Skip to main content
PMC home page
Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1979 Mar;9(3):305–316. doi: 10.1128/jcm.9.3.305-316.1979

Pleocytosis and immunoglobulin changes in cerebrospinal fluid and herpesvirus serology in patients with Guillain-Barré syndrome.

H Link, B Wahren, E Norrby
PMCID: PMC273021  PMID: 222797

Abstract

In a follow-up study of 24 patients with Guillain-Barré syndrome, 55% developed a cerebrospinal fluid (CSF) mononuclear pleocytosis, which persisted for 4 months or more. Raised index values of CSF-immunoglobulin G (IgG), CSF-IgA, and CSF-IgM, indicating synthesis of the immunoglobulin in question in the central nervous system, were found in 63, 35, and 25%, respectively. Agarose gel eletrophoresis revealed oligoclonal immunoglobulin in CSF in 21% and in both CSF and serum in another 21% of the patients. Twenty-five percent had abnormally low kappa/lambda ratios of CSF and/or serum, indicating synthesis of oligoclonal immunoglobulin, mainly of the lambda light-chain type. The inflammatory reaction in the central nervous system, as reflected by pleocytosis, immunoglobulin synthesis, and oligoclonal immunoglobulin, was not correlated to the severity or course of Guillain-Barré syndrome. A raised CSF-IgM index and oligoclonal immunoglobulin were found more often in the Guillain-Barré syndrome patients who displayed pleocytosis. All patients had or developed antibodies to Epstein-Barr virus. Three patients had serology indicating a primary infection, 11 patients had antibody changes indicating a reactivated infection, and 10 had serology indicating previous exposure. Two patients showed serological evidence for a primary cytomegalovirus infection, 2 had serology indicative of a reactivated infection, 12 had titers as caused by previous exposure, and 8 remained seronegative. Virus-specific IgM was measurable in all cases of primary infection. Neither primary or reactivated Epstein-Barr virus nor cytomegalovirus infections were obviously related to CSF pleocytosis.

