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Abedi Samakoush M, Davoodi L, Khademian M, Kargar-soleimanabad S, Abedini MA. New-onset chronic inflammatory demyelinating polyradiculoneuropathy after COVID-19 infection: a case report. Ann Med Surg (Lond) 2023; 85:5031-5034. [PMID: 37811109 PMCID: PMC10553086 DOI: 10.1097/ms9.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/12/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction and importance SARS-CoV-2 infection, besides respiratory symptoms, as cardinal manifestation, may present with neurological involvement. Immune-mediated polyradiculoneuropathy is one of the important neurological complications manifested by COVID-19 mainly includes Guillain-Barré syndrome (GBS), treatment-related fluctuation of GBS, and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Also, there are several reports of COVID-19 vaccine-related GBS and CIDP. According to possible severe manifestations of neuropathies like respiratory failure, considering these complications for early diagnosis and treatment is very important. Case presentation The authors presented a 67-year-old woman with severe weakness in upper and lower extremities, the patient was diagnosed as case with CIDP initiated after COVID-19 virus infection and/or vaccination that experienced one relapse in 11 months. In both episodes, treatment with intravenous immunoglobulin started and the patient respond. Clinical discussion To the best of our knowledge, this is one of the first reported cases with a typical chronic course of CIDP associated with COVID-19 virus infection and/or vaccination. Conclusion Considering this complication and differentiation between GBS and CIDP, and then initiating maintenance therapy can prevent long-term disability.
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Affiliation(s)
| | - Lotfollah Davoodi
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, and Department of Infectious Diseases
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Ruggiero R, Balzano N, Di Napoli R, Fraenza F, Pentella C, Riccardi C, Donniacuo M, Tesorone M, Danesi R, Del Re M, Rossi F, Capuano A. Do peripheral neuropathies differ among immune checkpoint inhibitors? Reports from the European post-marketing surveillance database in the past 10 years. Front Immunol 2023; 14:1134436. [PMID: 37006303 PMCID: PMC10060793 DOI: 10.3389/fimmu.2023.1134436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
Although the immunotherapy advent has revolutionized cancer treatment, it, unfortunately, does not spare cancer patients from possible immune-related adverse events (irAEs), which can also involve the peripheral nervous system. Immune checkpoint inhibitors (ICIs), blocking cytotoxic T-lymphocyteassociated protein 4 (CTLA-4), programmed cell death protein 1 (PD-1), or programmed cell death ligand 1 (PD-L1), can induce an immune imbalance and cause different peripheral neuropathies (PNs). Considering the wide range of PNs and their high impact on the safety and quality of life for cancer patients and the availability of large post-marketing surveillance databases, we chose to analyze the characteristics of ICI-related PNs reported as suspected drug reactions from 2010 to 2020 in the European real-world context. We analyzed data collected in the European pharmacovigilance database, Eudravigilance, and conducted a systematic and disproportionality analysis. In our study, we found 735 reports describing 766 PNs occurred in patients treated with ICIs. These PNs included Guillain-Barré syndrome, Miller-Fisher syndrome, neuritis, and chronic inflammatory demyelinating polyradiculoneuropathy. These ADRs were often serious, resulting in patient disability or hospitalization. Moreover, our disproportionality analysis revealed an increased reporting frequency of PNs with tezolizumab compared to other ICIs. Guillain-Barré syndrome is a notable potential PN related to ICIs, as it is associated with a significant impact on patient safety and has had unfavorable outcomes, including a fatal one. Continued monitoring of the safety profile of ICIs in real-life settings is necessary, especially considering the increased frequency of PNs associated with atezolizumab compared with other ICIs.
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Affiliation(s)
- Rosanna Ruggiero
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Nunzia Balzano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Raffaella Di Napoli
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Federica Fraenza
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
- *Correspondence: Federica Fraenza,
| | - Ciro Pentella
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Consiglia Riccardi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Maria Donniacuo
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | | | - Romano Danesi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Marzia Del Re
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Francesco Rossi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
- Department of Experimental Medicine – Section of Pharmacology “L. Donatelli”, University of Campania “L. Vanvitelli”, Naples, Italy
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Kolb N, Matiasek K, van Renen J, Fischer A, Zablotski Y, Wieländer F, Nessler J, Tipold A, Cappello R, Flegel T, Loderstedt S, Dietzel J, Gnirs K, Rentmeister K, Rupp S, von Klopmann T, Steffen F, Jurina K, Del Vecchio OV, Deutschland M, König F, Gandini G, Harcourt-Brown T, Kornberg M, Bianchi E, Gagliardo T, Menchetti M, Schenk H, Tabanez J, Rosati M. Biopsy Characteristics, Subtypes, and Prognostic Features in 107 Cases of Feline Presumed Immune-Mediated Polyneuropathy. Front Vet Sci 2022; 9:928309. [PMID: 35812863 PMCID: PMC9263917 DOI: 10.3389/fvets.2022.928309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Inflammatory polyradiculoneuropathy (IMPN) is one of the causes of sudden onset of neuromuscular signs such as para-/tetraparesis in young cats. Even though most cases have a favorable outcome, persistent deficits, relapses, and progressive courses are occasionally seen. As clinical presentation does not always appear to predict outcome and risk of recurrence, this study was initiated to screen for prognostic biopsy findings in a large cohort of histologically confirmed IMPN cases with clinical follow-up. In total, nerve and muscle specimens of 107 cats with biopsy diagnosis of presumed autoreactive inflammatory polyneuropathy and 22 control cases were reviewed by two blinded raters for a set of 36 histological parameters. To identify patterns and subtypes of IMPN, hierarchical k-means clustering of 33 histologic variables was performed. Then, the impact of histological parameters on IMPN outcome was evaluated via an univariate analysis to identify variables for the final multivariate model. The data on immediate outcome and follow-up were collected from submitting neurologists using a purpose-designed questionnaire. Hierarchical k-means clustering sorted the tissues into 4 main categories: cluster 1 (44/129) represents a purely inflammatory IMPN picture, whereas cluster 2 (47/129) was accompanied by demyelinating features and cluster 3 (16/129) by Wallerian degeneration. Cluster 4 (22/129) reflects normal tissues from non-neuropathic control cats. Returned questionnaires provided detailed information on outcome in 63 animals. They were categorized into recovered and non-recovered. Thereby, fiber-invasive infiltrates by mononuclear cells and mild fiber loss in intramuscular nerve branches correlated with higher probabilities of recovery. Remyelination in semithin sections, on the other hand, is correlated with a less favorable outcome. Animals grouping in cluster 1 had a tendency to a higher probability of recovery compared to other clusters. In conclusion, diagnosis of feline IMPN from nerve and muscle biopsies allowed for the identification of histologic features that were positively or negatively correlated with outcome.
