Fisher syndrome associated with IgG anti-GQ 1b antibody following infection by a specific serotype of Campylobacter jejuni

Abstract

Objective The purpose of the study was to describe clinical and serologic features of Fisher syndrome associated with IgG anti-GQ 1b ganglioside antibody following Campylobacter jejuni enteritis. Design A clinical trial. Participants Four consecutive patients with Fisher syndrome were studied. Intervention Samples of sera from four patients were tested for reactivity to GQ 1b ganglioside by enzyme-linked immunosorbent assay (ELISA). Campylobacter jejuni strains isolated from samples of stool from three patients were serotyped by the method of Penner and Hennessy and that of Lior. Main outcome measures Serum IgG anti-GQ 1b antibody titer and serotypes of C. jejuni. Results Diplopia occurred 8 to 14 days after the onset of diarrhea. Campylobacter jejuni was isolated from samples of stool from all of the patients. ELISA revealed a high serum IgG anti-GQ 1b antibody titer for all four patients. Two patients had high serum titers of other antiganglioside antibodies frequently related to Guillain-Barré syndrome. These two patients developed limb weakness following the onset of ophthalmoplegia. The C. jejuni serotype was Penner’s serotype 2 for all three of the patients tested. Conclusions These findings suggest that C. jejuni, especially Penner’s serotype 2, enteritis could trigger development of Fisher syndrome associated with IgG anti-GQ 1b antibody.