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Patterns of Guillain-Barre syndrome in children: results from a Mexican population
I Nachamkin1, P Arzarte Barbosa, P Arzate Barbosa
1Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, 3400 Spruce Street, 4th Floor Gates Building, Philadelphia, PA 19104-4283, USA. nachamki@mail.med.upenn.edu
Insights
This study found that acute motor axonal neuropathy (AMAN) is a significant subtype of Guillain-Barré syndrome (GBS) in Mexican children, often linked to diarrhea and seasonal occurrences. This research highlights AMAN
Area of Science:
- Neurology
- Immunology
- Pediatrics
Background:
- Guillain-Barré syndrome (GBS) is an acute, immune-mediated paralysis with distinct subtypes.
- Acute inflammatory demyelinative polyneuropathy (AIDP) is common in Western countries, while acute motor axonal neuropathy (AMAN) predominates in Asia.
- Previous studies suggested AMAN occurs in Mexican children, necessitating further investigation.
Purpose of the Study:
- To describe the subtypes of Guillain-Barré syndrome (GBS) in children from Mexico City.
- To investigate the clinical and microbiological characteristics of GBS subtypes in Mexican pediatric patients.
Main Methods:
- Prospective study of 121 children admitted to two Mexico City pediatric hospitals (1996-2002).
- Clinical histories, electrophysiologic studies for GBS subtyping, and microbiologic analyses were conducted.
- Serologic testing for antibodies (anti-GM1, anti-GD1a, anti-GQ1b) and Campylobacter stool cultures were performed.
Main Results:
- Of 121 children, 46 had AMAN and 32 had AIDP.
- AMAN cases showed a strong seasonal distribution (July-September) and were associated with diarrhea.
- Higher IgG anti-GM1 and anti-GQ1b antibody titers were observed in AMAN patients compared to AIDP.
- Campylobacter jejuni was identified in stool cultures of 14 AMAN and 6 AIDP patients.
Conclusions:
- Acute motor axonal neuropathy (AMAN) is a significant Guillain-Barré syndrome subtype in Mexican children.
- AMAN in this population is associated with preceding diarrhea and exhibits seasonal patterns.
- The findings underscore regional variations in GBS epidemiology and pathophysiology.
Background:
Guillain-Barré syndrome (GBS) is an acute, immune-mediated flaccid paralysis frequently associated with Campylobacter infection. Of two predominant GBS subtypes, a demyelinating subtype (acute inflammatory demyelinative polyneuropathy [AIDP]) predominates in the United States and Europe, and axonal subtype (acute motor axonal neuropathy [AMAN]) is the predominant form in China. Previous clinical studies suggested that AMAN also occurs in Mexican children. The purpose of this study was to describe the subtypes of GBS in children from Mexico City.
Methods:
We prospectively studied 121 children admitted to two pediatric hospitals in Mexico City from 1996 to 2002. Clinical histories were obtained, electrophysiologic studies were performed to determine GBS subtype, and microbiologic studies were performed.
Results:
Of the 121 children, 46 had AMAN and 32 had AIDP. The male to female ratio was 1.3 for AMAN cases (mean age = 6.3) and 3.0 for AIDP cases (mean age = 7.0). There was a strong seasonal distribution of AMAN cases in July to September. Children with AMAN, but not AIDP, had worsening of illness during hospitalization as judged by peak severity scores. Vomiting was more likely in AIDP (28.1%) vs AMAN (6.5%) (p = 0.012) and diarrhea was more common in AMAN (32.6%) than AIDP (12.5%) (p = 0.06). IgG anti-GM1 antibody titers were higher in patients with AMAN vs AIDP (p = 0.067). Anti-GD1a antibodies were equally present in both groups. Anti GQ1b titers were higher in AMAN vs AIDP (p = 0.009). Campylobacter antibody responses were positive in 44.1% of patients with AMAN and 37.0% of patients with AIDP. Twenty patients (14 = AMAN, 6 = AIDP) had positive stool cultures for C jejuni. Two serotypes, HS:19 and HS:41, accounted for 6 of 10 Campylobacter isolates available for serotyping from these cases.
Conclusions:
This study confirms that acute motor axonal neuropathy is an important Guillain-Barré syndrome subtype in Mexican children, is associated with diarrhea, and occurs seasonally.
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