Guillain-Barré syndrome and influenza virus infection.

Valérie Sivadon-Tardy (1, 2) , David Orlikowski (2, 3) , Raphaël Porcher (4, 5) , Tarek Sharshar (2, 3) , Marie-Christine Durand (2, 6) , Vincent Enouf (7, 8) , Flore Rozenberg (9, 10) , Christiane Caudie (11) , Djillali Annane (2, 3) , Sylvie van Der Werf (7, 8) , Pierre Lebon (9, 10) , Jean-Claude Raphaël (2, 3) , Jean-Louis Gaillard (1, 2) , Elyanne Gault (1, 2, 7, 8)

1 Laboratoire de Microbiologie
2 UVSQ - Université de Versailles Saint-Quentin-en-Yvelines
3 Service de Réanimation
4 Département de Biostatistique et Informatique Médicale
5 Biostatistique et épidemiologie clinique
6 Service de physiologie et d'explorations fonctionnelles [CHU Raymond-Poincaré]
7 Centre National de Référence de la Grippe (France Nord) - Centre Collaborateur de l'OMS Grippe et autres virus respiratoires (CNR - CCOMS)
8 Génétique Moléculaire des Virus Respiratoires
9 Laboratoire de Virologie
10 UPD5 Médecine - Université Paris Descartes - Faculté de Médecine
11 Fédération de Biologie

BACKGROUND: In Western countries, the cause of 60% of all Guillain-Barré syndrome (GBS) cases remains unidentified. The number of cases of unidentified cause peaks in winter, and these cases are commonly preceded by respiratory tract infection or influenza-like illness. We investigated the triggering role of influenza virus infection. METHODS: Of 405 patients with GBS who were admitted to a French reference center during 1996-2004, 234 had cases caused by an unidentified agent. We used time-series methods to study the correlation between the monthly incidence of such cases and influenza-like illnesses reported by the Sentinelles surveillance network. We analyzed anti-influenza antibodies using complement fixation testing and hemagglutination-inhibition assays. We studied etiological subgroups using Wilcoxon and Fisher's exact tests. RESULTS: We found a positive association between the monthly incidence of GBS caused by an unidentified agent and reported influenza-like illnesses. Of 73 patients whose cases occurred during periods in which there was a possible link to influenza, 10 (13.7%) had serological evidence of recent influenza A, and 4 (5.5%) had serological evidence of influenza B. Eight of 10 influenza A-related cases occurred during "major" influenza seasons, and antibodies specific to the current epidemic strain were found in 9 cases. Most patients with influenza A-related cases were aged < 65 years, and none had antiganglioside antibodies. Influenza-related cases differed both from Campylobacter jejuni-related cases, with regard to the lack of need for mechanical ventilation (P = .014), and from the cases caused by an unidentified agent, with regard to the presence of preceding influenza-like illness or respiratory tract infection (P = .015) and longer time from the infectious event to GBS onset (P = .04). CONCLUSIONS: Influenza viruses are infrequent triggering agents of GBS but may play a significant role during major influenza outbreaks. Influenza-related GBS displays specific features and is not associated with antiganglioside antibody response, which suggests the presence of underlying immune mechanisms.

Domaines: Virologie

Valérie Sivadon-Tardy, David Orlikowski, Raphaël Porcher, Tarek Sharshar, Marie-Christine Durand, et al.. Guillain-Barré syndrome and influenza virus infection.. Clinical Infectious Diseases, 2009, 48 (1), pp.48-56. ⟨10.1086/594124⟩. ⟨pasteur-00379844⟩