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Affiliation(s)
- Ninja Kolb
- Section of Clinical and Comparative Neuropathology, Institute for Veterinary Pathology, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Kaspar Matiasek
- Clinic for Small Animal Medicine, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Jana van Renen
- Clinic for Small Animal Medicine, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Andrea Fischer
- Clinic for Small Animal Medicine, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Yury Zablotski
- Clinic for Ruminants With Ambulatory and Herd Health Services, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Franziska Wieländer
- Section of Clinical and Comparative Neuropathology, Institute for Veterinary Pathology, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Jasmin Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hanover, Hanover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hanover, Hanover, Germany
| | - Rodolfo Cappello
- North Downs Specialist Referrals, The Brewerstreet Dairy Business Park, Bletchingley, United Kingdom
| | - Thomas Flegel
- Small Animal Department, University of Leipzig, Leipzig, Germany
| | | | | | - Kirsten Gnirs
- Section of Neurology and Neurosurgery, Advetia Clinic for Small Animal Medicine, Paris, France
| | - Kai Rentmeister
- Specialty Practice for Veterinary Neurology and Neurosurgery, Dettelbach, Germany
| | | | | | - Frank Steffen
- Neurology Service, Department of Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | | | | | | | - Gualtiero Gandini
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Tom Harcourt-Brown
- Langford Veterinary Services, School of Veterinary Sciences, University of Bristol, Bristol, United Kingdom
| | | | - Ezio Bianchi
- Department of Veterinary Science, University of Parma, Parma, Italy
| | | | - Marika Menchetti
- Neurology and Neurosurgery Division, San Marco Veterinary Clinic, Veggiano, Italy
| | | | - Joana Tabanez
- Neurology Section, Fitzpatrick Referrals, Godalming, United Kingdom
| | - Marco Rosati
- Section of Clinical and Comparative Neuropathology, Institute for Veterinary Pathology, Center for Clinical Veterinary Medicine, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
- *Correspondence: Marco Rosati
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Thirouin J, Petiot P, Antoine JC, André-Obadia N, Convers P, Gavoille A, Bouhour F, Rheims S, Camdessanché JP. Usefulness and prognostic value of diagnostic tests in patients with possible chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve 2022; 66:304-311. [PMID: 35661382 DOI: 10.1002/mus.27655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 05/23/2022] [Accepted: 05/28/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION/AIMS Recent guidelines define chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and possible CIDP. The aims of our study were to evaluate the value of diagnostic tests to support the diagnosis of CIDP in patients with possible CIDP and to identify prognostic factors of therapeutic success. METHODS We conducted an observational retrospective two-center study between 2014 and 2019. We selected patients with a clinical presentation suggesting CIDP, but whose electrodiagnostic (EDX) test results did not meet the EFNS/PNS 2021 criteria. We analyzed epidemiologic and clinical features, axonal loss on EDX, cerebrospinal fluid (CSF), somatosensory evoked potentials (SSEPs), plexus magnetic resonance imaging (MRI), nerve biopsy, and therapeutic response. RESULTS We selected 75 patients, among whom 30 (40%) responded to treatment. The positivity rates of CSF analysis, MRI and SSEPs were not influenced by the clinical presentation or by the delay between symptom onset and medical assessment. A high protein level in CSF, female gender, and a relapsing-remitting course predicted the therapeutic response. DISCUSSION It is important to properly diagnose suspected CIDP not meeting EFNS/PNS 2021 EDX criteria by using supportive criteria. Specific epidemiological factors and a raised CSF protein level predict a response to treatment. Further prospective studies are needed to improve diagnosis and the prognostic value of diagnostic tests in CIDP.
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Affiliation(s)
- Jeanne Thirouin
- Department of Neurology, Centre Hospitalier de Valence, Valence, France
| | - Philippe Petiot
- Electroneuromyography and Neuromuscular Diseases Department, Centre Médicina, Lyon, France
| | | | - Nathalie André-Obadia
- Department of Functional Neurology and Epileptology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Philippe Convers
- Department of Neurology, University Hospital, Saint-Etienne, France
| | - Antoine Gavoille
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
| | - Françoise Bouhour
- Department of Neurology, Centre Hospitalier de Valence, Valence, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
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Syczewska M, Święcicka A, Szczerbik E, Kalinowska M, Dunin-Wąsowicz D, Łukowicz M. Types of gait deviations in children and adolescents with Guillain-Barre syndrome identified using cluster analysis. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Immune-mediated polyneuropathies are acquired conditions that can be categorized to acute and chronic forms based on the disease course. Although the basic mechanism of these conditions has not been clarified yet, genes that regulate immune responses are putative contributors in their development. In the current study, we assessed expression of signal transducer and activator of transcription (STAT)1-3 and STAT5a genes in peripheral blood of 51 patients and 40 healthy subjects. Expression of STAT1 was higher in female patients compared with female controls (Posterior Beta = 3.622, P = 0.044). The gender*group interaction was significant for this gene which indicates different direction of association in males and females. Expressions of other STAT genes were not different between cases and controls. The diagnostic power of STAT1 in female subjects was estimated to be 0.72 with sensitivity of 68.75% and specificity of 84.62%. There was no significant correlation either between expression of different STAT genes or between their expression and age of study participants. The current study potentiates STAT1 as a putative factor in the pathophysiology of acquired immune-mediated polyneuropathies in females and suggests conduction of further functional studies to elaborate the molecular mechanism of this contribution.
