Abstract
IntroductionCampylobacter species represent the main cause of bacterial diarrhea in developed countries and one of the most frequent causes of enterocolitis in developing ones. In some patients, Campylobacter jejuni infection of the gastrointestinal tract has been observed as an antecedent illness of acute motor axonal neuropathy, a variant of Guillain-Barré syndrome.Case presentationWe present a case of acute motor axonal neuropathy following infection with Campylobacter jejuni subspecies jejuni, biotype II, heat stable serotype O:19. A 46-year-old Caucasian man developed acute motor neuropathy 10 days after mild intestinal infection. The proximal and distal muscle weakness of his upper and lower extremities was associated with serum antibodies to Campylobacter jejuni and antibodies to ganglioside GM1. The electromyographic signs of neuropathic muscle action potentials with almost normal nerve conduction velocities indicated axonal neuropathy. Our patient's clinical and electrophysiological features fulfilled criteria for the diagnosis of an acute motor axonal neuropathy, a subtype of Guillain-Barré syndrome.ConclusionAs this is the first case of acute motor axonal neuropathy following infection with Campylobacter jejuni subspecies jejuni reported from the Balkan area, the present findings indicate the need for systematic studies and further clinical, epidemiological and microbiological investigations on the prevalence of Campylobacter jejuni and its heat stable serotypes in the etiology of Guillain-Barré syndrome and other post-infectious sequelae.
Highlights
Campylobacter species represent the main cause of bacterial diarrhea in developed countries and one of the most frequent causes of enterocolitis in developing ones
As this is the first case of acute motor axonal neuropathy following infection with Campylobacter jejuni subspecies jejuni reported from the Balkan area, the present findings indicate the need for systematic studies and further clinical, epidemiological and microbiological investigations on the prevalence of Campylobacter jejuni and its heat stable serotypes in the etiology of Guillain-Barré syndrome and other post-infectious sequelae
The clinical entity ‘Guillain-Barré syndrome (GBS)’ can be divided into three forms: acute inflammatory demyelinating polyneuropathy (AIDP), which has as its main characteristic feature the macrophage-mediated demyelination of the peripheral nerves; axonal pattern, with axonal involvement, consisting of acute motor axonal neuropathy (AMAN); and rare acute motor-sensory axonal neuropathy (AMSAN)
Summary
Campylobacter jejuni enterocolitis was diagnosed in our patient with the AMAN form of GBS, suggesting a close association between the bacterial infection and the severe acute neuropathy, supporting the general hypothesis of cross-reactivity between bacteria and human peripheral neural tissue. After the administration of therapy including an antibacterial drug, our patient recovered fully despite the general poor prognosis in a case of campylobacter post-infectious sequelae. Besides neurological examinations, specific microbiological and immunological examinations are needed for etiological GBS diagnosis. As this is the first case of AMAN following infection with C. jejuni subspecies jejuni, reported from Serbia, further clinical, epidemiological and microbiological investigations on the prevalence of C. jejuni and its HS serotypes in the etiology of GBS and other post-infectious sequelae are warranted. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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