An International Perspective on Preceding Infections in Guillain-Barré Syndrome: The IGOS-1000 Cohort

Sonja E. Leonhard; Annemiek A. Van Der Eijk; Henning Andersen; Giovanni Antonini; Samuel Arends; Shahram Attarian; Fabio A. Barroso; Kathleen J. Bateman; Manou R. Batstra; Luana Benedetti; Bianca Van Den Berg; Peter Van Den Bergh; Jan Bürmann; Mark Busby; Carlos Casasnovas; David R. Cornblath; Amy Davidson; Alex Y. Doets; Pieter A. Van Doorn; Charlotte Dornonville De La Cour; Thomas E. Feasby; Janev Fehmi; Tania Garcia-Sobrino; Jonathan M. Goldstein; Kenneth C. Gorson; Volkan Granit; Robert D.M. Hadden; Thomas Harbo; Hans Peter Hartung; Imran Hasan; Jakob V. Holbech; James K.L. Holt; Israt Jahan; Zhahirul Islam; Summer Karafiath; Hans D. Katzberg; Ruud P. Kleyweg; Noah Kolb; Krista Kuitwaard; Motoi Kuwahara; Susumu Kusunoki; Linda W.G. Luijten; Satoshi Kuwabara; Edward Lee Pan; Helmar C. Lehmann; Marijke Maas; Lorena Martín-Aguilar; James A.L. Miller; Quazi Deen Mohammad; Soledad Monges; Velina Nedkova-Hristova; Eduardo Nobile-Orazio; Julio Pardo; Yann Pereon; Luis Querol; Ricardo Reisin; Wouter Van Rijs; Simon Rinaldi; Rhys C. Roberts; Joyce Roodbol; Nortina Shahrizaila; Søren Hein Sindrup; Beth Stein; Tan Cheng-Yin; Hatice Tankisi; Anne P. Tio-Gillen; María J. Sedano Tous; Christine Verboon; Frederique H. Vermeij; Leo H. Visser; Ruth Huizinga; Hugh J. Willison; Bart C. Jacobs

doi:10.1212/WNL.0000000000200885

An International Perspective on Preceding Infections in Guillain-Barré Syndrome: The IGOS-1000 Cohort

Sonja E. Leonhard, Annemiek A. Van Der Eijk, Henning Andersen, Giovanni Antonini, Samuel Arends, Shahram Attarian, Fabio A. Barroso, Kathleen J. Bateman, Manou R. Batstra, Luana Benedetti, Bianca Van Den Berg, Peter Van Den Bergh, Jan Bürmann, Mark Busby, Carlos Casasnovas, David R. Cornblath, Amy Davidson, Alex Y. Doets, Pieter A. Van Doorn, Charlotte Dornonville De La CourThomas E. Feasby, Janev Fehmi, Tania Garcia-Sobrino, Jonathan M. Goldstein, Kenneth C. Gorson, Volkan Granit, Robert D.M. Hadden, Thomas Harbo, Hans Peter Hartung, Imran Hasan, Jakob V. Holbech, James K.L. Holt, Israt Jahan, Zhahirul Islam, Summer Karafiath, Hans D. Katzberg, Ruud P. Kleyweg, Noah Kolb, Krista Kuitwaard, Motoi Kuwahara, Susumu Kusunoki, Linda W.G. Luijten, Satoshi Kuwabara, Edward Lee Pan, Helmar C. Lehmann, Marijke Maas, Lorena Martín-Aguilar, James A.L. Miller, Quazi Deen Mohammad, Soledad Monges, Velina Nedkova-Hristova, Eduardo Nobile-Orazio, Julio Pardo, Yann Pereon, Luis Querol, Ricardo Reisin, Wouter Van Rijs, Simon Rinaldi, Rhys C. Roberts, Joyce Roodbol, Nortina Shahrizaila, Søren Hein Sindrup, Beth Stein, Tan Cheng-Yin, Hatice Tankisi, Anne P. Tio-Gillen, María J. Sedano Tous, Christine Verboon, Frederique H. Vermeij, Leo H. Visser, Ruth Huizinga, Hugh J. Willison, Bart C. Jacobs

