Guillain–Barré Syndrome following Primary Cytomegalovirus Infection: A Prospective Cohort Study

December 28, 2011 at 11:36 am Leave a comment

Clinical Infect Diseases  Apr.1, 2011 V.52 N.6 P.837-844

David Orlikowski1,4, Raphaël Porcher5,6, Valérie Sivadon-Tardy4,10, Jean-Charles Quincampoix4,10, Jean-Claude Raphaël1,4,*, Marie-Christine Durand2, Tarek Sharshar1,4, Jacqueline Roussi3,4, Christiane Caudie11, Djillali Annane1,4, Flore Rozenberg7,8, Marianne Leruez-Ville8,9, Jean-Louis Gaillard4,10, and Elyanne Gault4,10

1Service de Réanimation

2Service de Physiologie et Explorations Fonctionnelles

3Service d’Hématologie Immunologie, AP-HP, Hôpital Raymond Poincaré, Garches

4Université de Versailles St-Quentin-en-Yvelines, UPRES EA4342, Guyancourt

5AP-HP, Hôpital St-Louis, Département de Biostatistique et Informatique Médicale, Paris

6Université Paris Diderot Paris 7, Inserm U717

7AP-HP, Hôpital Cochin-St-Vincent-de-Paul, Laboratoire de Virologie, Paris

8Université Paris Descartes Paris 5

9AP-HP, Hôpital Necker, Laboratoire de Virologie, Paris

10AP-HP, Hôpital Ambroise Paré, Laboratoire de Microbiologie, Boulogne-Billancourt

11Hôpital Neurologique de Lyon, Fédération de Biologie, Service d’Immunologie, Bron, France

Background

Little is known about the epidemiology and the prognostic factors of Guillain–Barré syndrome (GBS) following primary infection with cytomegalovirus (CMV-GBS).

Methods

We prospectively followed up 506 patients with cases of GBS who were admitted to our center from 1996 through 2006. We diagnosed 63 (12.4%) CMV-GBS cases by immunoglobulin (Ig) M detection and IgG avidity. Plasma CMV DNA was detected at hospital admission. Patient subgroups were compared using Fisher’s exact test and the Wilcoxon rank-sum test. Temporal variations were analyzed with time series methods.

Results

Patients with CMV-GBS were mostly young (median age, 32 years; sex ratio, 0.85), but we also identified a subpopulation of patients consisting of women aged >50 years. Sensory defects (in 72% of cases) and facial palsy (49%) were frequent, and test results positive for CMV DNA in plasma at hospital admission (found in 62% of cases) tended to be associated with objective sensory defect (P = .052). The main factors associated with long-term neurological sequelae (21%) were older age (P < .001) and assisted ventilation during hospitalization (P = .005). The number of CMV-GBS cases decreased between 1996 and 2006 (P = .019) and displayed an annual periodicity between the months of July and October. The incidence of CMV-GBS was estimated to be between 0.6 and 2.2 cases per 1000 cases of primary CMV infection (versus 0.25 to 0.65 cases per 1000 cases of Campylobacter jejuni infection).

Conclusions

This study provides new insights about the epidemiology of CMV-GBS and shows that the risk of developing GBS is similar following primary CMV infection or C. jejuni infection. Our results also suggest a direct or indirect involvement of viral replication in the neuropathological processes of CMV-GBS.

abstract

http://cid.oxfordjournals.org/content/52/7/837.abstract

PDF

http://cid.oxfordjournals.org/content/52/7/837.full.pdf+html

Entry filed under: Biología Molecular, Infecciones virales, Metodos diagnosticos.

Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases

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