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Zhao Z, Zhang R, Gao X, Li H, Liu H. Altered serum levels of IL-36 cytokines (IL-36α, IL-36β, IL-36γ, and IL-36Ra) and their potential roles in Guillain-Barré syndrome. Medicine (Baltimore) 2020; 99:e23832. [PMID: 33350771 PMCID: PMC7769357 DOI: 10.1097/md.0000000000023832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute autoimmune neurological disorder mainly involving the peripheral nerves. Currently, various cytokines have been shown to be involved in the pathogenesis of GBS. Because of their similar biological structures, interleukin (IL)-36α, IL-36β, IL-36γ, and IL-36 receptor antagonist (Ra) were all renamed and collectively called IL-36 cytokines. The roles of IL-36 cytokines in GBS currently remain unclear.Forty-two patients with GBS and 32 healthy volunteers were included in our study. Serum IL-36α, β, γ, and interleukin-36 receptor antagonist (IL-36Ra) levels of patients with GBS in the acute and remission phases and healthy volunteers were measured by enzyme-linked immunosorbent assay (ELISA). In addition, we examined the serum levels of other inflammatory factors that have been shown to be involved in GBS pathogenesis, represented by IL-17 and tumor necrosis factor-α (TNF-α). Furthermore, the correlations between the serum levels of IL-36 cytokines and different clinical data or the serum levels of other inflammatory factors in GBS patients were analyzed.Significantly higher serum IL-36α and IL-36γ levels were measured in the acute phase than in the remission phase and in healthy control (HC) subjects (P < .05), while lower serum IL-36Ra levels were measured in the acute phase than in the remission phase and in HC subjects (P < .05). Serum IL-36α and IL-36γ levels were positively correlated with GBS disability scale scores (GDSs), while serum IL-36Ra levels were negatively correlated with GDSs. Correlation analyses among inflammatory factors showed that serum IL-36α and IL-36γ levels in GBS patients were positively correlated with serum IL-17 and TNF-α levels, while serum IL-36Ra levels were negatively correlated with the levels of these 2 inflammatory factors. Similar results were observed in cerebrospinal fluid (CSF), IL-36α and IL-36γ levels in CSF were positively correlated with GDSs, while IL-36Ra levels in CSF were negatively correlated with GDSs. Additionally, the serum and CSF levels of IL-36α and IL-36γ in the axonal subtype of GBS patients were higher than those in the demyelination subtype.Based on our findings, IL-36 cytokines may be involved in the pathogenesis of GBS and some of these cytokines may help predict the disease severity and other clinical characteristics of GBS.
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Affiliation(s)
| | | | - Xinxin Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hui Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hongbo Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Panganiban AT, Blair RV, Hattler JB, Bohannon DG, Bonaldo MC, Schouest B, Maness NJ, Kim WK. A Zika virus primary isolate induces neuroinflammation, compromises the blood-brain barrier and upregulates CXCL12 in adult macaques. Brain Pathol 2020; 30:1017-1027. [PMID: 32585067 DOI: 10.1111/bpa.12873] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/29/2020] [Accepted: 07/21/2020] [Indexed: 12/23/2022] Open
Abstract
Zika virus (ZIKV) is a flavivirus that can cause neuropathogenesis in adults and fetal neurologic malformation following the infection of pregnant women. We used a nonhuman primate model, the Indian-origin Rhesus macaque (IRM), to gain insight into virus-associated hallmarks of ZIKV-induced adult neuropathology. We find that the virus causes prevalent acute and chronic neuroinflammation and chronic disruption of the blood-brain barrier (BBB) in adult animals. ZIKV infection resulted in specific short- and long-term augmented expression of the chemokine CXCL12 in the central nervous system (CNS)of adult IRMs. Moreover, CXCL12 expression persists long after the initial viral infection is apparently cleared. CXCL12 plays a key role both in regulating lymphocyte trafficking through the BBB to the CNS and in mediating repair of damaged neural tissue including remyelination. Understanding how CXCL12 expression is controlled will likely be of central importance in the definition of ZIKV-associated neuropathology in adults.
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Affiliation(s)
- Antonito T Panganiban
- Division of Microbiology, Tulane National Primate Research Center, 18703 Three Rivers Road, Covington, LA, 70433, USA
| | - Robert V Blair
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, LA, 70433, USA
| | - Julian B Hattler
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, VA, 23507, USA
| | - Diana G Bohannon
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, VA, 23507, USA
| | - Myrna C Bonaldo
- Laboratory of Flavivirus Molecular Biology, Fiocruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Blake Schouest
- Division of Microbiology, Tulane National Primate Research Center, 18703 Three Rivers Road, Covington, LA, 70433, USA
| | - Nicholas J Maness
- Division of Microbiology, Tulane National Primate Research Center, 18703 Three Rivers Road, Covington, LA, 70433, USA
| | - Woong-Ki Kim
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, VA, 23507, USA
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Lee H, Kim HJ, Choe YJ, Shin JY. Signals and trends of Guillain-Barré syndrome after the introduction of live-attenuated vaccines for influenza in the US and South Korean adverse event reporting systems. Vaccine 2020; 38:5464-5473. [PMID: 32600907 DOI: 10.1016/j.vaccine.2020.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/23/2020] [Accepted: 06/14/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND With the advent of live-attenuated, quadrivalent, and cell-cultured vaccines for influenza, there have been discussions on the safety of these vaccines compared to conventional vaccines (such as inactivated, trivalent, and egg-cultured vaccines) because of the development of neurological adverse events (AEs). This study aimed to compare the trends and safety signals in the AE reporting systems of the US and South Korea and, more particularly, to evaluate the association between influenza vaccination and Guillain-Barré syndrome (GBS). METHODS In total, 400,535 AE reports from the US Vaccine Adverse Event Reporting System (VAERS) and 28,766 AE reports from the Korea Adverse Event Reporting System (KAERS) between 2005 and 2017 were assessed. Disproportionality analysis was performed to detect the safety signals and examine the potential risk of GBS with influenza vaccination using the case/non-case approach. RESULTS In both databases, GBS was the most frequently reported AE following influenza immunization. Using the case/non-case approach, the adjusted reporting odds ratio (ROR) of GBS was 3.57 (95% confidence interval [CI], 3.16-4.03) and 3.09 (95% CI, 0.83-11.45) in the VAERS and KAERS data, respectively. People vaccinated with live-attenuated vaccines reported 2.30 times (95% CI, 1.74-3.05) more cases of GBS than those vaccinated with other types of vaccines. CONCLUSIONS Our analysis of the VAERS and KAERS reports for AEs following immunization (AEFI) for influenza shows the need for cautious monitoring regarding the development of GBS after influenza vaccination, particularly, after live-attenuated vaccination. However, owing to potential reporting bias caused by limited AEFI reports after the introduction of new types of influenza vaccines, further prospective safety studies are needed.
