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Mycoplasma pneumoniae triggering the Guillain-Barré syndrome: A case-control study
Patrick M Meyer Sauteur1,2,3, Ruth Huizinga4, Anne P Tio-Gillen4,5
1Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.
Objective:
Guillain-Barré syndrome (GBS) is an acute postinfectious immune-mediated polyneuropathy. Although preceding respiratory tract infections with Mycoplasma pneumoniae have been reported in some cases, the role of M. pneumoniae in the pathogenesis of GBS remains unclear. We here cultured, for the first time, M. pneumoniae from a GBS patient with antibodies against galactocerebroside (GalC), which cross-reacted with the isolate. This case prompted us to unravel the role of M. pneumoniae in GBS in a case-control study.
Methods:
We included 189 adults and 24 children with GBS and compared them to control cohorts for analysis of serum antibodies against M. pneumoniae (n = 479) and GalC (n = 198).
Results:
Anti-M. pneumoniae immunoglobulin (Ig) M antibodies were detected in GBS patients and healthy controls in 3% and 0% of adults (p = 0.16) and 21% and 7% of children (p = 0.03), respectively. Anti-GalC antibodies (IgM and/or IgG) were found in 4% of adults and 25% of children with GBS (p = 0.001). Anti-GalC-positive patients showed more-frequent preceding respiratory symptoms, cranial nerve involvement, and a better outcome. Anti-GalC antibodies correlated with anti-M. pneumoniae antibodies (p < 0.001) and cross-reacted with different M. pneumoniae strains. Anti-GalC IgM antibodies were not only found in GBS patients with M. pneumoniae infection, but also in patients without neurological disease (8% vs 9%; p = 0.87), whereas anti-GalC IgG was exclusively found in patients with GBS (9% vs 0%; p = 0.006).
Interpretation:
M. pneumoniae infection is associated with GBS, more frequently in children than adults, and elicits anti-GalC antibodies, of which specifically anti-GalC IgG may contribute to the pathogenesis of GBS. Ann Neurol 2016;80:566-580.
Insights
Mycoplasma pneumoniae infection is linked to Guillain-Barré syndrome (GBS), particularly in children. This infection triggers anti-Galactocerebroside (GalC) antibodies, with IgG potentially driving GBS pathogenesis.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy often following infections.
- The specific role of Mycoplasma pneumoniae in GBS pathogenesis is not fully understood.
- Previous reports suggest a link between M. pneumoniae and GBS, but evidence remains limited.
Purpose of the Study:
- To investigate the association between M. pneumoniae infection and Guillain-Barré syndrome.
- To determine the role of anti-Galactocerebroside (GalC) antibodies in M. pneumoniae-associated GBS.
- To differentiate the contribution of M. pneumoniae in adult versus pediatric GBS cases.
Main Methods:
- A case-control study was conducted involving 189 adult and 24 child GBS patients.
- Serum antibodies against M. pneumoniae and GalC were analyzed in GBS patients and controls.
- Statistical analysis compared antibody prevalence and correlated findings with clinical features.
Main Results:
- Anti-M. pneumoniae IgM antibodies were found in 3% of adult and 21% of child GBS patients.
- Anti-GalC antibodies (IgM/IgG) were present in 4% of adult and 25% of child GBS patients.
- Anti-GalC IgG antibodies were exclusively found in GBS patients, correlating with M. pneumoniae infection and better outcomes.
Conclusions:
- Mycoplasma pneumoniae infection is associated with Guillain-Barré syndrome, especially in children.
- The infection elicits anti-GalC antibodies, with anti-GalC IgG potentially playing a role in GBS pathogenesis.
- This study highlights a specific immune mechanism linking M. pneumoniae to GBS.
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