Review Question - QID 105015

This patient's symptoms are concerning for Guillain-barre syndrome (GBS). Campylobacter jejuni is the most frequently identified organism preceding GBS symptoms.

GBS is an acute acquired demyelinatng disease involving peripheral nerves, cranial nerves, and nerve roots. It is often preceded by a viral illness, bacterial illness, or vaccination. Symptoms usually evolve over the course of 1 to 2 weeks and classically include symmetrical ascending weakness and pain preceding weakness. Physical examination often elicits areflexia, sinus tachycardia (autonomic dysfunction), and various cranial nerve palsies.

Walling et al. discuss GBS. They describe GBS as a syndrome of progressive weakness and diminished or absent myotatic reflexes secondary to an aberrant immune response that attacks nerve tissues.The estimated annual incidence in the United States is 1.65 to 1.79 per 100,000 persons. Clinical features, cerebrospinal fluid testing (increased protein levels but a normal white blood cell count), and nerve conduction studies (slowed or blocked conduction) are all used for diagnosing this syndrome.

Nyati et al. discuss the role of C. jejuni infection in the pathogenesis of GBS. Most infections with C. jejuni are a result of acquisition through the consumption of raw or undercooked poultry, unpasteurized milk, or contaminated water. It is thought that there is molecular mimicry taking place between the sialylated lipooligosaccharide structures on the cell envelope of these bacteria and the ganglioside epitopes on the human nerves. This mimicry can then generate a cross-reactive immune response that results in autoimmune-driven nerve damage.

Illustration A demonstrates what happens when peripheral nerves are damaged in GBS. Illustration B depicts an image of the sources and transmission of C. jejuni. Illustration C is an image of C. jejuni.

Incorrect Answers:
Answer 1: Bacillus cereus is more often associated with generalized food poisoning following rice ingestion.
Answer 2: Although Staphylcoccus aureus is capable of causing gastroenteritis, it is not commonly associated with preceding GBS.
Answer 3: Streptococcus pneumoniae often can be associated with meningitis, otitis media, pneumonia, and sinusitis. It is however not commonly associated with gastroenteritis or with GBS.
Answer 5: Streptococcus viridans is often found as normal oral flora, and can be seen with dental caries and endocarditis.