Research output: Contribution to journal › Article › peer-review

Abstract

Background and ObjectivesInfections play a key role in the development of Guillain-Barré syndrome (GBS) and have been associated with specific clinical features and disease severity. The clinical variation of GBS across geographical regions has been suggested to be related to differences in the distribution of preceding infections, but this has not been studied on a large scale.MethodsWe analyzed the first 1,000 patients included in the International GBS Outcome Study with available biosamples (n = 768) for the presence of a recent infection with Campylobacter jejuni, hepatitis E virus, Mycoplasma pneumoniae, cytomegalovirus, and Epstein-Barr virus.ResultsSerologic evidence of a recent infection with C. jejuni was found in 228 (30%), M. pneumoniae in 77 (10%), hepatitis E virus in 23 (3%), cytomegalovirus in 30 (4%), and Epstein-Barr virus in 7 (1%) patients. Evidence of more than 1 recent infection was found in 49 (6%) of these patients. Symptoms of antecedent infections were reported in 556 patients (72%), and this proportion did not significantly differ between those testing positive or negative for a recent infection. The proportions of infections were similar across continents. The sensorimotor variant and the demyelinating electrophysiologic subtype were most frequent across all infection groups, although proportions were significantly higher in patients with a cytomegalovirus and significantly lower in those with a C. jejuni infection. C. jejuni-positive patients were more severely affected, indicated by a lower Medical Research Council sum score at nadir (p = 0.004) and a longer time to regain the ability to walk independently (p = 0.005). The pure motor variant and axonal electrophysiologic subtype were more frequent in Asian compared with American or European C. jejuni-positive patients (p < 0.001, resp. p = 0.001). Time to nadir was longer in the cytomegalovirus-positive patients (p = 0.004).DiscussionAcross geographical regions, the distribution of infections was similar, but the association between infection and clinical phenotype differed. A mismatch between symptom reporting and serologic results and the high frequency of coinfections demonstrate the importance of broad serologic testing in identifying the most likely infectious trigger. The association between infections and outcome indicates their value for future prognostic models.

Original language	English (US)
Pages (from-to)	E1299-E1313
Journal	Neurology
Volume	99
Issue number	12
DOIs	https://doi.org/10.1212/WNL.0000000000200885
State	Published - Sep 20 2022
Externally published	Yes

ASJC Scopus subject areas

Clinical Neurology

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10.1212/WNL.0000000000200885

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Leonhard, S. E., Van Der Eijk, A. A., Andersen, H., Antonini, G., Arends, S., Attarian, S., Barroso, F. A., Bateman, K. J., Batstra, M. R., Benedetti, L., Van Den Berg, B., Van Den Bergh, P., Bürmann, J., Busby, M., Casasnovas, C., Cornblath, D. R., Davidson, A., Doets, A. Y., Van Doorn, P. A., ... Jacobs, B. C. (2022). An International Perspective on Preceding Infections in Guillain-Barré Syndrome: The IGOS-1000 Cohort. Neurology, 99(12), E1299-E1313. https://doi.org/10.1212/WNL.0000000000200885

Leonhard, SE, Van Der Eijk, AA, Andersen, H, Antonini, G, Arends, S, Attarian, S, Barroso, FA, Bateman, KJ, Batstra, MR, Benedetti, L, Van Den Berg, B, Van Den Bergh, P, Bürmann, J, Busby, M, Casasnovas, C, Cornblath, DR, Davidson, A, Doets, AY, Van Doorn, PA, Dornonville De La Cour, C, Feasby, TE, Fehmi, J, Garcia-Sobrino, T, Goldstein, JM, Gorson, KC, Granit, V, Hadden, RDM, Harbo, T, Hartung, HP, Hasan, I, Holbech, JV, Holt, JKL, Jahan, I, Islam, Z, Karafiath, S, Katzberg, HD, Kleyweg, RP, Kolb, N, Kuitwaard, K, Kuwahara, M, Kusunoki, S, Luijten, LWG, Kuwabara, S, Lee Pan, E, Lehmann, HC, Maas, M, Martín-Aguilar, L, Miller, JAL, Mohammad, QD, Monges, S, Nedkova-Hristova, V, Nobile-Orazio, E, Pardo, J, Pereon, Y, Querol, L, Reisin, R, Van Rijs, W, Rinaldi, S, Roberts, RC, Roodbol, J, Shahrizaila, N, Sindrup, SH, Stein, B, Cheng-Yin, T, Tankisi, H, Tio-Gillen, AP, Sedano Tous, MJ, Verboon, C, Vermeij, FH, Visser, LH, Huizinga, R, Willison, HJ & Jacobs, BC 2022, 'An International Perspective on Preceding Infections in Guillain-Barré Syndrome: The IGOS-1000 Cohort', Neurology, vol. 99, no. 12, pp. E1299-E1313. https://doi.org/10.1212/WNL.0000000000200885