Full text

PDF
311

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Biberfeld G., Biberfeld P., Wigzell H. Antibodies of surface antigens of lymphocytes and lymphoblastoid cells in cold-agglutinin-positive sera from patients with Mycoplasma pneumoniae infection. Scand J Immunol. 1976;5(1-2):87–95. doi: 10.1111/j.1365-3083.1976.tb02995.x. [DOI] [PubMed] [Google Scholar]
  2. Feorino P. M., Humphrey D. Mononucleosis-associated subacute sclerosing panencephalitis. Lancet. 1975 Sep 20;2(7934):530–532. doi: 10.1016/s0140-6736(75)90898-3. [DOI] [PubMed] [Google Scholar]
  3. Fryden A., Link H., Norrby E. Cerebrospinal fluid and serum immunoglobulins and antibody titers in mumps meningitis and aseptic meningitis of other etiology. Infect Immun. 1978 Sep;21(3):852–861. doi: 10.1128/iai.21.3.852-861.1978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Grose C., Feorino P. M. Epstein-Barr virus and transverse myelitis. Lancet. 1973 Apr 21;1(7808):892–892. doi: 10.1016/s0140-6736(73)91470-0. [DOI] [PubMed] [Google Scholar]
  5. Grose C., Henle W., Henle G., Feorino P. M. Primary Epstein-Barr-virus infections in acute neurologic diseases. N Engl J Med. 1975 Feb 20;292(8):392–395. doi: 10.1056/NEJM197502202920804. [DOI] [PubMed] [Google Scholar]
  6. Holt S., Khan M. M., Charles R. G., Epstein E. J. Polyradiculoneuritis and Mycoplasma pneumoniae infection. Postgrad Med J. 1977 Jul;53(621):416–418. doi: 10.1136/pgmj.53.621.416. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. KNOX J. D., LEVY R., SIMPSON J. A. Herpes zoster and the Landry-Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 1961 May;24:167–172. doi: 10.1136/jnnp.24.2.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Klemola E., Weckman N., Haltia K., Käriäinen L. The Guillain-Barré syndrome associated with acquired cytomegalovirus infection. Acta Med Scand. 1967 May;181(5):603–607. doi: 10.1111/j.0954-6820.1967.tb07283.x. [DOI] [PubMed] [Google Scholar]
  9. LOWRY O. H., ROSEBROUGH N. J., FARR A. L., RANDALL R. J. Protein measurement with the Folin phenol reagent. J Biol Chem. 1951 Nov;193(1):265–275. [PubMed] [Google Scholar]
  10. Link H. Comparison of electrophoresis on agar gel and agarose gel in the evaluation of gamma-globulin abnormalities in cerebrospinal fluid and serum in multiple sclerosis. Clin Chim Acta. 1973 Jul 27;46(4):383–390. doi: 10.1016/0009-8981(73)90251-9. [DOI] [PubMed] [Google Scholar]
  11. Link H. Demonstration of oligoclonal immunoglobulin G IN Guillain-Barré syndrome. Acta Neurol Scand. 1975 Aug;52(2):111–120. doi: 10.1111/j.1600-0404.1975.tb05765.x. [DOI] [PubMed] [Google Scholar]
  12. Link H. Immunoglobulin abnormalities in the Guillain-Barré syndrome. J Neurol Sci. 1973 Jan;18(1):11–23. doi: 10.1016/0022-510x(73)90017-8. [DOI] [PubMed] [Google Scholar]
  13. Link H., Müller R. Immunoglobulins in multiple sclerosis and infections of the nervous system. Arch Neurol. 1971 Oct;25(4):326–344. doi: 10.1001/archneur.1971.00490040052007. [DOI] [PubMed] [Google Scholar]
  14. Link H., Panelius M., Salmi A. A. Immunoglobulins and measles antibodies in subacute sclerosing panencephalitis. Arch Neurol. 1973 Jan;28(1):23–30. doi: 10.1001/archneur.1973.00490190041004. [DOI] [PubMed] [Google Scholar]
  15. Link H., Tibbling G. Principles of albumin and IgG analyses in neurological disorders. II. Relation of the concentration of the proteins in serum and cerebrospinal fluid. Scand J Clin Lab Invest. 1977 Sep;37(5):391–396. doi: 10.1080/00365517709091497. [DOI] [PubMed] [Google Scholar]
  16. Link H., Tibbling G. Principles of albumin and IgG analyses in neurological disorders. III. Evaluation of IgG synthesis within the central nervous system in multiple sclerosis. Scand J Clin Lab Invest. 1977 Sep;37(5):397–401. doi: 10.1080/00365517709091498. [DOI] [PubMed] [Google Scholar]
  17. Link H., Zettervall O., Blennow G. Individual cerebrospinal fluid (CSF) proteins in the evaluation of increased CSF total protein. Z Neurol. 1972;203(2):119–132. doi: 10.1007/BF00316040. [DOI] [PubMed] [Google Scholar]
  18. Link H., Zettervall O. Multiple sclerosis: disturbed kappa: lambda chain ratio of immunoglobulin G in cerebrospinal fluid. Clin Exp Immunol. 1970 Mar;6(3):435–438. [PMC free article] [PubMed] [Google Scholar]
  19. Masucci E. F., Kurtzke J. F. Diagnostic criteria for the Guillain-Barré syndrome. An analysis of 50 cases. J Neurol Sci. 1971 Aug;13(4):483–501. doi: 10.1016/0022-510x(71)90010-4. [DOI] [PubMed] [Google Scholar]
  20. Nikoskelainen J., Leikola J., Klemola E. IgM antibodies specific for Epstein-Barr virus in infectious mononucleosis without heterophil antibodies. Br Med J. 1974 Oct 12;4(5936):72–75. doi: 10.1136/bmj.4.5936.72. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Norrby E., Link H., Olsson J. E. Measles virus antibodies in multiple sclerosis. Comparison of antibody titers in cerebrospinal fluid and serum. Arch Neurol. 1974 Apr;30(4):285–292. doi: 10.1001/archneur.1974.00490340013002. [DOI] [PubMed] [Google Scholar]
  22. Norrby E. Viral antibodies in multiple sclerosis. Prog Med Virol. 1978;24:1–39. [PubMed] [Google Scholar]
  23. Osterwalder R., Benini A., Jung M. Zytomegalie-Virusinfektion und Guillain-Barré-Syndrom. Dtsch Med Wochenschr. 1973 Sep 28;98(39):1812–1813. doi: 10.1055/s-0028-1107134. [DOI] [PubMed] [Google Scholar]
  24. Phillips C. A., Fanning W. L., Gump D. W., Phillips C. F. Cytomegalovirus encephalitis in immunologically normal adults. Successful treatment with vidarabine. JAMA. 1977 Nov 21;238(21):2299–2300. [PubMed] [Google Scholar]
  25. Reedman B. M., Klein G. Cellular localization of an Epstein-Barr virus (EBV)-associated complement-fixing antigen in producer and non-producer lymphoblastoid cell lines. Int J Cancer. 1973 May;11(3):499–520. doi: 10.1002/ijc.2910110302. [DOI] [PubMed] [Google Scholar]
  26. Schmitz H., Enders G. Cytomegalovirus as a frequent cause of Guillain-Barré syndrome. J Med Virol. 1977;1(1):21–27. doi: 10.1002/jmv.1890010105. [DOI] [PubMed] [Google Scholar]
  27. Schmitz H., Scherer M. IgM antibodies to Epstein-Barr virus in infectious mononucleosis. Arch Gesamte Virusforsch. 1972;37(4):332–339. doi: 10.1007/BF01241456. [DOI] [PubMed] [Google Scholar]
  28. Sterner G., Agell B. O., Wahren B., Espmark A. Acquired cytomegalovirus infection in older children and adults. A clinical study of hospitalized patients. Scand J Infect Dis. 1970;2(2):95–103. doi: 10.3109/inf.1970.2.issue-2.04. [DOI] [PubMed] [Google Scholar]
  29. Tibbling G., Link H., Ohman S. Principles of albumin and IgG analyses in neurological disorders. I. Establishment of reference values. Scand J Clin Lab Invest. 1977 Sep;37(5):385–390. doi: 10.1080/00365517709091496. [DOI] [PubMed] [Google Scholar]
  30. Wahren B., Carlens E., Espmark A., Lundbeck H., Löfgren S., Madar E., Henle G., Henle W. Antibodies to various herpesviruses in sera from patients with sarcoidosis. J Natl Cancer Inst. 1971 Oct;47(4):747–755. [PubMed] [Google Scholar]
  31. Wahren B., Espmark A., Walldén G. Serological studies on cytomegalovirus infection in relation to infectious mononucleosis and similar conditions. Scand J Infect Dis. 1969;1(3):145–151. [PubMed] [Google Scholar]
  32. Wahren B., Link H. Antibodies to Epstein-Barr virus and cytomegalovirus in Guillain-Barre syndrome. J Neurol Sci. 1976 Jun;28(2):129–138. doi: 10.1016/0022-510x(76)90098-8. [DOI] [PubMed] [Google Scholar]
  33. Zivin I., Schwager V. A. The Guillain-Barre syndrome as a complication of varicella. Dis Nerv Syst. 1972 Nov;33(11):742–744. [PubMed] [Google Scholar]

Articles from Journal of Clinical Microbiology are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES