Antecedent infections in Guillain-Barré syndrome in endemic areas of arbovirus transmission: A multinational case-control study

Sonja E. Leonhard, Cheng Yin Tan, Annemiek A. van der Eijk, Ricardo R. Reisin, Suzanne C. Franken, Ruth Huizinga, Samuel Arends, Manou R. Batstra, Selma M. Bezerra Jeronimo, Judith Drenthen, Laura de Koning, Luciana Leon Cejas, Cintia Marchesoni, Wilson Marques, Nortina Shahrizaila, Dardo F. Casas, Andrea Sotelo, Belen Tillard, Mario Emilio Dourado, Bart C. Jacobs*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Half of the world's population is at risk of arthropod-borne virus (arbovirus) infections. Several arbovirus infections have been associated with Guillain-Barré syndrome (GBS). We investigated whether arboviruses are driving GBS beyond epidemic phases of transmission and studied the antibody response to glycolipids. The protocol of the International Guillain-Barré syndrome Outcome Study (IGOS), an observational prospective cohort study, was adapted to a case-control design. Serum samples were tested for a recent infection with Zika virus (ZIKV), dengue virus (DENV), chikungunya (CHIKV) virus, hepatitis E virus, Epstein-Barr virus (EBV), cytomegalovirus (CMV), Campylobacter jejuni, and Mycoplasma pneumoniae, and for antibodies to glycolipids. Forty-nine patients were included from Brazil (63%), Argentina (14%), and Malaysia (22%). Evidence of a recent infection was found in 27/49 (55%) patients: C jejuni (n = 15, 31%), M pneumoniae (n = 5, 10%), CHIKV (n = 2, 4%), EBV (n = 1, 2%), C jejuni and M pneumoniae (n = 2, 4%), CMV and DENV (n = 1, 2%), and C jejuni and DENV (n = 1, 2%). In 22 patients, 35 paired controls were collected. Odds ratio for recent infections did not significantly differ between cases and controls. No typical anti-ganglioside antibody binding was associated with recent arbovirus infection. We conclude that arbovirus infections occur in GBS patients outside of epidemic viral transmission, although not significantly more than in controls. Broad infection and anti-ganglioside antibody serology are important to establish the most likely pathogenic trigger in GBS patients. Larger studies are necessary to determine the association between arboviruses and GBS.

Original languageEnglish
Pages (from-to)449-460
Number of pages12
JournalJournal of the Peripheral Nervous System
Issue number4
Early online date22 Sept 2021
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
The IGOS‐Zika project was funded by the European Union (Horizon 2020, ZikaPLAN Grant Agreement No. 734584). The automatic TLC sampler (ATS4) was funded via financial support from Stichting GBS. Funding information

Publisher Copyright:
© 2021 The Authors. Journal of the Peripheral Nervous System published by Wiley Periodicals LLC on behalf of Peripheral Nerve Society.


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