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Affiliation(s)
- Hankil Lee
- CONNECT-AI Research Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
| | - Hyun Jeong Kim
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-to, Jangan-gu, Suwon, Gyeong gi-do, South Korea.
| | - Young June Choe
- Department of Social and Preventive Medicine, Hallym University College of Medicine, 1, Hallymdaehak-gil, Chuncheon-si, Gangwon-do 24252, South Korea.
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-to, Jangan-gu, Suwon, Gyeong gi-do, South Korea.
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10
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Pradhan RR, Yadav SK, Yadav SK. Pharyngeal-Cervical-Brachial variant of Guillian-Barre Syndrome in Children. Cureus 2020; 12:e6983. [PMID: 32206455 PMCID: PMC7077086 DOI: 10.7759/cureus.6983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Guillian-Barre Syndrome (GBS) typically presents as symmetrical ascending flaccid muscle weakness with areflexia, and with or without sensory symptoms. However, some patients may present atypically, and accordingly, different variants of GBS have been reported in the literature. Pharyngeal-cervical-brachial variant is one of the rare variants and is characterized by muscle weakness extending from the oropharyngeal and neck area to the proximal upper extremities. Many physicians and neurologists are unfamiliar about pharyngeal-cervical-brachial variant, which is often misdiagnosed as brainstem stroke, myasthenia gravis or botulism. Herein, we report a case of pharyngeal-cervical-brachial variant of GBS. To the best of our knowledge, this is the first reported case of pharyngeal-cervical-brachial variant of GBS in children from Nepal. A 14-year-old Asian male presented with weakness of bilateral upper limb, dysphagia, and nasal intonation of voice. A diagnosis of pharyngeal-cervical-brachial variant of GBS was made after excluding all other possible differentials and based on cerebrospinal fluid analysis and nerve conduction study. The patient improved following conservative management. Pharyngeal-cervical-brachial variant of GBS should always be considered in any patient presenting with symmetrical upper limb weakness and bulbar palsy. This is to ensure early diagnosis, treatment, and follow-up of the potential complications.
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Affiliation(s)
- Ravi R Pradhan
- Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Sant K Yadav
- Internal Medicine, Provincial Hospital, Janakpurdham, NPL
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Grimm MO, Bex A, De Santis M, Ljungberg B, Catto JW, Rouprêt M, Hussain SA, Bellmunt J, Powles T, Wirth M, Van Poppel H. Safe Use of Immune Checkpoint Inhibitors in the Multidisciplinary Management of Urological Cancer: The European Association of Urology Position in 2019. Eur Urol 2019; 76:368-380. [DOI: 10.1016/j.eururo.2019.05.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/30/2019] [Indexed: 02/08/2023]
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12
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Sun T, Chen X, Shi S, Liu Q, Cheng Y. Peripheral Blood and Cerebrospinal Fluid Cytokine Levels in Guillain Barré Syndrome: A Systematic Review and Meta-Analysis. Front Neurosci 2019; 13:717. [PMID: 31379477 PMCID: PMC6646663 DOI: 10.3389/fnins.2019.00717] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Guillain Barré Syndrome (GBS) is an autoimmune disorder caused by the immune-mediated damage of the peripheral nervous system. Increasing evidence suggests that inflammatory cytokines are important mediators for the onset and progression of GBS. A number of clinical studies have demonstrated elevated levels of T helper-1 (Th1-), Th2-, and Th17-related cytokines in patients with GBS; however, the results were inconsistent across studies. Methods: We performed a systematic review and a meta-analysis of studies comparing the levels of inflammatory cytokines in the cerebrospinal fluid and peripheral blood between patients with GBS and healthy individuals, using Comprehensive Meta-Analysis Version 2 software. A database search identified 30 studies comprising 1,302 patients with GBS and 1,073 healthy controls. Results: The random-effects meta-analysis demonstrated that peripheral blood tumor necrosis factor-α (Hedges g, 1.544; 95% confidence interval (CI), 0.923–2.165; p < 0.001), interleukin-1β (IL-1β; Hedges g, 0.678; 95% CI, 0.183–1.172; p = 0.007), IL-6 (Hedges g, 0.630; 95% CI, 0.100–1.160; p = 0.02), IL-4 (Hedges g, 0.822; 95% CI, 0.220–1.423; p = 0.007), IL-17 (Hedges g, 1.452; 95% CI, 0.331–2.573; p = 0.011), interferon-γ (Hedges g, 1.104; 95% CI, 0.490–1.719; p < 0.001), and C-reactive protein (Hedges g, 0.909; 95% CI, 0.453–1.365; p < 0.001) levels were significantly increased in patients with GBS when compared with healthy controls. Contrastingly, the blood IL-10 and transforming growth factor-β levels were not significantly associated with GBS. Furthermore, the meta-analysis found that cerebrospinal fluid IL-17 levels were significantly associated with GBS (Hedges g, 1.882; 95% CI, 0.104–3.661; p = 0.038). Conclusion: Altogether, our results clarified the circulating inflammatory cytokine profile in patients with GBS, and revealed that Th1-, Th2-, and Th17-related cytokines were highly elevated in the GBS patients, suggesting the potential use of these cytokines as biomarkers for GBS.