@article{9fa34031c4da49a291f5ea820c8a453c,

title = "An International Perspective on Preceding Infections in Guillain-Barr{\'e} Syndrome: The IGOS-1000 Cohort",

abstract = "Background and ObjectivesInfections play a key role in the development of Guillain-Barr{\'e} syndrome (GBS) and have been associated with specific clinical features and disease severity. The clinical variation of GBS across geographical regions has been suggested to be related to differences in the distribution of preceding infections, but this has not been studied on a large scale.MethodsWe analyzed the first 1,000 patients included in the International GBS Outcome Study with available biosamples (n = 768) for the presence of a recent infection with Campylobacter jejuni, hepatitis E virus, Mycoplasma pneumoniae, cytomegalovirus, and Epstein-Barr virus.ResultsSerologic evidence of a recent infection with C. jejuni was found in 228 (30%), M. pneumoniae in 77 (10%), hepatitis E virus in 23 (3%), cytomegalovirus in 30 (4%), and Epstein-Barr virus in 7 (1%) patients. Evidence of more than 1 recent infection was found in 49 (6%) of these patients. Symptoms of antecedent infections were reported in 556 patients (72%), and this proportion did not significantly differ between those testing positive or negative for a recent infection. The proportions of infections were similar across continents. The sensorimotor variant and the demyelinating electrophysiologic subtype were most frequent across all infection groups, although proportions were significantly higher in patients with a cytomegalovirus and significantly lower in those with a C. jejuni infection. C. jejuni-positive patients were more severely affected, indicated by a lower Medical Research Council sum score at nadir (p = 0.004) and a longer time to regain the ability to walk independently (p = 0.005). The pure motor variant and axonal electrophysiologic subtype were more frequent in Asian compared with American or European C. jejuni-positive patients (p < 0.001, resp. p = 0.001). Time to nadir was longer in the cytomegalovirus-positive patients (p = 0.004).DiscussionAcross geographical regions, the distribution of infections was similar, but the association between infection and clinical phenotype differed. A mismatch between symptom reporting and serologic results and the high frequency of coinfections demonstrate the importance of broad serologic testing in identifying the most likely infectious trigger. The association between infections and outcome indicates their value for future prognostic models.",

author = "Leonhard, {Sonja E.} and {Van Der Eijk}, {Annemiek A.} and Henning Andersen and Giovanni Antonini and Samuel Arends and Shahram Attarian and Barroso, {Fabio A.} and Bateman, {Kathleen J.} and Batstra, {Manou R.} and Luana Benedetti and {Van Den Berg}, Bianca and {Van Den Bergh}, Peter and Jan B{\"u}rmann and Mark Busby and Carlos Casasnovas and Cornblath, {David R.} and Amy Davidson and Doets, {Alex Y.} and {Van Doorn}, {Pieter A.} and {Dornonville De La Cour}, Charlotte and Feasby, {Thomas E.} and Janev Fehmi and Tania Garcia-Sobrino and Goldstein, {Jonathan M.} and Gorson, {Kenneth C.} and Volkan Granit and Hadden, {Robert D.M.} and Thomas Harbo and Hartung, {Hans Peter} and Imran Hasan and Holbech, {Jakob V.} and Holt, {James K.L.} and Israt Jahan and Zhahirul Islam and Summer Karafiath and Katzberg, {Hans D.} and Kleyweg, {Ruud P.} and Noah Kolb and Krista Kuitwaard and Motoi Kuwahara and Susumu Kusunoki and Luijten, {Linda W.G.} and Satoshi Kuwabara and {Lee Pan}, Edward and Lehmann, {Helmar C.} and Marijke Maas and Lorena Mart{\'i}n-Aguilar and Miller, {James A.L.} and Mohammad, {Quazi Deen} and Soledad Monges and Velina Nedkova-Hristova and Eduardo Nobile-Orazio and Julio Pardo and Yann Pereon and Luis Querol and Ricardo Reisin and {Van Rijs}, Wouter and Simon Rinaldi and Roberts, {Rhys C.} and Joyce Roodbol and Nortina Shahrizaila and Sindrup, {S{\o}ren Hein} and Beth Stein and Tan Cheng-Yin and Hatice Tankisi and Tio-Gillen, {Anne P.} and {Sedano Tous}, {Mar{\'i}a J.} and Christine Verboon and Vermeij, {Frederique H.} and Visser, {Leo H.} and Ruth Huizinga and Willison, {Hugh J.} and Jacobs, {Bart C.}",

