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Published Date: 2011-07-08 15:14:31
Subject: PRO/EDR> Guillain-Barre syndrome - Mexico (SO), USA (AZ) post-diarrhea
Archive Number: 20110708.2072

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[1] Mexico (Sonora)
[2] USA (Arizona)
[3] USA (Arizona): correction

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[1] Mexico (Sonora)
Date: Wed 22 Jun 2011
Source: SDP noticias, Notimex report [in Spanish, trans. & summ.,
edited]
http://sdpnoticias.com/nota/103036/Registran_16_casos_del_sindrome_de_Guillain_Barre_en_SLRC

On 22 Jun 2011, the state Public Health Secretariat (SSP) confirmed
another case of Guillain-Barre syndrome in the border city of San Luis
Rio Colorado, Sonora, Mexico, bringing the total to 16 patients seen
during recent weeks. The director of the SSP General Hospital in the
city, Sergio Kelly Berraza, said that the new patient was taken to a
hospital in Mexicali, Baja California.

"In total we have recorded 16 cases, including one hospitalized in
Mexicali, 4 recovering at home, and the rest fully recovered," said
Kelly Barraza. He explained that due to the presence of the disorder,
the health sector began a campaign to prevent diarrheal diseases among
the local population and reduced their incidence.

"Although cases of diarrhea have declined and with it the risk of
Guillain-Barre syndrome (GBS), health authorities will not let our
guard down," he said. He added that all patients in recent weeks who
showed symptoms of the syndrome, first had diarrhea.

--
communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

******
[2] USA (Arizona)
Date: Wed 22 Jun 2011
Source: Yuma SUn (Arizona) [edited]
http://www.yumasun.com/news/syndrome-70907-health-san.html

A diarrhea outbreak south of the border in San Luis Rio Colorado,
Sonora, Mexico, is being followed closely by officials at the Yuma
County Health Department, who are watching for a possible health
impact to Yuma area residents.

Over the weekend [18-19 Jun 2011], health officials in that border
city confirmed an increase in gastrointestinal illnesses with diarrhea
symptoms, which they are studying for a possible connection to
Guillain-Barre syndrome [GBS].

Benito Lopez, an epidemiologist at the county health department,
reported that the agency, in coordination with a statewide effort, is
studying recent cases of gastrointestinal illnesses in the Yuma area.
"We have no results yet, but we are very aware of the registered cases
and we are trying to determine what caused them. We are in constant
communication with the health sector in San Luis."

In San Luis Rio Colorado, Gustavo Lopez, the Sonora assistant
secretary of health, recommended not eating food from street vendors
and only eating where it is clear that food is hygienically and safely
prepared with water available for washing hands.

Yuma Regional Medical Center said the hospital is not aware of a
diarrhea outbreak or any cases of Guillain-Barre syndrome in the Yuma
area.

[byline: Cesar Neyoy]

--
communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

******
[3] USA (Arizona): correction
Date: 23 Jun 2011
Source: Yuma Sun [edited]
http://www.yumasun.com/news/story-70943-thursday-barr%C3%A9.html

A story in the Yuma Sun had some inaccurate information about Yuma
Regional Medical Center [YRMC].

According to Kaitlan Schick, corporate communications specialist with
YRMC, the hospital has seen some patients with symptoms of
Guillain-Barre syndrome, coming from both San Luis, Arizona, and San
Luis Rio Colorado, Sonora. However, the Yuma County Health Department
is tracking the actual number of cases in the county.

--
communicated by:
Ronan Kelly
for FluTrackers.com
<ronankelly@comcast.net>

[San Luis Rio Colorado in Sonora, Mexico and San Luis in the US state
of Arizona can be seen on the HealthMap/ProMED-mail interactive map at
http://healthmap.org/r/11ds. - Sr.Tech.Ed.MJ

ProMED-mail thanks Ronan Kelly of Flu Trackers for these reports.
This moderator apologizes to the readers for the delay in posting. The
2010 report cited in the "see alsos" was from the Veracruz state,
which is substantially separated from Sonora, which borders the USA.

Although not stated in the reports, _Campylobacter jejuni_ is the
likely cause of the diarrheal illnesses in this cluster of GBS. Since
the 1995 paper by Rees, et al (1), _C. jejuni_ was found to be
associated with GBS as recent campylobacteriosis was found in 26 per
cent of patients with GBS as compared to 1 per cent of matched
controls. Of note, the GBS cases associated with _C. jejuni_ were
significantly associated with the poorer outcome of slow recovery and
residual disability. Although no specific serotype of _C. jejuni_ was
linked to GBS in the study above, a subsequent paper (2) found that
serotype O:19 strains were overrepresented in USA and Germany cases of
GBS and these strains were likely to be serum-resistant.

Subsequently, it has been found that the pathophysiology of the
association was an example of antigenic mimicry (3). That is, the
lipooligosaccharide of certain _C. jejuni_ strains cross reacted with
human GM1 ganglioside and, in rabbits, anti-GM1 antibody was elicited
following _C. jejuni_ lipooligosaccharide and limb weakness developed.
More recently, Bax, et al (4) reported that differences in sialic acid
linkage of the bacterial saccharide produced different modulations of
the immune response which can explain why some organisms may be linked
to GBS and others not.

References
----------
1. Rees JH, Soudain SE, Gregson NA, Hughes RAC. _Campylobacter
jejuni_ infection and Guillain-Barre syndrome. N Engl J Med 1995;
333(21): 1374-9. Available at
http://www.nejm.org/doi/full/10.1056/NEJM199511233332102#t=article.
2. Allos BN, Lippy FT, Carlsen A, Washburn RG, Blaser MJ.
_Campylobacter jejuni_ strains from patients with Guillian-Barre
syndrome. Emerg Infect Dis 1998; 4(2): 263-8. Available at
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640125/.
3. Yuki N, Susuki K, Koga M, et al. Carbohydrate mimicry between
human ganglioside GM1 and _Campylobacter jejuni_ lipooligosaccharide
causes Guillain-Barre syndrome. Proc Natl Acad Sci USA 2004; 101(31):
11404-9. Available at
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC509213/.
4. Bax M, Kuijf ML, Heikema AP, et al: _Campylobacter jejuni_
lipooligosaccharides modulate dendritic cell-mediated T cell
polarization in a sialic acid linkage-dependent manner. Infect Immun
2011; 79(7): 2681-9. Abstract available at
http://www.ncbi.nlm.nih.gov/pubmed/21502591 - Mod.LL]

See Also