Infectious and noninfectious triggers in Guillain–Barré syndrome

Abstract

Guillain–Barré syndrome (GBS) is the commonest cause of acquired flaccid paralysis in the world and regarded by many as the prototype for postinfectious autoimmunity. Here the authors consider both infectious and noninfectious triggers of GBS and determine where possible what immunological mechanisms may account for this association. In approximately two-thirds of cases, an infectious trigger is reported in the weeks that lead up to disease onset, indicating that the host’s response to infection must play an important role in disease pathogenesis. The most frequently identified bacteria, Campylobacter jejuni, through a process known as molecular mimicry, has been shown to induce cross-reactive anti-ganglioside antibodies, which can lead to the development of axonal-type GBS in some patients. Whether this paradigm can be extended to other infectious organisms or vaccines remains an important area of research and has public health implications. GBS has also been reported rarely in patients with underlying systemic diseases and immunocompromised states and although the exact mechanism is yet to be established, increased susceptibility to known infectious triggers should be considered most likely.

Keywords::

• acute inflammatory demyelinating polyneuropathy
• acute motor axonal neuropathy
• Bickerstaff brainstem encephalitis
• Campylobacter jejuni
• Fisher syndrome
• Guillain–Barré syndrome
• molecular mimicry

Acknowledgements

Study concept and design: BR Wakerley; drafting of the manuscript: BR Wakerley; critical revision of the manuscript for important intellectual content: N Yuki; study supervision: N Yuki.

Financial & competing interests disclosure

This study was supported by the National Medical Research Council (IRG 10nov086 to N Yuki) in Singapore. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.