Could Lyme disease be another infection associated with the onset of Guillain-Barre Syndrome?

Guillain-Barre Syndrome (GBS) is a life-threatening illness in which the body's immune system attacks the peripheral nervous system. It's characterized by a rapid onset of muscle weakness which can lead to respiratory distress and death. The initial symptoms are typically tingling and weakness in the feet and legs. The exact cause is unknown, but GBS is usually preceded by an infectious illness such as a respiratory infection or stomach flu. While many infections have been associated with GBS, Borrelia burgdorferi, the pathogen causing Lyme disease, has rarely been connected with the syndrome. According to a study by Patel and colleagues, only four cases have been reported in the literature. [1]

 

by Daniel J. Cameron, MD, MPH

However, in their case study Clinical association: Lyme disease and Guillain-Barre Syndrome, the authors highlight “Borrelia burgdorferi as an important antecedent infection associated with the development of GBS,” [1] and describe a 31-year-old man diagnosed with both Lyme disease and GBS. The case raises the question: Could Lyme disease be an underrecognized infectious disease triggering or contributing to the onset of Guillain-Barre Syndrome?

Eight months prior to admission, the man reported having a dime-sized lesion on his left arm. He later developed progressive numbness and weakness in both his hands and feet, along with areflexia. The numbness and burning in his feet progressed to his bilateral upper extremities, and he developed new weakness in all extremities. He also had blurry vision with decreased sensation and numbness in his tongue, and a right temporal headache that worsened with light and sound.

The exam revealed “decreased sensation to pinprick with a distal to proximal gradient up to proximal thigh,” according to Patel from SUNY Upstate Medical University, Syracuse, New York. “Other significant findings were 4/5 weakness in all extremities along with areflexia in biceps, triceps, patellar and achilles.”

Diagnostic testing revealed a mildly high white count of 12,800 WBC/μL, with mildly elevated ESR of 17 mm/h, a spinal tap revealing an elevated protein of 190 mg/dL, and pleocytosis of 10mm3. “An electromyography (EMG) was done showing absent F waves in bilateral tibial and peroneal motor responses consistent evidence of acute, acquired polyradiculoneuropathy with active denervation,” according to Patel. “A clinical picture with ascending neuropathy and EMG findings of isolated absence of F waves favor a diagnosis of GBS.”

A Lyme disease diagnosis was confirmed with immunoblots positive for IgM p23 and p41, as well as IgG p18, p23, p30, p39 and p41. Elevated protein and pleocytosis have been described in neurologic Lyme disease. [2]

The EMG findings, clinical picture and laboratory results were compatible with a diagnosis of Lyme disease and GBS. And the man was prescribed a combination of intravenous immunoglobulin 0.4 g/kg daily, plasma exchange therapy, and intravenous ceftriaxone 2 g. daily. Within 7 days, his symptoms had resolved.

Guillain-Barre Syndrome, the authors point out, “is an immune-mediated polyneuropathy characterized by acute, generalized, ascending peripheral neuropathic weakness with demyelination being the main electrophysiological and pathological feature.” [1] Lyme disease is also associated with demyelination [2] and immune-mediated.

“The actual mechanism between the relationship of GBS and Lyme disease remains unclear,” explains Patel. “However, there is evidence of immune responses associated with tick-borne pathogens. It is possible that these immune complexes in some individuals result in the development of antiganglioside antibodies causing GBS.”

 

References:

  1. Patel K, Shah S, Subedi D. Clinical association: Lyme disease and Guillain-Barre syndrome. Am J Emerg Med. 2017.
  2. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-1444.

 


8 Replies to "Could Lyme disease be another infection associated with the onset of Guillain-Barre Syndrome?"

  • Yvonne
    07/30/2017 (1:10 am)
    Reply

    Hallo

    Ik heb in mijn overtuiging een Guillian Baree syndroom gehad in 2006. Ik had toen al 8 jaar de ziekte van Lyme!
    De spoedopname die de huisarts stond te regelen, kon niet doorgaan door bizarre omstandigheden. Ik heb in 2016 voor het eerst allerlei antigliosiden laten testen en de specifieke van een Guillian Barree syndroom, waren een tiende meer verhoogd, dan de andere!!!! Nu 11 jaar later, nog steeds de ziekte van Lyme en al de uiteenlopende klachten worden nog steeds verkeerd gediagnosticeerd en de bron word vergeten!

