positive serologic response increased with age. Conclusions: Patients with the Guillain-Barre syndrome are more likely than controls to have serologic evidence of C. jejuni infection in the weeks before onset of neurologic symptoms. Campylobacter jejuni may play a role in the initiation of the Guillain-Barre syndrome in many patients.