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Guillain-Barr? Syndrome and Influenza Virus Infection [Chicago Journals - Clinical Infectious Diseases]
Clinical Infectious Diseases 2009;48:000?000
? 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2009/4801-00XX$15.00
DOI: 10.1086/594124
MAJOR ARTICLE
Guillain-Barr? Syndrome and Influenza Virus Infection
Val?rie Sivadon-Tardy,1,2 David Orlikowski,2,3 Rapha?l Porcher,5,6 Tarek Sharshar,2,3 Marie-Christine Durand,2,4 Vincent Enouf,7,8 Flore Rozenberg,9,10 Christiane Caudie,11 Djillali Annane,2,3 Sylvie van der Werf,7,8P ierre Lebon,9,10 Jean-Claude Rapha?l,2,3 Jean-Louis Gaillard,1,2 and Elyanne Gault 1,2,7,8
1 Laboratoire de Microbiologie, H?pital Ambroise Par?, Assistance Publique?H?pitaux de Paris (AP-HP), Boulogne-Billancourt,
2 Universit? de Versailles?St. Quentin, Facult? de M?decine Paris-Ile-de-France-Ouest,
3 Service de R?animation, and
4 Physiologie et Explorations Fonctionnelles, H?pital Raymond Poincar? (AP-HP), Garches,
5 D?partement de Biostatistique et Informatique M?dicale, H?pital St.-Louis (AP-HP),
6 Universit? Paris Inserm U717,
7 Unit? de G?n?tique Mol?culaire des Virus Respiratoires, URA CNRS 3015, EA302 Universit? Paris 7,
8 Centre National de R?f?rence du Virus Influenza (R?gion Nord), Institut Pasteur,
9 Laboratoire de Virologie, H?pital Cochin?St. Vincent-de-Paul (AP-HP), and
10 Universit? Paris Descartes, Facult? de M?decine, Paris, and
11 F?d?ration de Biologie, Service d'Immunologie, H?pital Neurologique, Lyon, France
Background.
In Western countries, the cause of 60% of all Guillain-Barr? 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 ( ), and from the cases caused by an unidentified agent, with regard to the presence of preceding influenza-like illness or respiratory tract infection ( ) and longer time from the infectious event to GBS onset ( ).
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.
Received 3 June 2008; accepted 24 August 2008; electronically published 24 November 2008.
Reprints or correspondence: Dr. Elyanne Gault, Laboratoire de Microbiologie, H?pital Ambroise Par?, 9, ave. Charles de Gaulle, 92100 Boulogne-Billancourt, France (elyanne.gault@apr.aphp.fr)
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<cite cite="http://www.journals.uchicago.edu/doi/abs/10.1086/594124">Chicago Journals - Clinical Infectious Diseases</cite>
? 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2009/4801-00XX$15.00
DOI: 10.1086/594124
MAJOR ARTICLE
Guillain-Barr? Syndrome and Influenza Virus Infection
Val?rie Sivadon-Tardy,1,2 David Orlikowski,2,3 Rapha?l Porcher,5,6 Tarek Sharshar,2,3 Marie-Christine Durand,2,4 Vincent Enouf,7,8 Flore Rozenberg,9,10 Christiane Caudie,11 Djillali Annane,2,3 Sylvie van der Werf,7,8P ierre Lebon,9,10 Jean-Claude Rapha?l,2,3 Jean-Louis Gaillard,1,2 and Elyanne Gault 1,2,7,8
1 Laboratoire de Microbiologie, H?pital Ambroise Par?, Assistance Publique?H?pitaux de Paris (AP-HP), Boulogne-Billancourt,
2 Universit? de Versailles?St. Quentin, Facult? de M?decine Paris-Ile-de-France-Ouest,
3 Service de R?animation, and
4 Physiologie et Explorations Fonctionnelles, H?pital Raymond Poincar? (AP-HP), Garches,
5 D?partement de Biostatistique et Informatique M?dicale, H?pital St.-Louis (AP-HP),
6 Universit? Paris Inserm U717,
7 Unit? de G?n?tique Mol?culaire des Virus Respiratoires, URA CNRS 3015, EA302 Universit? Paris 7,
8 Centre National de R?f?rence du Virus Influenza (R?gion Nord), Institut Pasteur,
9 Laboratoire de Virologie, H?pital Cochin?St. Vincent-de-Paul (AP-HP), and
10 Universit? Paris Descartes, Facult? de M?decine, Paris, and
11 F?d?ration de Biologie, Service d'Immunologie, H?pital Neurologique, Lyon, France
Background.
In Western countries, the cause of 60% of all Guillain-Barr? 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 ( ), and from the cases caused by an unidentified agent, with regard to the presence of preceding influenza-like illness or respiratory tract infection ( ) and longer time from the infectious event to GBS onset ( ).
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.
Received 3 June 2008; accepted 24 August 2008; electronically published 24 November 2008.
Reprints or correspondence: Dr. Elyanne Gault, Laboratoire de Microbiologie, H?pital Ambroise Par?, 9, ave. Charles de Gaulle, 92100 Boulogne-Billancourt, France (elyanne.gault@apr.aphp.fr)
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