Oligoclonal Bands of Immunoglobulins in Serum Leading to Diagnosis of Human Immunodeficiency Virus 1 Infection

CSF oligoclonal bands in neurological diseases besides CNS inflammatory demyelinating disorders

Objective

To understand the distribution characteristics and clinical significance of cerebrospinal fluid (CSF) oligoclonal bands (OCBs) in different nervous system diseases besides typical central nervous system (CNS) inflammatory demyelinating disorders.

Material

A total of 2259 patients who underwent CSF examination for OCBs at Peking University First Hospital from January 2011 to December 2023 were tested. A cohort of 257 patients presenting with various types of OCBs but without CNS inflammatory demyelinating diseases was included in the analysis. Relevant medical history was collected from all patients.

Results

OCBs were most common in patients with autoimmune encephalitis. OCB types II and III were most common in patients with autoimmune encephalitis and CNS infection, whereas OCB types IV and V were present in immune-mediated neuropathy mostly. The distribution of OCBs also varied among different disease subtypes. Other CSF characteristics varied between diseases with different OCBs.

Conclusions

In addition to CNS inflammatory demyelinating diseases, OCBs also appear in other neurological diseases including cerebral angiopathy and neurodegenerative conditions, informing the potential immune background. Further research is still needed to determine the significance of OCBs in these diseases.

Endocarditis Caused by Bartonella quintana: A Case Report

Infective endocarditis (IE) is a complex and potentially life-threatening condition characterized by infection of the heart's endocardial surface, often leading to systemic complications. Historically recognized as a distinct pathological entity, IE has been associated with a wide range of bacterial pathogens, with Bartonella species emerging as a notable cause in recent years. Among these, Bartonella quintana is a rare but significant etiological agent, particularly in cases of culture-negative endocarditis. The management of Bartonella-induced IE remains challenging due to the evolving understanding of its pathophysiology and the need for tailored therapeutic strategies. We present a unique case of a patient with B. quintana IE, remarkable for its simultaneous involvement of three cardiac valves - mitral, tricuspid, and aortic - each exhibiting vegetations. This multisite valvular involvement is an uncommon and distinctive feature, underscoring the aggressive nature of the infection. Notably, the patient's initial presentation was a massive ischemic stroke in the territory of the middle cerebral artery, an atypical manifestation of IE that highlights the potential for cardioembolic complications as the first clinical sign. Further evaluation revealed additional systemic embolization, including septic emboli to the spleen, further complicating the clinical picture. This case underscores the importance of considering IE in patients presenting with embolic stroke, even in the absence of classic symptoms such as fever or heart failure. It also emphasizes the need for a high index of suspicion for Bartonella species in culture-negative endocarditis, particularly in cases with multisite valvular involvement and systemic embolic phenomena. Early diagnosis and targeted treatment are critical to improving outcomes in this rare but devastating condition.

Central nervous system Listeria monocytogenes infection mimicking central nervous system idiopathic inflammatory demyelinating disease

Listeria monocytogenes (Lm) is an opportunistic pathogen that causes life-threatening infections, especially when the central nervous system (CNS) is involved. Here, we report a patient who was admitted to the hospital with headache, dizziness, right side facial numbness, and hoarseness. The individual was initially diagnosed with central nervous system idiopathic inflammatory demyelinating disease (CNS IIDD), which was then found to be CNS Lm infection (brainstem and cervical cord infection). CNS Lm infection mimicking CNS IIDD is rare but must be considered because the treatment is totally different and therapeutic error may be life-threatening.

Neuromuscular diseases associated with Human Immunodeficiency Virus infection

From the most common distal symmetric polyneuropathy (Bilgrami and O'Keefe, 2014) to the rare motor neuron diseases, HIV infection is associated with pathology at all levels of the peripheral nervous system. HIV infection can cause these conditions due to viral exposure itself, the resulting immune dysregulation, opportunistic infections found in untreated patients, and from the therapy used in treatment of the virus. Before the advent of antiretroviral therapy, 5 neuromuscular diseases associated with HIV often resulted from opportunistic infections. With advances in antiretroviral therapy, the etiologies of neuromuscular complications more frequently become the result of prolonged HIV exposure, comorbid diseases, and side effects of medications. In this article we review the literature on HIV associated neuromuscular diseases, emphasizing the more recent studies in the post antiretroviral era, but also reviewing conditions more prevalent in the pre antiretroviral era which continue to be seen in developing countries and resource poor areas. This discussion includes the following conditions: distal symmetric polyneuropathy, autonomic neuropathy, inflammatory demyelinating polyneuropathy, mononeuropathy, mononeuropathy multiplex, polyradiculopathies, myelopathy, myopathy, motor neuron disease, and antiretroviral treatment related conditions.