Guillain-Barré syndrome
From IDWiki
Background
Types
- Guillain-Barré syndrome
- Acute inflammatory demyelinating polyneuropathy (AIDP)
- Acute motor axonal neuropathy
- Acute motor-sensory axonal neuropathy
- Acute motor-conduction-block neuropathy
- Pharyngeal-cervical-branchial weakness
- Miller Fisher syndrome
- Incomplete MFS
- Acute motor-ophthalmoparesis, without ataxia
- Acute ataxic neyropathy, without ophthalmoparesis
- Bickerstaff's brainstem encephalitis
- Incomplete MFS
Etiology
- Campylobacter jejuni
- Cytomegalovirus, Haemophilus influenzae, Mycoplasma pneumoniae, Influenza, HIV
- Also COVID-19, Zika virus, EBV, HSV, VZV, Chikungunya, Escherichia coli, Japanese encephalitis virus
- Non-infectious causes
- Immunization
- Surgery, trauma
- Medications, including TNF-α inhibitors, tacrolimus, suramin, isotretinoin, and immune checkpoint inhibitors
- Hematopoietic stem cell transplantation
Pathophysiology
- Immune crossreactivity causes autoimmune destruction of either the myelin sheath (AIDP) or the axon itself
- Most common ADAM antibodies are anti-GM1 or anti-GD1a IgG, which recognize gangliosides
- Most common MFS antibody is anti-GQ1b IgG (in 90%)
Epidemiology
- About 1 case per 100,000 people per year in Western countries
Clinical Manifestations
- Ascending paralysis ± sensory involvement
- Usually occurs 1 to 2 weeks after an immune-stimulating even such as illness or vaccination
- Preceding illness usually a gastrointestinal or respiratory infection
- Campylobacter jejuni is the most common causative organism identified
- Rare following influenza vaccination; most notable was the 1976 H1N1 vaccine, with about 1 in 100,000 vaccine recipients developing GBS
Differential Diagnosis
- CIDP
- Thiamine deficiency
- Polyneuropathy, including acute arsenic poisoning and other toxin-induced peripheral polyneuropathy, Lyme disease, tick paralysis, vasculitis, sarcoidosis, porphyria
- Leptomeningeal lymphoma
- Paraneoplastic syndrome
- Spinal cord disorder
- Botulism, myasthenia gravis, Lambert-Eaton syndrome
- Acute polymyositis, dermatomyositis, necrotizing myopathy, critical illness neuropathy
Further Reading
- Guillain-Barré syndrome. Lancet. 2016;388:717-727. doi: 10.1016/S0140-6736(16)00339-1
