ギラン・バレー症候群と先行感染—日常診療のエッセンス

Antecedent Infections in Guillain-Barré Syndrome: Knowledge in Clinical Practice

ギラン・バレー症候群は軸索型と脱髄型の2つに大別されるが，これは表現型の違いに過ぎず，病態の上流にある先行感染ごとに分けて診療にあたる必要がある。個々の症例で先行感染を同定することが求められ，「先行感染」という用語は単に先行した感染症を指すのではなく，病態に関与したと考えられる感染症について用いるべきである。誤った先行感染の判断を避けるため，臨床の場で簡便に使用可能な先行感染同定の判断基準を提唱する。

Abstract

Guillain-Barré syndrome (GBS) is a post-infectious disease in which a diversity of pathogenetic factors and clinical features is surely determined by the type of preceding infections. It is necessary in clinical practice and research to identify the antecedent infectious agent in each case. Several lines of evidence indicate that the ganglioside-like epitopes on the infectious agents induce the production of anti-ganglioside autoantibodies and thereby cause GBS. This makes it possible to evaluate the causal significance of the pathogen by examining the cross-reactivity of the detected autoantibodies with outer antigens of the pathogens, although such an investigation is practical only when the pathogen is successfully isolated from the patients. The term "antecedent infection" should be strictly used in the situation in which the infection is thought to be closely related to the development of GBS but not for the situation without findings that suggest such a relationship. Simple but nonvalidated criteria for the judgment of antecedent infection in each GBS case are proposed in this review in order to prevent numerous and unreliable suspicions of "new" and "unknown" prior infectious agents of GBS, which are only built on the precedence in the disease.