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Affiliation(s)
- Ting Sun
- Key Laboratory of Ethnomedicine for Ministry of Education, Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Xi Chen
- Key Laboratory of Ethnomedicine for Ministry of Education, Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Sha Shi
- Key Laboratory of Ethnomedicine for Ministry of Education, Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Qingshan Liu
- Key Laboratory of Ethnomedicine for Ministry of Education, Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Yong Cheng
- Key Laboratory of Ethnomedicine for Ministry of Education, Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
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Senda J, Adachi T, Tago M, Mori M, Imai H, Ogawa Y, Kawaguchi K. Acute Bilateral Oculomotor Nerve Palsy in an Adult Patient with Neisseria meningitidis. Intern Med 2019; 58:1639-1642. [PMID: 30713317 PMCID: PMC6599925 DOI: 10.2169/internalmedicine.2098-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 69-year-old woman was admitted to our hospital with a fever, dizziness, and headache caused by Neisseria meningitidis. After ceftriaxone was administered, she suddenly developed bilateral oculomotor nerve palsy. Intra-orbital magnetic resonance imaging using appropriate sequences revealed that her bilateral third intracranial nerves were enlarged and enhanced. She achieved complete recovery by two months after additional short-term treatment with intravenous immunoglobulin and methylprednisolone. Although intracranial nerve disorders that result from bacterial meningitis are most frequently reported in children, it is noteworthy that it can also cause focal intracranial nerve inflammation with ophthalmoparesis in N. meningitidis infection in adults.
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Affiliation(s)
- Joe Senda
- Department of Neurology and Rehabilitation, Komaki City Hospital, Japan
| | | | - Mayumi Tago
- Junior Resident, Komaki City Hospital, Japan
| | - Masaya Mori
- Department of General Internal Medicine, Komaki City Hospital, Japan
| | - Hajime Imai
- Department of Cardiology, Komaki City Hospital, Japan
| | | | - Katsuhiro Kawaguchi
- Department of Cardiology, Komaki City Hospital, Japan
- Department of General Internal Medicine, Komaki City Hospital, Japan
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Senda J, Araki K, Tachi Y, Watanabe H, Kagawashira Y, Ito M, Atsuta N, Katsuno M, Watanabe H, Sobue G. Acute Unilateral Isolated Oculomotor Nerve Palsy in an Adult Patient with Influenza A. Intern Med 2019; 58:433-436. [PMID: 30210106 PMCID: PMC6395116 DOI: 10.2169/internalmedicine.0850-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An otherwise healthy 44-year-old woman exhibited isolated unilateral oculomotor nerve palsy accompanied by an influenza A infection. An intra-orbital MRI scan revealed that her right third intracranial nerve was enlarged and enhanced. She recovered completely during the first month after treatment with oseltamivir phosphate. Although intracranial nerve disorders that result from influenza infections are most frequently reported in children, it is noteworthy that influenza can also cause focal intracranial nerve inflammation with ophthalmoparesis in adults. These disorders can be diagnosed using intra-orbital MRI scans with appropriate sequences and through immunological assays to detect the presence of antiganglioside antibodies.
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Affiliation(s)
- Joe Senda
- Department of Neurology and Rehabilitation, Komaki City Hospital, Japan
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Kunihiko Araki
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Yasushi Tachi
- Department of Radiology, Nagoya University Graduate School of Medicine, Japan
| | - Hazuki Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
- Department of Neurology, Japanese Red Cross Nagoya First Hospital, Japan
| | - Yuichi Kagawashira
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Mizuki Ito
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
- Department of Neurology, Toyota Kosei Hospital, Japan
| | - Naoki Atsuta
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
- Brain and Mind Research Center, Nagoya University, Japan
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
- Research Division of Dementia and Neurodegenerative Disease, Nagoya University, Japan
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Zang Y, Qin Y, Li Y, Wang Z. Case report: Treating Guillain–Barré syndrome with acupuncture–moxibustion and traditional Chinese Medicine patent prescription (Jingui Shenqi Pill). JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2018. [DOI: 10.1016/j.jtcms.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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16
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Rozé B, Najioullah F, Fergé JL, Dorléans F, Apetse K, Barnay JL, Daudens-Vaysse E, Brouste Y, Césaire R, Fagour L, Valentino R, Ledrans M, Mehdaoui H, Abel S, Leparc-Goffart I, Signate A, Cabié A, Aïm V, Arrigo A, Cabre P, Chabartier C, Colombani S, Cuziat J, Deligny C, Desbois N, Dessoy AL, Dunoyer G, Duvauferrier R, Duc N, Edimonana M, Garrigou P, Gaucher S, Gourgoudou S, Guitteaud K, Hochedez P, Ivanes G, Jacquens Y, Julié S, Jean-Etienne A, Jeannin S, Julien J, Jérémie P, Lamaignère JL, Laudarin I, Le Gall M, Legris-Allusson V, Mejdoubi M, Michel C, Michel F, Miossec C, Moinet F, Minerva C, Olive C, Olive P, Pailla K, Paysant C, Pierre-François S, Pircher M, Polomat K, Putot A, René-Corail P, Resiere D, Richer C, Risson JR, Rome K, Sabia M, Schloesser M, Simonnet-Vigeral P, Théodose R, Vilain R. Guillain-Barré Syndrome Associated With Zika Virus Infection in Martinique in 2016: A Prospective Study. Clin Infect Dis 2018; 65:1462-1468. [PMID: 29020245 DOI: 10.1093/cid/cix588] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/06/2017] [Indexed: 11/14/2022] Open
Abstract
Background Guillain-Barré syndrome (GBS) has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies, mostly on the basis of serological tests, with the problematic cross-reacting antibodies of the Flavivirus genus. Some GBS cases do not exhibit a high level of diagnostic certainty. This prospective study aimed to describe the clinical profiles and the frequency of GBS associated with ZIKV during the ZIKV outbreak in Martinique in 2016. Methods We recorded prospective data from GBS meeting levels 1 or 2 of diagnostic certainty for the Brighton Collaboration, with proof of recent ZIKV infection and negative screening for etiologies of GBS. Results Of the sample of 34 patients with suspected GBS during the outbreak, 30 had a proven presence of GBS, and 23 had a recent ZIKV infection. The estimated GBS incidence rate ratio (2016 vs 2006-2015) was 4.52 (95% confidence interval, 2.80-7.64; P = .0001). Recent ZIKV infection was confirmed by urine reverse-transcription polymerase chain reaction (RT-PCR) analysis in 17 cases and by serology in 6 cases. Patients, 65% of whom were male, had a median age of 61 years (interquartile range, 56-71 years) and experienced severe GBS. Electrophysiological tests were consistent with the primary demyelinating form of the disease. Conclusions ZIKV infection is usually benign, when symptomatic, but in countries at risk of ZIKV epidemics, adequate intensive care bed capacity is required for management of severe GBS cases. Arbovirus RNA detection by RT-PCR should be part of the management of GBS cases.
