The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study

Neurology. 1998 Oct;51(4):1110-5. doi: 10.1212/wnl.51.4.1110.


Objective: To determine which antecedent infections are specifically associated with the Guillain-Barré syndrome (GBS).

Background: Infections with many agents have been reported preceding GBS. Some infections are related to specific clinical and immunologic subgroups in GBS. Most agents were reported in case reports and uncontrolled small series of GBS patients only, and their relation to GBS and its subgroups remains unclear.

Method: A serologic study for 16 infectious agents in 154 GBS patients and 154 sex- and age-matched controls with other neurologic diseases. Acute phase, pretreatment samples were used from clinically well-defined GBS patients. The seasonal distribution of serum sampling in the GBS and control group was the same.

Results: Multivariate analysis showed that in GBS patients, infections with Campylobacter jejuni (32%), cytomegalovirus (13%), and Epstein-Barr virus (10%) were significantly more frequent than in controls. Mycoplasma pneumoniae infections occurred more often in GBS patients (5%) than in controls in univariate analysis. Infections with Haemophilus influenzae (1%), parainfluenza 1 virus (1%), influenza A virus (1%), influenza B virus (1%), adenovirus (1%), herpes simplex virus (1%), and varicella zoster virus (1%) were also demonstrated in GBS patients, but not more frequently than in controls. C. jejuni infections were associated with antibodies to the gangliosides GM1 and GD1b and with a severe pure motor form of GBS. Cytomegalovirus infections were associated with antibodies to the ganglioside GM2 and with severe motor sensory deficits. Other infections were not related to specific antiganglioside antibodies and neurologic patterns.

Conclusions: Recent infections with C. jejuni, cytomegalovirus, Epstein-Barr virus, and M. pneumoniae are specifically related to GBS. The variety of infections may contribute to the clinical and immunologic heterogeneity of GBS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoviridae Infections / epidemiology
  • Adenoviridae Infections / immunology
  • Antibodies, Bacterial / blood
  • Antibodies, Viral / blood
  • Bacterial Infections / epidemiology
  • Bacterial Infections / immunology*
  • Campylobacter Infections / epidemiology
  • Campylobacter Infections / immunology
  • Campylobacter jejuni
  • Case-Control Studies
  • Cytomegalovirus Infections / epidemiology
  • Cytomegalovirus Infections / immunology
  • Epstein-Barr Virus Infections / epidemiology
  • Epstein-Barr Virus Infections / immunology
  • Female
  • Gangliosides / immunology
  • Haemophilus Infections / epidemiology
  • Haemophilus Infections / immunology
  • Haemophilus influenzae
  • Humans
  • Incidence
  • Influenza A virus
  • Influenza B virus
  • Influenza, Human / epidemiology
  • Influenza, Human / immunology
  • Male
  • Pneumonia, Mycoplasma / epidemiology
  • Pneumonia, Mycoplasma / immunology
  • Polyradiculoneuropathy / immunology
  • Polyradiculoneuropathy / microbiology*
  • Polyradiculoneuropathy / virology*
  • Seroepidemiologic Studies
  • Virus Diseases / epidemiology
  • Virus Diseases / immunology*


  • Antibodies, Bacterial
  • Antibodies, Viral
  • Gangliosides