Correspondence

Campylobacter jejuni Infection and Treatment for Guillain–Barré Syndrome

N Engl J Med 1996; 335:208-209July 18, 1996

Article

To the Editor:

Rees et al. (Nov. 23 issue)1 reported that patients with the Guillain–Barré syndrome and recent infection with Campylobacter jejuni have a more severe residual disability after one year than patients without C. jejuni infection. In later studies they showed that patients with the combination of C. jejuni infection and antibodies against GM1 ganglioside have the worst prognosis.2 The effect of treatment was not included in their analyses, however.

We studied the outcome in 147 patients with Guillain–Barré syndrome six months after their enrollment in a trial comparing plasma exchange with intravenous immune globulin.3 None of the patients could walk independently at the time of randomization. Pretreatment serum samples from 133 patients were tested serologically for C. jejuni and anti-GM1 antibodies.4 The patients were classified according to whether C. jejuni infection and anti-GM1 antibodies were present. Table 1Table 1Patients with Guillain–Barré Syndrome Who Could Walk Independently Six Months after the Start of Treatment. summarizes our findings.

Our study confirmed the unfavorable prognosis in the patients with both C. jejuni infection and anti-GM1 antibodies. However, the more severe residual disability was found only after treatment with plasma exchange, not after treatment with intravenous immune globulin. Five of the patients treated with plasma exchange were studied again at least one year after randomization, and none could walk independently. In contrast, 8 of 10 patients with C. jejuni infection and anti-GM1 antibodies treated with intravenous immune globulin recovered. In a logistic-regression model, the percentage of recovery among the patients with C. jejuni infection and anti-GM1 antibodies was also lower after plasma exchange (18 percent) than after treatment with intravenous immune globulin (82 percent). The difference in outcome between the patients treated with plasma exchange and those treated with intravenous immune globulin could not be explained by other prognostic factors, such as age and severity of disease at onset. Our data indicate that the combination of C. jejuni infection and anti-GM1 antibodies is associated with a poor prognosis in patients with Guillain–Barré syndrome who are treated with plasma exchange. Prospective studies are needed to investigate whether such patients should be treated preferentially with intravenous immune globulin.

Bart C. Jacobs, M.D.
Paul I.M. Schmitz, Ph.D.
Frans G.A. van der Meché, M.D., Ph.D.
Erasmus University, 3000 DR Rotterdam, the Netherlands

4 References

1. 1

   Rees JH, Soudain SE, Gregson NA, Hughes RAC. Campylobacter jejuni infection and Guillain-Barré syndrome. N Engl J Med 1995;333:1374-1379
   Full Text | Web of Science | Medline

2. 2

   Rees JH, Gregson NA, Hughes RA. Anti-ganglioside GM1 antibodies in Guillain-Barré syndrome and their relationship to Campylobacter jejuni infection. Ann Neurol 1995;38:809-816
   CrossRef | Web of Science | Medline

3. 3

   van der Meche FG, Schmitz PIM, Dutch Guillain-Barre Study Group. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. N Engl J Med 1992;326:1123-1129
   Full Text | Web of Science | Medline

4. 4

   Jacobs BC, van Doorn PA, Schmitz PIM, et al. Campylobacter jejuni infections and anti-GM1 antibodies in Guillain–Barré syndrome. Ann Neurol (in press).
   

Author/Editor Response

Dr. Rees replies:

To the Editor: We are grateful to Jacobs et al. for their comments about the improved outcome at six months in patients with both C. jejuni infection and anti-GM1 antibodies who were treated with intravenous immune globulin rather than plasma exchange. We could not make a similar comparison in our group of 13 patients with C. jejuni infection and anti-GM1 antibodies, because none of our patients were treated with plasma exchange. Ten received intravenous immune globulin, and three were not treated at all. Follow-up data were available on 9 of the 10 patients treated with intravenous immune globulin. After one year, seven were walking, one could walk only with canes, and one had died. Therefore, we can neither confirm nor refute the observations of Jacobs et al., and we agree that further prospective studies are needed to answer this important question of management.

Jeremy H. Rees, Ph.D., M.R.C.P.
Royal Free Hospital, London NW3 2QG, United Kingdom

Citing Articles (2)

Citing Articles

1. 1

   Donka Lange, Stojanka Aleksic, Jan Kassubek, Miroslav M. Vrvic, Manfred Kist, Bernhard Steinbrückner, Marija Mitova. (1999) Detection of Antibodies against Campylobacter jejuni Serogroup PEN 0:19 Purified Flagellar Protein in a Patient with Guillain-Barre Syndrome. Zentralblatt für Bakteriologie 289:4, 429-444
   CrossRef

2. 2

   Martin Stangel, Hans-Peter Hartung, Peter Marx, Ralf Gold. (1998) Intravenous immunoglobulin treatment of neurological autoimmune diseases. Journal of the Neurological Sciences 153:2, 203-214
   CrossRef