ABSTRACT
In Guillain-Barre syndrome [GBS] antibodies to GM1 and the presence of an antecedent Campylobacter jejuni [C jejuni] infection were correlated with a more severe course of the disease. Morever, C jejuni was reported as the most frequent antecedent infection in GBS. On the other hand, Epstein-Barr virus [EBV] was reported as a leading cause of GBS in children. Twenty five patients were studied in the acute phase and at convalescence and 15 normal children were taken as controls. Serum and CSF levels of the immunoglobulins G and M, and complement in addition to the serum levels of antibodies against the ganglioside GM1, C jejuni and EBV and CSF total protein [TP] were examined in patients and controls. Immunoglobulins and C3c and C4 were determined by single radial immunodiffusion technique, while the anti-GM 1 [GM1b and GM1 alpha and IgG and IgM], anti-C jejuni [IgA and IgG] and anti-EBV [IgG and 1gM] antibodies were measured by the ELISA technique. TP was estimated colorimetrically. Significant increases in serum IgM, IgG, C3c and C4 were found in patients at acute illness compared to the controls. In 15 patients at acute illness IgG was detected in the CSF, which was significantly higher than that of th controls. The sera of Twelve cases of them were positive for anti-C jejuni antibodies as well as IgG anti-GMI antibodies and they experienced a more severe course of illness. However, 8 patients at acute illness showed detectable 1gM in their CSF. Five of these patients were positive for 1gM anti-EBV. The sera of the remaining 3 cases were positive for anti-C jejuni antibodies as well as IgM anti-GMI antibodies. These patients ran a mild to moderately severe course of illness. Serum C3c and CSF TP levels were significantly higher in patients either with detectable CSF IgG or IgM than those of the controls, or when the two groups were compared. The incidence of positive serum anti-GM I antibodies is significantly higher in patients than that of controls. Furthermore, the incidence of anti-GM1b and GM1 alpha of the IgG and 1gM types, in particular IgGs is significantly higher in patients compared to controls. Serum 1gM anti-EBV antibodies were detected in 5 patients at acute illness and in none of the controls. However, a high incidence of serum IgG anti-EBV antibodies was detected in both patients and controls. In conclusion axonal cases of GBS which run a severe course have anti-GM 1I antibodies in their sera more frequently of the IgG type. However antecedent EBV infection is more often encountered in less severe cases of the disease in children in whom antiganglioside antibodies are less frequently found. The serum antigangliosides together with C3c levels might be used as biochemical markers for monitoring the disease