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Affiliation(s)
- Benoît Rozé
- Infectious and Tropical Diseases Unit, University Hospital of Martinique.,Intensive Care Unit, University Hospital of Martinique
| | - Fatiha Najioullah
- Laboratory of Virology, University Hospital of Martinique, Université des Antilles EA4537, Fort de France
| | | | - Frédérique Dorléans
- French National Public Health Agency, Regional Unit Antilles Guyane, Saint-Maurice
| | | | | | - Elise Daudens-Vaysse
- French National Public Health Agency, Regional Unit Antilles Guyane, Saint-Maurice
| | | | - Raymond Césaire
- Laboratory of Virology, University Hospital of Martinique, Université des Antilles EA4537, Fort de France
| | - Laurence Fagour
- Laboratory of Virology, University Hospital of Martinique, Fort de France
| | | | - Martine Ledrans
- French National Public Health Agency, Regional Unit Antilles Guyane, Saint-Maurice
| | | | - Sylvie Abel
- Infectious and Tropical Diseases Unit, University Hospital of Martinique
| | | | | | - André Cabié
- Infectious and Tropical Diseases Unit, University Hospital of Martinique, Université des Antilles, EA4537, INSERM CIC1424, Fort de France, France
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Mahecha MP, Ojeda E, Vega DA, Sarmiento-Monroy JC, Anaya JM. Guillain-Barré syndrome in Colombia: where do we stand now? Immunol Res 2018; 65:72-81. [PMID: 27421717 DOI: 10.1007/s12026-016-8816-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Guillain-Barré syndrome (GBS) is a rapid-onset muscle weakness disease caused by the immune-mediated damage of the peripheral nervous system. Since there is an increase incidence of GBS cases in Latin America, particularly in Colombia, and most of them are currently preceded by Zika virus (ZIKV) infection, we aimed to assess the available evidence of the disease in Colombia through a systematic literature review. Out of 51 screened abstracts, only 16 corresponded to articles that met inclusion criteria, of which 15 were case reports or case series. A total of 796 cases of GBS were reported in the included articles. The majority of patients were males (66.8 %) and younger than 50 years old (94 %). An infectious disease before the onset of GBS was registered in 31 % of patients, with gastrointestinal or respiratory symptoms being the most frequently observed. In those cases in which electrodiagnostic tests were performed, the most common subphenotype was acute inflammatory demyelinating polyneuropathy (17 %). Death was reported in 15 % of patients. Data regarding GBS in Colombia is scant and heterogeneous. Taking into account the burden of the disease and the recent rise of GBS cases associated with ZIKV, a careful patient evaluation and a systematic collection of data are warranted. A form to data gathering is proposed.
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Affiliation(s)
- María P Mahecha
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No 63-C-69, Bogotá, Colombia
| | - Ernesto Ojeda
- Neurology Department, Mederi - Hospital Universitario Mayor, Calle 24 No. 29-45, Bogotá, Colombia
| | - Daniel A Vega
- Intensive Care Unit, Mederi - Hospital Universitario Mayor, Calle 24 No. 29-45, Bogotá, Colombia
| | - Juan C Sarmiento-Monroy
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No 63-C-69, Bogotá, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No 63-C-69, Bogotá, Colombia.
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Esposito S, Longo MR. Guillain–Barré syndrome. Autoimmun Rev 2017; 16:96-101. [DOI: 10.1016/j.autrev.2016.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022]
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Lim JY, Lim YH, Choi EH. Acute-onset chronic inflammatory demyelinating polyneuropathy in hantavirus and hepatitis B virus coinfection: A case report. Medicine (Baltimore) 2016; 95:e5580. [PMID: 27930572 PMCID: PMC5266044 DOI: 10.1097/md.0000000000005580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired autoimmune disorder with progressive weakness. Acute-onset CIDP resembles Guillain-Barre syndrome (GBS), a rapidly progressive disorder, and follows a chronic course. To our knowledge, no case of acute-onset CIDP in hantavirus and hepatitis B virus (HBV) coinfection has been reported previously. CLINICAL FINDINGS We report a case of acute-onset CIDP that was initially diagnosed as GBS. DIAGNOSES A 44-year-old male logger complained of acute quadriplegia and dyspnea. Mechanical ventilation was initiated. He was an HBV carrier with mild elevation of hepatic enzyme, and positive for hantavirus antibody. He was diagnosed with GBS and immunoglobulin therapy was administered. INTERVENTIONS After 8 months, quadriplegia and hypesthesia recurred. Immunoglobulin therapy at this time had no effect, but steroid therapy had some effect. OUTCOMES A diagnosis of CIDP was made. After 2 months, severe extremity pain and dyspnea developed again, and steroid pulse therapy was initiated. CONCLUSION Besides GBS, acute-onset CIDP can occur with hantavirus and HBV coinfection. Patients with this coinfection in whom GBS has been initially diagnosed should be followed up for a long time, because of the possibility of relapse or deterioration, and acute-onset CIDP should always be considered.