    • Dr. Daniel Cameron
      07/30/2017 (12:36 pm)
      Reply

      Google translation interprets the Dutch comments as:
      I have had a Guillian Baree syndrome in 2006. I had Lyme’s disease for 8 years now!
      The speed uptake that the GP was able to control could not continue through bizarre circumstances. I first tested all kinds of antigliosides in 2016 and the specifics of a Guillian Barree syndrome were one tenth more elevated than the other !!!! Now 11 years later, Lyme’s disease and all the various complaints are still misdiagnosed and the source is forgotten!

      Thanks for sharing the question.

  • samuel
    07/30/2017 (2:47 am)
    Reply

    perhaps “frozen shoulder” as well.

    • Dr. Daniel Cameron
      07/30/2017 (12:38 pm)
      Reply

      Bursitis and synovitis are common place in tick borne illnesses. I am not familiar with any other research on the subject.

  • David R Thomas
    07/30/2017 (1:48 pm)
    Reply

    Hello,
    I am responding to this great thought process By Dr. Cameron because I know and am close enough to somebody that has experienced the wrath that GBS can unleash. I am also a Lyme disease advocate. Through my years of studying and listening. I am finding that Flu shots given to possible Lyme infected people may trigger a GBS autoimmune attack. This person also a diagnosed RA sufferer, Knee and leg issue sufferer, nerve and I am sure Peripheral nerve issues. The subject went paralyzed for sometime and was tested with protocol testing and as usual. Came back as read negative for Lyme disease on the protocol test. Which means nothing because I didn’t see the tests and they are basically junk tests for Late stage testing anyway. This person went on to a prestigious Non Lyme Literate Hospital and received numerous Blood washes and slowly came out of the experience and now manages the days with out a Lyme diagnosis. But I am sure there is Tick related issues in this subject. But subject refuses to talk about it. I believe the blood wash helped, but I am no longer close enough to observe. I presume the subject is doing well for what it is.
    Thank you Dr. Cameron for striking this response.
    David R Thomas
    Lyme Advocate

    • Dr. Daniel Cameron
      07/30/2017 (2:44 pm)
      Reply

      There are certainly questions that have not been resolved.

  • Lynne Hatfield
    03/21/2018 (11:05 pm)
    Reply

    Sir:
    My husband has been suffering from several issues stemming from several sources so this may become a bit convoluted. In July of 2017 he became very ill from an infection he had that was not completely resolved by antibiotics. He went back to the doctor to receive more antibiotics which seemed to cure the infection by the end of July. Early in September he became ill again with a high fever and chills as well as diarrhea and vomiting for several days. He recovered from this without any doctor visits or antibiotics and felt it had resolved on it’s own. After a few weeks he began to have pain in his back and hip and tried to see our GP but was unable to get an appointment. He went to ER and the doctor felt he had sciatica and suggested a chiropractor. My husband had 12 sessions which proved to be of no benefit and during that time began to lose balance and have weakness in his left leg. Soon he was falling and needed a cane which did help for a while. His other leg had become weak during this time and soon he required a walker. In any case he saw a neurologist eventually who diagnosed GBS. Many blood tests later a Lyme test came up positive and so a lumbar puncture and an MRI were done and Lyme was definitely present. I should say that he never experienced the paralysis up into his lungs and although both legs were affected only one arm and hand were affected. He just went through a round of 30 days of antibiotics and the inflammation in his feet has subsided. He still has the numbness and bone pain in his legs and hand, and the right foot is still experiencing severe neurological shocks on a regular basis while his hand, arm and left leg have sporadic shocks. The right arm also occasionally receives them as well but it has been the least affected. I’ve left out some of the symptoms and issues that he has even now as my story would be much longer and involved but the main thing is that the doctors still aren’t positive this was just Lyme disease. We’ll find out more next month when we meet with some of the specialists he’s been to in the last 6 months. The biggest question for us is was this a case of Lyme disease mimicking GBS or did the Lyme trigger GBS? He never had the treatment for GBS but his symptoms are still present and really haven’t changed in the intensity of the pain he’s in. He has been taking 3000 mg of Gabapentin daily as well as 20 mg of Noretrypteline for the pain and it only allows him to sleep at night. Any information or input on this would be greatly appreciated as it’s been a long struggle for us and answers would be nice. Thanks
    Lynne H

    • Dr. Daniel Cameron
      03/22/2018 (2:56 am)
      Reply

      Your husband’s case is all to common. His course is severe enough to look at both Lyme disease and tick borne co-infections as well as Guillain-Barré syndrome (GBS). There are common symptoms of tick borne illness including feet pain. Some doctors focus on the feet pain calling it Plantar fasciitis. I encourage working with a range of consultation until you get your husband back.


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