Background Although infection with Campylobacter jejuni is recognizedas a common antecedent of the Guillain–Barré syndrome,the clinical and epidemiologic features of this associationare not well understood.
Methods We performed a prospective case–control studyin a cohort of patients with Guillain–Barré syndrome(96 patients) or Miller Fisher syndrome (7 patients) who wereadmitted to hospitals throughout England and Wales between November1992 and April 1994. Bacteriologic and serologic techniqueswere used to diagnose preceding C. jejuni infection.
Results There was evidence of recent C. jejuni infection in26 percent of the patients with Guillain–Barréor Miller Fisher syndrome, as compared with 2 percent of householdcontrols and 1 percent of age-matched hospital controls (P<0.001).Of the 27 patients with C. jejuni infection, 19 (70 percent)reported having had a diarrheal illness within 12 weeks beforethe onset of the neurologic illness. No specific serotypes wereassociated with Guillain–Barré syndrome. C. jejuniinfection was slightly more common in men (P = 0.14) and wasmore likely to be associated with a pure motor syndrome anda slower recovery (P = 0.03). The patients with preceding C.jejuni infection were more likely to have acute axonal neuropathyor axonal degeneration in association with acute inflammatorydemyelinating polyradiculoneuropathy, and they had greater disabilityafter one year (P = 0.02). C. jejuni infection was significantlyassociated with a poor outcome even after correction for otherfactors associated with a poor prognosis.
Conclusions Infection with C. jejuni often precedes the Guillain–Barrésyndrome and is associated with axonal degeneration, slow recovery,and severe residual disability.
Source Information
From the Department of Neurology (J.H.R., S.E.S., R.A.C.H.) and the Division of Anatomy and Cell Biology (N.A.G.), United Medical and Dental Schools, Guy's Hospital, London.
Address reprint requests to Dr. Rees at the Department of Neurology, Royal Free Hospital, Hampstead, London NW3 2QG, United Kingdom.
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