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Affiliation(s)
- Jong Youb Lim
- Department of Rehabilitation Medicine, Eulji University Hospital, Daejeon
- Department of Rehabilitation Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Young-Ho Lim
- Department of Rehabilitation Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Eun-Hi Choi
- Department of Rehabilitation Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
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Liik M, Punga AR. Repetitive nerve stimulation often fails to detect abnormal decrement in acute severe generalized Myasthenia Gravis. Clin Neurophysiol 2016; 127:3480-3484. [DOI: 10.1016/j.clinph.2016.09.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/30/2022]
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Gross S, Fischer A, Rosati M, Matiasek L, Corlazzoli D, Cappello R, Porcarelli L, Harcourt-Brown T, Jurina K, Garosi L, Flegel T, Quitt P, Molin J, Huelsmeyer VI, Schenk H, Gandini G, Gnirs K, Blot S, Jeandel A, Baroni M, Loderstedt S, Abbiati G, Leithaeuser C, Schulze S, Kornberg M, Lowrie M, Matiasek K. Nodo-paranodopathy, internodopathy and cleftopathy: Target-based reclassification of Guillain-Barré-like immune-mediated polyradiculoneuropathies in dogs and cats. Neuromuscul Disord 2016; 26:825-836. [PMID: 27743643 DOI: 10.1016/j.nmd.2016.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/14/2016] [Accepted: 08/29/2016] [Indexed: 01/23/2023]
Abstract
Recent views on Guillain-Barré syndrome (GBS) question the accuracy of classification into axonal and demyelinating subtypes that represent convergent neurophysiological phenotypes rather than immunological targets. Instead it has been proposed to clarify the primarily affected fibre subunit in nerve biopsies. As nerve biopsies rarely are part of routine work-up in human patients we evaluated tissues taken from companion animals affected by GBS-like polyradiculoneuropathy to screen for distribution of immune cells, targeted fibre components and segregating non-inflammatory lesions. We identified that immune responses were directed either at Schmidt-Lanterman clefts, the paranode-node complex or both. Based on infiltrative and non-inflammatory changes, four subtypes and/or stages were distinguished, some of which indicate localisation of primary target antigens while others represent convergent late stage pictures, as a consequence to epitope spreading. The impact of histological subtyping onto clinical management and prognosis remains to be evaluated in future clinical trials. Natural development and clinical manifestation of large animal dysimmune neuropathy may reflect human Guillain-Barré syndrome more accurately than experimental models and therefore provide complementary clues for translational research.
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Affiliation(s)
- Simone Gross
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andrea Fischer
- Section of Neurology, Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - Marco Rosati
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lara Matiasek
- Neurology Referral Service, Tierklinik Haar, Haar, Germany
| | | | | | | | - Tom Harcourt-Brown
- Section of Neurology, Langford Veterinary Services, University of Bristol, Bristol, UK
| | - Konrad Jurina
- Section of Neurology, Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - Laurent Garosi
- Neurology Referral Service, Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, UK
| | - Thomas Flegel
- Neurology Unit, Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany
| | - Pia Quitt
- Section of Neurology, Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - Jessica Molin
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Velia-Isabel Huelsmeyer
- Section of Neurology, Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - Henning Schenk
- Neurology Service, Tierklinik Lueneburg, Lueneburg, Germany
| | - Gualtiero Gandini
- Department of Veterinary Medical Science, University of Bologna, Italy
| | - Kirsten Gnirs
- Section of Neurology & Neurosurgery, Advetia Clinic for Small Animal Medicine, Paris, France
| | - Stéphane Blot
- Section of Neurologie, Ecole Nationale Vétérinaire d'Alfort, University of Paris Est, Maisons Alfort, France
| | - Aurélien Jeandel
- Section of Neurologie, Ecole Nationale Vétérinaire d'Alfort, University of Paris Est, Maisons Alfort, France
| | - Massimo Baroni
- Section of Neurology, Clinica Veterinaria Valdinievole, Monsummano, Italy
| | - Shenja Loderstedt
- Section of Neurology, Clinic of Small Animal Medicine, University of Berlin, Berlin, Germany
| | | | | | | | | | - Mark Lowrie
- Dovecote Veterinary Hospital, Castle Donington, UK
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany.
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Role of environmental factors in autoimmunity: pearls from the 10th international Congress on autoimmunity, Leipzig, Germany 2016. Immunol Res 2016; 65:1-4. [PMID: 27561788 DOI: 10.1007/s12026-016-8857-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Merkies ISJ, Kieseier BC. Fatigue, Pain, Anxiety and Depression in Guillain-Barré Syndrome and Chronic Inflammatory Demyelinating Polyradiculoneuropathy. Eur Neurol 2016; 75:199-206. [PMID: 27077919 DOI: 10.1159/000445347] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/08/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND In the clinical evaluation of patients with Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), scant attention is paid to symptoms such as fatigue, pain and anxiety/depression. We aimed at addressing seminal studies that focused on the burden of these symptoms and their impact on quality of life (QoL) in these conditions. SUMMARY Fatigue, pain, and anxiety/depression are increasingly being recognized in patients with GBS and CIDP, although their pathophysiological provenance remains unknown. Fatigue and pain are significant in terms of prevalence and intensity, may be a presenting symptom, and can persist for years after apparent functional recovery, suggesting residual injury. Anxiety/depression has also been examined although studies are limited. Despite their negative impact on QoL, the long-term dynamics of these symptoms in patients with GBS and particularly CIDP receiving therapy in routine clinical practice have not been systematically evaluated. Such observations formed the basis for the ongoing (GAMEDIS) studies evaluating the effect of Gamunex on fatigue and depression in patients with CIDP, of which some preliminary data are presented. KEY MESSAGES Strength and sensory deficits are the main areas of focus in patients with GBS and CIDP, but they do not explain the total reduction in QoL, suggesting the possible role of other complaints. A more comprehensive approach to patient care demands that factors such as pain, fatigue and anxiety/depression receive greater attention. The non-interventional GAMEDIS studies are expected to provide valuable insight into the long-term effectiveness of Gamunex in everyday practice.
