Guillain-Barré syndrome following primary cytomegalovirus infection: a prospective cohort study

Clin Infect Dis. 2011 Apr 1;52(7):837-44. doi: 10.1093/cid/cir074.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antibodies, Viral / blood
  • Cohort Studies
  • Cytomegalovirus Infections / complications*
  • DNA, Viral / blood
  • Female
  • Guillain-Barre Syndrome / epidemiology*
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin M / blood
  • Male
  • Middle Aged
  • Prospective Studies
  • Young Adult


  • Antibodies, Viral
  • DNA, Viral
  • Immunoglobulin G
  • Immunoglobulin M