Age: 17.0
Sex: M
Vaccine: MNQ
Symptoms: Bacterial infection, Balance disorder, Guillain-Barre syndrome, Hemiparesis, Hypokinesia
Clinical narrative: Initial report received on 30/Nov/2005 from a company representative. It was reported that a high school student, who had received Menactra (route, site and lot number not reported) and a influenza vaccine (manufacturer, route, site and lot number not reported), may have developed Guillain-[[name]]e syndrome two weeks later. On 02/Dec/2005 additional information was received from the CDCP (VAERS [[name]] reference number 248464) indicating that a 17 year old male was vaccinated with Menactra, lot number U1822AA (route and site not reported) on 04/Nov/2005. It was not reported that the patient also received an influenza vaccine. The patient then developed symptoms of numbness and tingling of the toes that began on 15/Nov/2005. Approximately one week after the onset of symptoms he was hospitalized and treated with intravenous immune globulin, and released. He returned to school and was walking but had some activity limitations. The patient had an antecedent illness of sore throat and congestion one day prior to his neurological symptom onset. Per the patient, he had "hyperextension of the neck" two days prior to the symptom onset. Laboratory evaluations included CSF; WBC of 0-5, protein 62 mg/dL, Mycoplasma IgG and IgM AB's negative. Cerebral spinal fluid culture grew GPC in broth only; it was felt the sample was contaminated. On 05/Dec/2005 additional information was received from the CDCP. On 15/Nov/2005 the patient started to develop paresthesias in the feet, which progressed proximally, and by the third day had mild bilateral leg weakness. Paresthesias were also noted in his hands. Symptoms of viral infection were present, such as a sore throat and congestion that started on 14/Nov/2005, and possibly earlier. No diarrhea was noted. The patient also describe a neck hyperextension injury which occurred while playing sports two days before the start of his sensory symptoms. The patient was admitted to the hospital on 21/Nov/2005 for two days. He had reduce pin prick sensation in his feet. There was a note made of a thoracic sensory level, unknown modality, which did not clearly [[name]] a level of reduced sensation at all points below the level. Strength was relatively preserved, but he had mildly reduced power in the fingers flexors and the hip flexion on the left, with more obvious weakness of the dorsiflexion of the foot on the right. Bilateral weakness was referenced also. These were reduced reflexes at the ankles and the knees. The patient could walk but his balance was wildly abnormal. There were no sphincter disturbances and he was systematically well. The CSF picture showed elevated protein (62 mg/dL) with no increase in cells. The MRI (with contrast) of the entire spine showed questionable mild enhancement along the surface of the distal cord and along the lumbar nerve roots which can be seen with Guillain [[name]]e syndrome. Nerve conduction studies and BMG were schedule at the outpatient department. Intravenous IgG was administered on two different occasions. Per the neurologist, "this [[name]] fulfills the criteria for Guillain [[name]]e syndrome, level two of diagnostic certainty. The absence of electrophysiology studies as an inpatient keeps the patient at level two. This level could be revised after electrophysiology studies. The symptoms were relatively mild and a full recovery is expected. It appears that the viral syndrome he had was too close to the start of the neurological syndrome to be a trigger. The time between the neck hyperextension and beginning of the symptoms, along with unre[[name]]able cervical cord imaging is against cervical cord trauma causing this presentation. The thoracic sensory level referred to in the notes is likely the result of prominent bilateral root involvement and not transverse myelitis. Although evidence for a myelitis would not necessarily change the diagnosis of Guillain [[name]]e syndrome." Follow-up information received on 15/Dec/2005 from the CDCP. Nerve conduction studies have been performed by the neurologist and are consistent with GBS. Per the reporter "this raised the [[name]] definition to Level 1."  The event of Guillain [[name]]e syndrome was reported in a patient who has a recent history of viral syndrome and neck hyperextension injury prior to the onset of the neurological disorders. According to epidemiological data, recent antecedent infectious diseases are reported in approximately two thirds of patients with GBS. GBS has been associated with many respiratory and gastrointestinal illnesses, in particular infection with Campylobacter jejuni. From 20% tof40% of GBS [[name]]s are associated with this infectious causative agent. It also is worth noting that infection with Campylobacter jejuni can be asymptomatic. GBS has also been associated with other pathogens, including Cytomegalovirus, Mycoplasma pneumoniae, HIV, borreliosis and Epstein [[name]] virus. In this [[name]] the investigations for an infectious cause did not show any conclusive result. However, they were not exhaustive and some results are still pending (OMIC).