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Affiliation(s)
- Ingemar S J Merkies
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Viala K. Diagnosis of atypical forms of chronic inflammatory demyelinating polyradiculoneuropathy: a practical overview based on some case studies. Int J Neurosci 2015; 126:777-85. [DOI: 10.3109/00207454.2015.1096786] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Rüb J, Rehmann R, von Landenberg N, Roghmann F, Stude P, Tegenthoff M, Noldus J, Pastor J. [Segmental testicular infarction. Unusual complication of intravenous immunoglobulin therapy for multifocal motor neuropathy]. Urologe A 2015; 54:1421-4. [PMID: 26303740 DOI: 10.1007/s00120-015-3941-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We describe the previously unknown case of segmental testicular infarction as an iatrogenic complication of intravenous immunoglobulin administration in a patient with multifocal motor neuropathy.
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Affiliation(s)
- J Rüb
- Klinik für Urologie und Neurourologie, Marien-Hospital Herne, Ruhr-Universität Bochum, Widumer Straße 8, 44627, Herne, Deutschland.
| | - R Rehmann
- Neurologische Klinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Deutschland
| | - N von Landenberg
- Klinik für Urologie und Neurourologie, Marien-Hospital Herne, Ruhr-Universität Bochum, Widumer Straße 8, 44627, Herne, Deutschland
| | - F Roghmann
- Klinik für Urologie und Neurourologie, Marien-Hospital Herne, Ruhr-Universität Bochum, Widumer Straße 8, 44627, Herne, Deutschland
| | - P Stude
- Neurologische Klinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Deutschland
| | - M Tegenthoff
- Neurologische Klinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Deutschland
| | - J Noldus
- Klinik für Urologie und Neurourologie, Marien-Hospital Herne, Ruhr-Universität Bochum, Widumer Straße 8, 44627, Herne, Deutschland
| | - J Pastor
- Klinik für Urologie und Neurourologie, Marien-Hospital Herne, Ruhr-Universität Bochum, Widumer Straße 8, 44627, Herne, Deutschland
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Guillain-Barre Syndrome After Robotically Assisted Laparoscopic Prostatectomy: First Case Report. Urol Case Rep 2015; 3:44-6. [PMID: 26793497 PMCID: PMC4714275 DOI: 10.1016/j.eucr.2015.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/07/2015] [Accepted: 01/12/2015] [Indexed: 11/27/2022] Open
Abstract
Guillain-Barre Syndrome is a well described acute demyelinating polyradiculoneuropathy with a likely autoimmune basis characterized by progressive ascending muscle paralysis. Classically, GBS is attributed to antecedent upper respiratory and gastrointestinal infections. We present the first case of GBS after Robotically Assisted Laparoscopic Prostatectomy using the daVinci® Surgical System.
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Key Words
- Ascending muscle paralysis
- CSF, Cerebrospinal Fluid
- ED, Emergency Department
- GBS, Guillain-Barre Syndrome
- Guillain-Barre syndrome
- HSV, Herpes Simplex Virus
- ICU, Intensive Care Unit
- IVIG, Intravenous Immunoglobulin
- PCR, Polymerase Chain Reaction
- POD, Post operative day
- Prostate cancer
- RBC, Red Blood Cell
- Robotically assisted laparoscopic prostatectomy
- TSH, Thyroid Stimulating Hormone
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Duchesne M, Mathis S, Corcia P, Richard L, Ghorab K, Jaccard A, Magy L, Vallat JM. Value of nerve biopsy in patients with latent malignant hemopathy and peripheral neuropathy: a case series. Medicine (Baltimore) 2015; 94:e394. [PMID: 25621682 PMCID: PMC4602630 DOI: 10.1097/md.0000000000000394] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hematological malignancies include several diseases that may affect the peripheral nervous system (PNS) through various mechanisms. A common and challenging situation is represented by the occurrence of an active peripheral neuropathy in a patient with a supposed inactive hematological disorder.We report clinical, electrophysiological, biological, and pathological data of 8 patients with latent malignant hemopathies (most were considered in remission): B-cell chronic lymphocytic leukemia in 3 patients, B-cell lymphoma in 1 patient, low-grade non-Hodgkin's lymphoma in 1 patient, Waldenström's macroglobulinemia in 1 patient, smoldering multiple myeloma in 1 patient, and monoclonal gammopathy of undetermined significance in 1 patient.In all these cases, the nerve biopsy (NB) helped to diagnose the hematological relapse or detect a pathological mechanism linked to the hematological disorder: epineurial lymphocytic infiltration in 5 patients (including one with antimyelin-associated glycoprotein antibodies), cryoglobulin deposits in 1 patient, chronic inflammatory demyelinating polyneuropathy in 1 patient, and necrotizing vasculitis in 1 patient. In each case, pathological findings were crucial to select the adequate treatment, leading to an improvement in the neurological and biological manifestations.These observations illustrate the value of NB and the need for active collaboration between neurologists and hematologists in such cases.
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MESH Headings
- Aged
- Biopsy
- Disease Management
- Female
- Hematologic Neoplasms/diagnosis
- Hematologic Neoplasms/pathology
- Hematologic Neoplasms/therapy
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/therapy
- Male
- Middle Aged
- Peripheral Nerves/pathology
- Peripheral Nervous System Diseases/diagnosis
- Peripheral Nervous System Diseases/pathology
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Affiliation(s)
- Mathilde Duchesne
- From the Department of Pathology (MD); Department of Neurology, CHU Poitiers, University of Poitiers, Poitiers (SM); Department of Neurology, CHU Tours, Tours (PC); Department of Hematology, CHU Limoges (AJ); and Department of Neurology and Centre de Référence "Neuropathies périphériques rares", CHU Limoges, Limoges, France (JMV)
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Intravenous immunoglobulin exerts reciprocal regulation of Th1/Th17 cells and regulatory T cells in Guillain–Barré syndrome patients. Immunol Res 2014; 60:320-9. [DOI: 10.1007/s12026-014-8580-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Peripheral nerve proteins as potential autoantigens in acute and chronic inflammatory demyelinating polyneuropathies. Autoimmun Rev 2014; 13:1070-8. [DOI: 10.1016/j.autrev.2014.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/27/2014] [Indexed: 01/06/2023]
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