Antecedent infections and vaccinations in chronic inflammatory demyelinating polyneuropathy: a European collaborative study

Yusuf A. Rajabally, Stojan Peric, Ivo Bozovic, Lay Khoon Loo, Aida Kalac, Aleksa Palibrk, Ivana Basta

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction/Aims: Chronic inflammatory demyelinating polyneuropathy (CIDP) may be rarely preceded by infection. A causative link remains unproven, in contrast to Guillain-Barré syndrome (GBS), which is commonly postinfectious with well-demonstrated pathophysiological mechanisms of molecular mimicry following Campylobacter jejuni enteritis. Uncommonly, infections are reported before the onset of CIDP. In this study we aimed to determine the frequency and characteristics of CIDP occurring after antecedent infections or vaccinations in two large European cohorts. 

Methods: We reviewed the records of 268 subjects with “definite” or “probable” CIDP from the Inflammatory Neuropathy Clinic, Birmingham, UK (129 subjects), and from the Serbian national CIDP database (139 subjects). 

Results: Twenty-five of 268 (9.3%) subjects had a respiratory or gastrointestinal infection in the 6 weeks preceding CIDP onset, and 3 of 268 (1.1%) had received an influenza vaccination. CIDP disease onset occurred at a younger age (mean [standard deviation], 44.25 [17.36] years vs 54.05 [15.19] years; P <.005) and acute-onset CIDP was more common (42.9% vs 12.1%; odds ratio, 5.46; 95% confidence interval, 2.35-12.68; P <.001) in subjects with preceding infections or vaccinations. No differences in CIDP subtype, rates of cerebrospinal fluid protein level elevation, disability, or likelihood of treatment response, were observed. 

Discussion: Antecedent infections or vaccinations may precede about 10% of cases of CIDP and are more common in younger subjects. Acute-onset CIDP is more frequent after antecedent events. These findings may suggest specific pathophysiological mechanisms in such cases.

Original languageEnglish
JournalMuscle and Nerve
Early online date15 Jul 2021
DOIs
Publication statusE-pub ahead of print - 15 Jul 2021

Bibliographical note

This is the peer reviewed version of the following article: Rajabally, Y.A., Peric, S., Bozovic, I., Loo, L.K., Kalac, A., Palibrk, A. and Basta, I. (2021), Antecedent infections and vaccinations in chronic inflammatory demyelinating polyneuropathy: a European collaborative study. Muscle & Nerve. Accepted Author Manuscript., which has been published in final form at https://doi.org/10.1002/mus.27374. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for self-archiving.

Keywords

  • acute‐onset
  • chronic inflammatory demyelinating polyneuropathy
  • gastrointestinal
  • infection
  • respiratory
  • vaccination
  • acute onset

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