Medicolegal investigation of Vibrio parahaemolyticus-related foodborne illness as the most probable cause of Guillain-Barré Syndrome

Abstract

Foodborne illness is a common cause of gastrointestinal symptoms, the majority of which are self-limiting and benign, although serious complications and sequelae occur in a minority of cases. Negligent or improper food processing, storage, and preparation are among the most prevalent risk factors for foodborne illness, and thus illnesses and outbreaks that occur in a public setting may become legally contested matters. The present case study provides the details of a medicolegal investigation into the cause of a case of Guillain-Barré Syndrome (GBS) that manifested shortly following a bout of foodborne illness. GBS is an immune-mediated neurological disorder that is most commonly associated with campylobacter-related foodborne illness. In the case study the unusually brief latency between the consumption of the contaminated food and the first symptoms indicating the onset of gastrointestinal illness (<3 h) ruled out campylobacter infection, which typically requires 12–24 h incubation time. An informal probabilistic analysis and process of elimination based on the type of food consumed (raw oysters) and the brevity of incubation time indicated that the most likely cause or trigger of the gastrointestinal illness that preceded the GBS was Vibrio parahaemolyticus. This is the first reported case of GBS associated with the consumption of raw oysters, or that has been attributed to a likely case of V. parahaemolyticus-related gastroenteritis. Keywords: Foodborne illness, Guillain-Barré Syndrome, Vibrio parahaemolyticus, Bayesian reasoning