note = "Publisher Copyright: {\textcopyright} 2022 American Academy of Neurology.",

year = "2022",

month = sep,

day = "20",

doi = "10.1212/WNL.0000000000200885",

language = "English (US)",

volume = "99",

pages = "E1299--E1313",

journal = "Neurology",

issn = "0028-3878",

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TY - JOUR

T1 - An International Perspective on Preceding Infections in Guillain-Barré Syndrome

T2 - The IGOS-1000 Cohort

AU - Leonhard, Sonja E.

AU - Van Der Eijk, Annemiek A.

AU - Andersen, Henning

AU - Antonini, Giovanni

AU - Arends, Samuel

AU - Attarian, Shahram

AU - Barroso, Fabio A.

AU - Bateman, Kathleen J.

AU - Batstra, Manou R.

AU - Benedetti, Luana

AU - Van Den Berg, Bianca

AU - Van Den Bergh, Peter

AU - Bürmann, Jan

AU - Busby, Mark

AU - Casasnovas, Carlos

AU - Cornblath, David R.

AU - Davidson, Amy

AU - Doets, Alex Y.

AU - Van Doorn, Pieter A.

AU - Dornonville De La Cour, Charlotte

AU - Feasby, Thomas E.

AU - Fehmi, Janev

AU - Garcia-Sobrino, Tania

AU - Goldstein, Jonathan M.

AU - Gorson, Kenneth C.

AU - Granit, Volkan

AU - Hadden, Robert D.M.

AU - Harbo, Thomas

AU - Hartung, Hans Peter

AU - Hasan, Imran

AU - Holbech, Jakob V.

AU - Holt, James K.L.

AU - Jahan, Israt

AU - Islam, Zhahirul

AU - Karafiath, Summer

AU - Katzberg, Hans D.

AU - Kleyweg, Ruud P.

AU - Kolb, Noah

AU - Kuitwaard, Krista

AU - Kuwahara, Motoi

AU - Kusunoki, Susumu

AU - Luijten, Linda W.G.

AU - Kuwabara, Satoshi

AU - Lee Pan, Edward

AU - Lehmann, Helmar C.

AU - Maas, Marijke

AU - Martín-Aguilar, Lorena

AU - Miller, James A.L.

AU - Mohammad, Quazi Deen

AU - Monges, Soledad

AU - Nedkova-Hristova, Velina

AU - Nobile-Orazio, Eduardo

AU - Pardo, Julio

AU - Pereon, Yann

AU - Querol, Luis

AU - Reisin, Ricardo

AU - Van Rijs, Wouter

AU - Rinaldi, Simon

AU - Roberts, Rhys C.

AU - Roodbol, Joyce

AU - Shahrizaila, Nortina

AU - Sindrup, Søren Hein

AU - Stein, Beth

AU - Cheng-Yin, Tan

AU - Tankisi, Hatice

AU - Tio-Gillen, Anne P.

AU - Sedano Tous, María J.

AU - Verboon, Christine

AU - Vermeij, Frederique H.

AU - Visser, Leo H.

AU - Huizinga, Ruth

AU - Willison, Hugh J.

AU - Jacobs, Bart C.

PY - 2022/9/20

Y1 - 2022/9/20

N2 - Background and ObjectivesInfections play a key role in the development of Guillain-Barré syndrome (GBS) and have been associated with specific clinical features and disease severity. The clinical variation of GBS across geographical regions has been suggested to be related to differences in the distribution of preceding infections, but this has not been studied on a large scale.MethodsWe analyzed the first 1,000 patients included in the International GBS Outcome Study with available biosamples (n = 768) for the presence of a recent infection with Campylobacter jejuni, hepatitis E virus, Mycoplasma pneumoniae, cytomegalovirus, and Epstein-Barr virus.ResultsSerologic evidence of a recent infection with C. jejuni was found in 228 (30%), M. pneumoniae in 77 (10%), hepatitis E virus in 23 (3%), cytomegalovirus in 30 (4%), and Epstein-Barr virus in 7 (1%) patients. Evidence of more than 1 recent infection was found in 49 (6%) of these patients. Symptoms of antecedent infections were reported in 556 patients (72%), and this proportion did not significantly differ between those testing positive or negative for a recent infection. The proportions of infections were similar across continents. The sensorimotor variant and the demyelinating electrophysiologic subtype were most frequent across all infection groups, although proportions were significantly higher in patients with a cytomegalovirus and significantly lower in those with a C. jejuni infection. C. jejuni-positive patients were more severely affected, indicated by a lower Medical Research Council sum score at nadir (p = 0.004) and a longer time to regain the ability to walk independently (p = 0.005). The pure motor variant and axonal electrophysiologic subtype were more frequent in Asian compared with American or European C. jejuni-positive patients (p < 0.001, resp. p = 0.001). Time to nadir was longer in the cytomegalovirus-positive patients (p = 0.004).DiscussionAcross geographical regions, the distribution of infections was similar, but the association between infection and clinical phenotype differed. A mismatch between symptom reporting and serologic results and the high frequency of coinfections demonstrate the importance of broad serologic testing in identifying the most likely infectious trigger. The association between infections and outcome indicates their value for future prognostic models.

AB - Background and ObjectivesInfections play a key role in the development of Guillain-Barré syndrome (GBS) and have been associated with specific clinical features and disease severity. The clinical variation of GBS across geographical regions has been suggested to be related to differences in the distribution of preceding infections, but this has not been studied on a large scale.MethodsWe analyzed the first 1,000 patients included in the International GBS Outcome Study with available biosamples (n = 768) for the presence of a recent infection with Campylobacter jejuni, hepatitis E virus, Mycoplasma pneumoniae, cytomegalovirus, and Epstein-Barr virus.ResultsSerologic evidence of a recent infection with C. jejuni was found in 228 (30%), M. pneumoniae in 77 (10%), hepatitis E virus in 23 (3%), cytomegalovirus in 30 (4%), and Epstein-Barr virus in 7 (1%) patients. Evidence of more than 1 recent infection was found in 49 (6%) of these patients. Symptoms of antecedent infections were reported in 556 patients (72%), and this proportion did not significantly differ between those testing positive or negative for a recent infection. The proportions of infections were similar across continents. The sensorimotor variant and the demyelinating electrophysiologic subtype were most frequent across all infection groups, although proportions were significantly higher in patients with a cytomegalovirus and significantly lower in those with a C. jejuni infection. C. jejuni-positive patients were more severely affected, indicated by a lower Medical Research Council sum score at nadir (p = 0.004) and a longer time to regain the ability to walk independently (p = 0.005). The pure motor variant and axonal electrophysiologic subtype were more frequent in Asian compared with American or European C. jejuni-positive patients (p < 0.001, resp. p = 0.001). Time to nadir was longer in the cytomegalovirus-positive patients (p = 0.004).DiscussionAcross geographical regions, the distribution of infections was similar, but the association between infection and clinical phenotype differed. A mismatch between symptom reporting and serologic results and the high frequency of coinfections demonstrate the importance of broad serologic testing in identifying the most likely infectious trigger. The association between infections and outcome indicates their value for future prognostic models.

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U2 - 10.1212/WNL.0000000000200885

DO - 10.1212/WNL.0000000000200885

M3 - Article

C2 - 35981895

AN - SCOPUS:85140580632

SN - 0028-3878

VL - 99

SP - E1299-E1313

JO - Neurology

JF - Neurology

IS - 12

ER -

An International Perspective on Preceding Infections in Guillain-Barré Syndrome: The IGOS-1000 Cohort

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